Endoscopic Trans-Sphenoidal surgery: Efficacy and response in pituitary adenoma

Abstract

Objectives:The purpose of the study was to access the efficacy and response of the endoscopic transsphenoidal surgery in pituitary adenomas.Methods:It was descriptive case study, conducted at Neurosurgery Department in collaboration with the Endocrine Unit (Medical Unit-II) Of Jinnah Post Graduate Medical Center Karachi from January 2015 to July 2017. Patients with sellar, supra sellar and para sellar tumors were enrolled in the study. Patients with prolactinoma and recurrent pituitary tumors were excluded. Data was analyzed using SPPS 17.Results:Sixty three patients were included in the study with mean age of 42±8.34 years. There were 40(63.5%) male patients and 23(36.5%) female patients with pituitary adenoma. Headache and visual impairment were the main presentation 55(87.3%) and 56 (88.8%) respectively. Out of all these patients the pituitary adenomas, 51(81%) patients had non secretory and 12 (19%) patients had secretory tumor. Out of these pituitary adenomas 53(84.1%) were macroadenomas and 10(15.9%) were microadenoma. Post operatively marked improvement in the headache was in all 100% patients and vision improved in 54 (96.4%). The most common post operative complication was cerebrospinal fluid (CSF) leak in 10 (15.9%) with 44 (69.8%) having no post complications at all. Mortality was reported to be just 1.6% i-e one patient.Conclusion:The endoscopic transsphenoidal approach for pituitary adenoma is the safest procedure with marked improvement in complications and reduction in patient’s hospital stay.

The effects of cognitive bias modification for attention and interpretation on the postoperative psychological resilience and quality of life of patients with pituitary adenoma: a randomized trial

“…Pituitary adenomas account for 8-15% of intracranial tumors (21). These tumors are mainly treated through a combination of surgery and medicine (5,22). Most patients with pituitary adenoma require long-term drug treatment after undergoing surgery.…”

“…Functional pituitary adenomas can lead to elevated secretion of 1 or multiple hormones, while nonfunctional adenomas compress the areas surrounding the anterior pituitary, resulting in hormonal deficiencies (3,4). Transsphenoidal surgery is the first-line treatment for pituitary adenomas (5). However, surgery entails great psychological pressure as well as physical discomfort, which can deteriorate patients' social psychological state.…”

Updates in the Medical Treatment of Pituitary Adenomas

“…Considering this option, some clinical and economic results have shown that surgical resection costs mirror the costs of medical therapy over a 10-year period, after which TSS might be considered more cost effective for perhaps young patients with microadenomas [8,37]. Complication rates with TSS are minimal [38], though surgical outcome is very dependent upon the skill and experience of the surgeon as well as the size of the tumor and baseline serum PRL levels, with gross total removal achieved in 18-75 % of patients [38,39]. Patients with microprolactinomas are shown to have a higher rate of normalizing serum PRL levels post-surgery, at 75-90 % versus 33-50 % of patients with macroprolactinomas [1,4,9,27].…”

“…Patients with microprolactinomas are shown to have a higher rate of normalizing serum PRL levels post-surgery, at 75-90 % versus 33-50 % of patients with macroprolactinomas [1,4,9,27]. However, recurrence rates of hyperprolactinemia can be observed if there was no gross total resection [39] or if patients had large tumors [25]. Recurrence of hyperprolactinemia may occur in 18-22 % of patients after initial normalization [4,9,27].…”

Clinical Outcome and Complication of Endoscopic Endonasal Transsphenoidal Surgery (ETSS) for Pituitary Adenoma: A Retrospective Study at Prime Teaching Hospital Peshawar

“…The prevalence of complications after endoscopic TSS has been reported between 3 -36%, which are mostly due to the CSF leak, dysfunction of the anterior lobe, and diabetes insipidus (DI). [3][4] Rehman et al (2018) 4 reported around 31% complications from TSS.…”