Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas

Gondim, Jackson; Almeida, João Paulo; Albuquerque, Lucas Alverne Freitas de; Gomes, Eymeric; Schops, Michele; Mota, José Ítalo Soares

doi:10.3171/2014.10.jns14372

Cited by 73 publications

(66 citation statements)

References 39 publications

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“…The sphenoid sinus is surrounded by vital anatomical structures, injury to which may result in severe morbidity or mortality. 8,9,[13][14][15] Although rates of injury to the ICAs are low, surgeons need to minimize these risks as far as possible to prevent significant complications. In the case where injury does occur, there is a mortality rate of 14% and a morbidity rate of 24%.…”

Section: Discussionmentioning

confidence: 99%

“…As the method requires no skin incision or external craniotomy, this translates to fewer complications, less discomfort, and speedier recovery in comparison to a traditional external approach. [3][4][5][6][7][8][9] However, cavernous segment internal carotid artery (ICA) injury is recognized as a rare but potentially fatal complication [10][11][12] with an incidence of 0.5 to 3.8%. [13][14][15] To minimize the risk of complication, it is crucial for the operating surgeon to scrutinize the preoperative imaging studies to identify the necessary landmarks and important structures surrounding the sella turcica, as well as any anatomical variant, which may potentially be problematic.…”

Section: Introductionmentioning

confidence: 99%

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Radiological “Teddy Bear” Sign on CT Imaging to Aid Internal Carotid Artery Localization in Transsphenoidal Pituitary and Anterior Skull Base Surgery

et al. 2017

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Internal carotid artery (ICA) injury remains a rare but potentially fatal complication of transsphenoidal pituitary or anterior skull base surgery. Preoperative imaging must be scrutinized to minimize risk. On axial computed tomography (CT), the protrusions of the ICAs into the sphenoid resemble a "teddy bear." This article aims to describe the sign, its grading system (0-2) and quantify its presence. Retrospective review of preoperative CT imaging. Tertiary referral center in the United Kingdom. One hundred patients who underwent endoscopic transsphenoidal surgery for pituitary disease were enrolled. The presence and grading of the "teddy bear" sign were assessed on preoperative CT imaging. A grade 2 (strongly positive) "teddy bear" sign was identified in 40% at the level of the superior pituitary fossa, 78% at the inferior pituitary fossa, and 59% at the clivus. A grade 1 (intermediate) sign was seen in 23.5, 7.5, and 10% of cases, respectively. In 5% of cases, the sign was grade 0 at all levels-indicating poor intraoperative localization of the ICA. The "teddy bear" sign is a useful preoperative tool for identification of anatomy predisposing patients to a higher risk of ICA injury. Those patients who have an absent or grade 0 "teddy bear" sign require extra care to ensure intraoperative localization of the ICAs which may include the use of neuronavigation or a Doppler probe. A grade 2 sign predicts good intraoperative localization of the ICA intraoperatively to inform the safe lateral limit of sellar bone resection.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiological “Teddy Bear” Sign on CT Imaging to Aid Internal Carotid Artery Localization in Transsphenoidal Pituitary and Anterior Skull Base Surgery

et al. 2017

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“…Diabetes insipidus is the most common complication following pituitary adenoma surgery, and is caused by damage to the pituitary stalk, posterior pituitary, hypothalamus or the blood supply, which results in an insufficient secretion of antidiuretic hormones (26)(27)(28). The results from the present study demonstrated that postoperative complications in the bromocriptine treatment group were more prevalent than those in the group who were not treated with bromocriptine; however, the only post-operative complication that was statistically significant different in prevalence between the two groups was diabetes insipidus.…”

Section: Discussionmentioning

confidence: 99%

Effects of preoperative bromocriptine treatment on prolactin-secreting pituitary adenoma surgery

Cao

Wang

Liu

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. Pituitary adenomas are benign intracranial endocrine tumors, accounting for ~10% of intracranial tumors. The aim of the present study was to analyze the effects of preoperative treatment with bromocriptine on the surgical treatment and postoperative complications of prolactin-secreting pituitary adenomas (prolactinomas). Data from 102 patients whose prolactinomas were surgically treated between March 2006 and March 2010 were retrospectively reviewed in the present study. The study group included 54 patients who had been treated preoperatively with bromocriptine. The patients were examined by magnetic resonance imaging (MRI) of the head and coronal computed tomography (CT) scanning, after which the pathological diagnosis of prolactinoma was confirmed. A total of 64 patients underwent total resection surgery through the nose and sphenoid sinus, and 25 patients underwent subtotal resection surgery or excision of a large portion of the tumor, leaving only a small quantity of residual tumor or tumor capsule. Patients were followed up for 1-9 months using MRI and measurements of serum prolactin levels. Seven patients were lost to follow-up. The results of the present study demonstrated that patients who were treated with large doses of bromocriptine or used bromocriptine chronically suffered from an increased rate of surgical difficulties and postoperative complications, as compared with the patents who had not been pre-treated with bromocriptine. In conclusion, oral administration of bromocriptine is important in the treatment of prolactinoma tumors. However, large doses or long-term use of bromocriptine may increase difficulties in surgery or postoperative complications, and reduce its ability to treat prolactinonas, as it can lead to hardening of the tumor tissue and capsules, and aggravate pituitary stalk adhesions.

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“…The timing of post-operative visual assessment is specified infrequently and most studies clarifying this have relatively short follow-up (<6 months) underestimating long-term rates of visual improvement (1). Exceptions to this are two series with mean follow-up of 37 and 50 months, giving rates of vision improvement 80 and 74%, respectively (38,39). Given the delays in the diagnosis of visual deterioration in elderly patients (11), post-operative visual outcomes in this group are of particular interest.…”

Section: Visual Improvement and Factors Affecting Itmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Visual morbidity in patients with pituitary adenoma

Lithgow

Batra

Matthews

et al. 2019

European Journal of Endocrinology

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Visual dysfunction is an important element in the morbidity encountered in patients with pituitary adenoma leading to functional impairment and compromised quality of life. It consists of many parameters (even in the absence of reported symptomatology) as a result of tumour growth in proximity to structures critical for vision (anterior visual pathway, cranial nerves within cavernous sinuses), and as an adverse consequence of therapeutic interventions. Adenoma resection leads to high rates of visual improvement and possibly continues beyond a year post surgery, but the exact timing of maximum effect requires elucidation. Retinal nerve fibre layer measurement may be a reliable, objective parameter predicting favourable visual outcomes, although its prognostic value when pathological, needs to be confirmed. For compromised vision after pituitary apoplexy, early surgical decompression remains usual practice until evidence-based guidance becomes available. The risk of radiation-induced visual toxicity is mainly influenced by total and per fraction dose of radiation and treatment modality. Careful selection of cases and of radiotherapy technique/planning are of major importance in minimising this risk. Dopamine agonists lead to visual recovery in a considerable number of prolactinoma patients. Visual morbidity should be considered a vital indicator in the metrics of quality of service/care in pituitary disease making regular, full ophthalmic examination an essential component of modern management of pituitary pathology at all time points of patient pathway. Well-designed studies minimising effects of bias and using tools and scoring systems reliably reflecting visual status will provide robust evidence on valid prognostication and patient stratification guiding clinical decision making.

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Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas

Cited by 73 publications

References 39 publications

Radiological “Teddy Bear” Sign on CT Imaging to Aid Internal Carotid Artery Localization in Transsphenoidal Pituitary and Anterior Skull Base Surgery

Radiological “Teddy Bear” Sign on CT Imaging to Aid Internal Carotid Artery Localization in Transsphenoidal Pituitary and Anterior Skull Base Surgery

Effects of preoperative bromocriptine treatment on prolactin-secreting pituitary adenoma surgery

MANAGEMENT OF ENDOCRINE DISEASE: Visual morbidity in patients with pituitary adenoma

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