Endoscopic, endonasal, trans-sphenoidal hypophysectomy: retrospective analysis of 171 procedures

Kumar, Suman; Darr, Adnan; Hobbs, Christopher; Carlin, W. V.

doi:10.1017/s0022215112001223

Cited by 26 publications

(29 citation statements)

References 18 publications

(50 reference statements)

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“…8,13,16,20). Two endoscopic TSS studies reported sinusitis rates of 1.75% and 8.5% (5,15). In our study, no purulent secretion was detected in the nasal cavities of any patient during the nasal endoscopic examinations.…”

Section: █ Discussionsupporting

confidence: 43%

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Late postoperative rhinological complications after microscopic transnasal hypophysectomy

Postalcı¹,

Erdim²,

Demirgil³

et al. 2015

Turkish Neurosurgery

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Rhinological complications have been reported previously, but no study has thoroughly investigated them. In this study, we extensively examined postoperative rhinological complications in patients who underwent MTHS due to pituitary adenoma.Serious vascular complications, such as carotid injury, as well as major complications, such as optic nerve injury and cerebrospinal fluid rhinorrhea, can occur during MTHS. However, rhinological complications can be ignored because they are a minor cause of morbidity compared to major complications. These patients may experience problems such as epistaxis, █ InTRODuCTIOn T he sphenoid sinus approach to the pituitary gland was a breakthrough treatment for lesions in this region. The lateral rhinotomy approach to trans-sphenoidal hypophysectomy was performed for the first time in 1907 by Schloffer (26). Halsted (9) and Hardy (10) laid the foundation for today's microscopic transnasal hypophyseal surgery (MTHS) procedure by improving their technique. The development of neuroendoscopy in the 1990s resulted in new approaches to this region (2).AIM: Major complications of microscopic transnasal hypophyseal surgery (MTHS), such as cerebrospinal fluid rhinorrhea, carotid injury, and optic nerve injury, are very rare. However, late rhinological complications can be ignored because they are a minor cause of morbidity compared with major complications. In this study, we extensively examined postoperative rhinological complications in patients who underwent MTHS for pituitary adenoma. MATERIAL and METhODS:Thirty-one patients diagnosed with pituitary adenoma, who underwent MTHS and whose preoperative nasal examinations were recorded between January 2007 and January 2014, were included in the study. A detailed rhinological examination of the patients was performed. RESuLTS:A total of 12 of 31 patients (38.7%) had a perforated nasal septum, and synechiae were detected in the nasal cavities of 13 patients (42%). Anosmia occurred in three patients, hyposmia in two, and a nasal tip deflection and saddle nose deformity were detected in one patient with a perforated nasal septum. No perinasal loss of sense, oronasal fistula, or purulent secretion in the nasal cavity was found in any patient. COnCLuSIOn:The nasal structures, particularly the nasal septum mucosa, should be treated gently during MTHS. The nasal stages of the operation should be performed with the help of an otolaryngologist until adequate experience is gained.

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Section: █ Discussionsupporting

confidence: 43%

“…However, no septal perforations were reported in two studies (15,27), and perforation rates were 1.85-10% in three other studies (12,14,24). Dew et al reported an incidence of 18% (7).…”

Section: █ Discussionmentioning

confidence: 99%

Late postoperative rhinological complications after microscopic transnasal hypophysectomy

Postalcı¹,

Erdim²,

Demirgil³

et al. 2015

Turkish Neurosurgery

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“…There were no incidences of ICA injury, blindness, or death in this study. Of note, this experience spanned nearly 2 decades, during a time period when instrumentation, technique, and expertise significantly changed, possibly confounding the results . In our cohort, patients receiving revision surgery were not significantly more likely to have a major complication as compared to patients receiving primary surgery.…”

Section: Discussionmentioning

confidence: 82%

“…Reports of complications specifically following revision transsphenoidal pituitary surgery are limited. One retrospective report from the United Kingdom looked at complications in 35 revision cases performed at a single center over 18 years and noted a high rate of complications . This study demonstrated that revision cases involved a CSF leak rate of 17.1%, bacterial meningitis rate of 8.6%, posterior pituitary insufficiency rate of 14.3%, and anterior pituitary insufficiency rate of 14.3%.…”

Section: Discussionmentioning

confidence: 99%

Complications following primary and revision transsphenoidal surgeries for pituitary tumors

et al. 2014

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Objective This study aimed to determine the incidence of major complications following both primary and revision transsphenoidal pituitary surgery. Major complications included endocrinopathic, skull base, orbital, hemorrhagic and thromboembolic complications, respiratory failure, and death. Secondarily, this study aimed to examine factors associated with the occurrence of complications. Study Design Retrospective cohort analysis of California and Florida all-payer databases from 2005-2008. Methods The major complication rate following both primary and revision transsphenoidal pituitary surgery was calculated. Bivariate analyses were performed to investigate the relationship of patient characteristics with complication occurrence, and a multivariate model was constructed to determine risk factors associated with these complications. Results 5,277 primary cases and 192 revision cases met inclusion criteria. There was a non-significant absolute difference of 3.09% (95% CI −11.00 to 16.14) between the rate of complications following primary (n=443; 8.39%) and revision (n=22; 11.46%) surgeries. Multivariate analyses showed that patients with Medicare (OR=1.74; 95% CI 1.17 to 2.61), Medicaid (OR=2.13; 95% CI 1.59 to 2.86), or a malignant neoplasm (OR=3.10; 95% CI 1.62 to 5.93) were more likely to have complications. Conclusions The rate of major complications following transsphenoidal pituitary surgery is lower than earlier retrospective reports. The overall complication rate following revision surgery was not significantly different from primary surgery. Insurance status and a diagnosis of a malignant neoplasm were associated with a higher rate of complications.

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“…A total of 136 primary resections and 35 revision cases were initially reviewed between the years of 1990 and 2008 . This study examines all endoscopic trans‐sphenoidal hypophysectomy procedures in this centre over 24 years with emphasis on the role that the navigation system has had on resection and complications.…”

Section: Introductionmentioning

confidence: 99%

Evolution of pituitary surgery in a tertiary centre

McNamara

Saunders

Darr

et al. 2018

Clinical Otolaryngology

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Endoscopic, endonasal, trans-sphenoidal hypophysectomy: retrospective analysis of 171 procedures

Abstract: Despite its steep 'learning curve', our series demonstrates that the endoscopic approach not only allows superior anatomical visualisation and therefore facilitates full oncological resection of tumours, but also reduces the incidence of peri-operative complications.

Cited by 26 publications

References 18 publications

Late postoperative rhinological complications after microscopic transnasal hypophysectomy

Late postoperative rhinological complications after microscopic transnasal hypophysectomy

Complications following primary and revision transsphenoidal surgeries for pituitary tumors

Evolution of pituitary surgery in a tertiary centre

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