Surgical complications after endoscopic transsphenoidal pituitary surgery

Charalampaki, Patra; Ayyad, Ali; Kockro, Ralf A.; Perneczky, Axel

doi:10.1016/j.jocn.2008.09.002

Cited by 136 publications

(115 citation statements)

References 25 publications

(48 reference statements)

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“…In the present series, there was a predominance of female patients and the majority of the tumors were classified as non-functioning, corroborating the results found in the literature 16,17 . Endoscopic surgery, performed by experienced hands, is quite safe, well-tolerated by patients, and hospitalization time is shorter when compared to conventional surgery 18,19,20 . In the present series, average hospitalization period was four days, varying between three and 22 days, which is very similar to other series described by others authors: some with an average of 4.1 days ( first group of 15 cases), 4.5 days (second group of 15 cases), and 2.4 days (third group of 15 cases) 21; and others with an average hospitalization period of 3.36 days in their first 100 cases operated by the endoscopic transnasal approach; in comparison, a series of 100 patients operated by the sublabial approach presents an average hospitalization period of 6.35 days 11 .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic transnasal approach for removing pituitary tumors

Castro

Michel²,

Denaro

et al. 2014

Arq. Neuro-Psiquiatr.

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To describe a series of 129 consecutive patients submitted to the resection of pituitary tumors using the endoscopic transsphenoidal approach in a public medical center. Method: Retrospective analysis based on the records of patients submitted to the resection of a pituitary tumor through the endoscopic transsphenoidal approach between 2004 and 2009. Results: One hundred and twenty-nine records were analyzed. The tumor was non-secreting in 96 (74.42%) and secreting in 33 patients (22.58%). Out of the secretory tumors, the most prevalent was the growth hormone producer (7.65%), followed by the prolactinoma, (6.98%). Eleven patients developed cerebral spinal fluid (CSF) fistulas, and four of them developed meningitis. One patient died due to intracerebral hemorrhage in the postoperative period. Conclusion: The endoscopic transsphenoidal approach to sellar tumors proved to be safe when the majority of the tumors were nonsecreting. The most frequent complication was CSF. This technique can be done even in a public hospital with financial limits, since the health professionals are integrated.Keywords: pituitary neoplasms, cerebrospinal fluid, fistula, sphenoid sinus. RESUMO Descrever uma série de 129 pacientes submetidos à ressecção de tumor de hipófise com acesso endoscópico transesfenoidal em um serviço de público referência em Belo Horizonte. Método: Análise retrospectiva realizada por análise dos prontuários de pacientes submetidos à ressecção de tumor de hipófise com acesso endoscópico transesfenoidal entre os anos 2004 e 2009. Resultados: Foram avaliados 129 prontuários. O tumor era não secretante em 96 (74,42%) e secretante em 33 pacientes (22,58%). Dos tumores secretores, o de maior prevalência foi o produtor de hormônio do crescimento: 15 pacientes (7,65%). Onze pacientes desenvolveram fístula liquórica. Um paciente faleceu devido hemorragia intracerebral no pós-operatório. Conclusão: O acesso endoscópico transfenoidal aos tumores selares mostrou-se seguro numa população em que a maioria dos tumores era não secretante. A principal complicação encontrada foi fístula liquórica. Esta técnica é passível de utilização em hospital público mesmo com limites financeiros desde que haja integração multiprofissional.Palavras-chave: neoplasias hipofisárias, líquido cefalorraquidiano, fistula, seio esfenoidal.Transnasal approaches to the sella turcica have been used since 1910 when the incision in the gingivolabial groove associated with the transseptal approach was introduced. Subsequently, the sublabial incision was combined with the septal submucous incision, preserving the nasal function and avoiding scarring 1 . The use of intraoperative fluoroscopy and microscope in the 1960s represented an important advance, replacing craniotomy and reducing the rate of surgical mortality to less than two percent. The transseptal approach associated with the use of the microscope remained the gold standard of the transsphenoidal approach for more than 30 years and is still the preferred method in some centers 2 . The popul...

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Section: Discussionmentioning

confidence: 99%

Endoscopic transnasal approach for removing pituitary tumors

Castro

Michel²,

Denaro

et al. 2014

Arq. Neuro-Psiquiatr.

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“…The comparison between microscopic approach and transnasal endoscopic approach had been discussed in a great number of literature [3][4][5][6][7][8][9][10]. We have no experiences in microscopic pituitary adenoma surgery; so we simply focus on the practical skill of transnasal endoscopic pituitary surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In the pituitary surgery, the procedure by nasal endoscope has a lot of advantages that microscope can't afford [3][4][5][6][7][8][9][10][11][12][13][14][15]17], though it also has several disadvantages, however which will be overcomed along with the continuously developing of new instruments and new techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Many articles which compared the outcome of nasal endoscopy with traditional microscopy transsphenoidal surgery had been published [6][7][8][9][10]. Some of them [6][7][8] concluded that nasal endoscopic procedure overmatched microscopic surgery in terms of duration, remission rate, rate of total or subtotal excision, and the iatrogenic complications.…”

Section: Introductionmentioning

confidence: 99%

“…Some of them [6][7][8] concluded that nasal endoscopic procedure overmatched microscopic surgery in terms of duration, remission rate, rate of total or subtotal excision, and the iatrogenic complications. Other articles [9,10] however, indicated that endoscopic pituitary surgery had no difference in outcome compared with microscopic approach.…”

Section: Introductionmentioning

confidence: 99%

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Full Endoscopic Transsphenoidal Surgery for Pituitary Adenoma-emphasized on Surgical Skill of Otolaryngologist

Fan

Feng

et al. 2011

Indian J Otolaryngol Head Neck Surg

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The purpose is to summarize the experience in full endoscopic transsphenoidal resection of pituitary adenoma in 28 patients by rhinologist, and introduce the surgical skill of otolaryngologist, especially skills and cautions when operating inside nose. We removed pituitary adenoma in 28 patients via entirely endoscopic transsphenoidal approach with the help of special-designed instruments; we performed the procedure bloodlessly within limited time. The skill emphasized bilateral nostrils and four hands technique which was as delicate as possible not to scratch nasal mucosa or injure nasal frame. The special instruments included curette with suction, monopolar electrotome and bipolar coagulation forceps with suction, powered surgical equipments (Diamond Bur, Irrigation Tubing for Blades and Burs for nasal endoscopic surgery). Among 28 patients, there were 16 total resections, 8 subtotal resections, 3 partial resections, and 1 only biopsy due to excessive bleeding and hard nature. Of 19 patients with preoperative visual impairment, 12 patients had postoperative improvement in visual acuity and visual field. All the procedures were finished within 60 to 90 min. Complications seldom occurred except transient diabetes insipidus, especially no nasal-related signs or complications but 1 had epistaxis. The full endoscopic transsphenoidal surgery is a promising approach for pituitary adenoma resection. Multidisciplinary collaboration will lead to optimal cure for the patients. New technique and special-designed instruments can facilitate greatly this procedure.

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Rate of rhinosinusitis and sinus surgery following a minimally destructive approach to endoscopic transsphenoidal hypophysectomy

Rimmer

Vimawala

Chitguppi

et al. 2019

Int Forum Allergy Rhinol

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Background There remains considerable variation in the extent of sinonasal preservation during the approach for endoscopic transsphenoidal hypophysectomy (TSH). We advocate for a minimally destructive approach utilizing turbinate lateralization, small posterior septectomy, no ethmoidectomy, and preservation of nasoseptal flap (NSF) pedicles bilaterally. Due to these factors, this approach may affect the rates of postoperative rhinosinusitis. The objective of this study is to define the rates of postoperative rhinosinusitis in patients undergoing this approach. Methods Single institution, retrospective chart review of patients undergoing TSH from 2005 to 2018. Results A total of 415 patients were identified and 14% developed an episode of postoperative rhinosinusitis within 3 months. These patients were significantly more likely to have had a history of recurrent acute or chronic rhinosinusitis. Most cases were sphenoethmoidal sinusitis managed with 1 to 2 courses of antibiotics. Of patients with postoperative rhinosinusitis, most did not undergo NSF. Average follow‐up was 38 months. Six patients (1.4%) underwent post‐TSH functional endoscopic sinus surgery (FESS). Average time from TSH to FESS was 26.3 months. Two of these patients had a history of prior chronic rhinosinusitis without polyposis. Two patients underwent revision TSH for recurrent tumor as the primary indication for surgery at time of FESS. Twenty‐two–item Sino‐Nasal Outcome Test (SNOT‐22) scores generally increased immediately postoperatively, but frequently decreased below preoperative level by the time of last follow‐up, regardless of whether patients developed rhinosinusitis. Conclusion Sinonasal preservation during TSH is associated with a low rate of postoperative rhinosinusitis requiring FESS and excellent long‐term patient reported outcomes. We continue to advocate for sinonasal preservation during pituitary surgery.

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Surgical complications after endoscopic transsphenoidal pituitary surgery

Cited by 136 publications

References 25 publications

Endoscopic transnasal approach for removing pituitary tumors

Endoscopic transnasal approach for removing pituitary tumors

Full Endoscopic Transsphenoidal Surgery for Pituitary Adenoma-emphasized on Surgical Skill of Otolaryngologist

Rate of rhinosinusitis and sinus surgery following a minimally destructive approach to endoscopic transsphenoidal hypophysectomy

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