Hemorrhagic Vascular Complications of Endoscopic Transsphenoidal Surgery

Cavallo, Luigi Maria; Briganti, Francesco; Cappabianca, Paolo; Maiuri, Francesco; Valente, Vinicio; Tortora, Fabio; Volpe, Antonio Della; Messina, A.; Elefante, Andrea; Divitiis, Enrico de

doi:10.1055/s-2004-818489

Cited by 60 publications

(58 citation statements)

References 15 publications

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“…Vascular complications of endoscopic TS and microscopic TS are identical. 38 We previously reported a complication rate of 29% in our study on results of primary endoscopic TS in patients with CD, 3 which is similar to the complication rates reported in studies of primary microscopic TS in patients with CD. The studies on repeated TS in patients with persistent or recurrent CD report complication rates varying between 0% and 91%.…”

Section: Discussionsupporting

confidence: 86%

Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing's disease (CD)

Wagenmakers¹,

Netea‐Maier²,

Lindert

et al. 2009

Clinical Endocrinology

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SummaryBackground No data on results of repeated transsphenoidal surgery via the endoscopic technique for patients with persistent or recurrent Cushing's disease are available. Design and patients We retrospectively evaluated the remission rates and complications of repeated transsphenoidal surgery via the endoscopic technique in 14 patients with persistent ( N = 6) or recurrent ( N = 8) Cushing's disease treated in our centre between 1999 and 2007. Main outcomes Remission was defined as the disappearance of symptoms of hypercortisolism with basal plasma cortisol level ≤ 50 nmol/l 24-48 h after glucocorticoid withdrawal and/or suppression of plasma cortisol level ≤ 50 nmol/l after 1 mg dexamethasone overnight within the first 3 months after transsphenoidal surgery. Results With repeated endoscopic transsphenoidal surgery a remission rate of 10/14 (71%) was achieved. No patient had a relapse during a median follow-up of 24 months. Cerebrospinal fluid leakage was the most frequent complication (6 patients) and 11 patients required hormonal substitution after surgery. The success of repeated transsphenoidal surgery could not be predicted by visualization of an adenoma on MRI before first or second surgery, histopathological confirmation of an ACTH secreting adenoma after first or second surgery, treatment with cortisol lowering agents before first or second surgery, the operation technique used during the first surgery, persistent vs. recurrent disease after the first surgery, age, gender and interval between the two surgeries. Conclusion Repeated transsphenoidal surgery via the endoscopic technique is a good treatment option for selected patients with recurrent or persistent Cushing's disease following primary pituitary surgery.

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Section: Discussionsupporting

confidence: 86%

Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing's disease (CD)

Wagenmakers¹,

Netea‐Maier²,

Lindert

et al. 2009

Clinical Endocrinology

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“…A mechanical device is used to fixate the endoscope (a mechanical arm or holder); after the sphenoidal sinus is opened, the endoscope is fixated, leaving the neurosurgeon with both hands free to perform the procedure. 7,8,12,17,18,21,22,25,[27][28][29][30][31][32] Other authors prefer not to use an endoscope with a holder 14,15,19,20,24,26 . In the current study we did not use endoscope holders, as one of the most important advantages of the endoscope is its mobility; it can be rapidly repositioned without having to be released and refixated.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors routinely used a cleaning system for the tip of the endoscope -irrigation with saline -to try to solve this problem. 7,8,12,17,[27][28][29][30][31][32] Certain measures should be taken during the surgical approach to avoid complications. When the nasal fossae are prepared by placing cottonoid with vasoconstrictors between the middle turbinate and the nasal septum, the turbinate should be lateralized with great care so that it does not fracture close to the cranial base (lateral lamella of the lamina cribosa).…”

Section: Discussionmentioning

confidence: 99%

“…Aust et al 45 reported a postoperative bleeding rate of 14.28%; many other authors have reported lower rates compared to our series in this paper. 8,15,22,23,27,32 The criteria used to define an episode of nasal bleeding may be an explanation of this finding. Nasal bleeding was defined as present whenever an otorhinolaryngological assessment was required postoperative to evaluate bleeding.…”

Section: Discussionmentioning

confidence: 99%

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Acesso endoscópico transnasal aos tumores selares

Santos

Zymberg

Filho

et al. 2007

Rev. Bras. Otorrinolaringol.

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Transsphenoi dal surgery for sellar region tumors is traditionally done only by neurosurgeons. The use of endoscopes has permitted a direct transnasal approach to the sphenoidal sinus, without dissection of the septal mucosa, reducing postoperative morbidity. Aim: The purpose of this study was to assess the technical difficulties, and per and postoperative complications of the otolaryngological management of the endoscopic transnasal approach to the sellar region. Material and Method: 159 patients undergoing sellar region surgery between March 2001 and December 2006 were assessed retrospectively. 91 patients who underwent 95 endoscopic transnasal procedures were included in this study. Study design: a clinical retrospective study. Results: The endoscopic transnasal technique was feasible for every patient, independent of age, anatomical variations, tumor characteristics, tumor etiology, and previous surgical history. There was no need to remove the middle turbinate or septal deviations in any of the cases. The most significant peroperative complication was CSF leak during tumor removal (13.68%). Postoperative complications were: nasal bleeding (8.42%), CSF leak (8.42%), and meningitis (2.19). Conclusion: The transnasal endoscopic approach was accomplished with minimal invasion, preserving nasal structures in all 95 procedures, independent of age, anatomical variations, tumor characteristics,tumor etiology, and previous surgical history.

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“…The most serious complication of this surgery is cavernous internal carotid artery injury during the dural incision in sellar base. This catastrophic complication is seen in 0.3% -8% of cases [7]- [16]. Optic nerve injury is another complication of this surgery.…”

Section: Introductionmentioning

confidence: 99%