Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications

Constantino, Edson; Leal, Rafael; Ferreira, Christian Cândido; Acioly, Marcus André; Landeiro, José Alberto

doi:10.1590/0004-282x20160042

Cited by 40 publications

(25 citation statements)

References 26 publications

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“…Patients presented with visual acuity complaints in 14–84% of cases (Supplementary Table 3) [ 5 , 36 ]. Ten studies evaluated postoperative visual acuity in their case series [ 5 , 6 , 9 , 20 , 22 , 25 , 30 , 36 , 37 , 46 ]. Pooled prevalence of overall improvement was 67.5% (95% CI: 59.1–75.0%, I 2 : 86.0%, n = 163/219).…”

Section: Resultsmentioning

confidence: 99%

Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis

et al. 2017

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PurposePatients with pituitary adenomas often present with visual deficits. While the aim of endoscopic endonasal transsphenoidal surgery (EETS) is to improve these deficits, permanent worsening is a possible outcome. The aim of this meta-analysis was to evaluate the effect of EETS for pituitary adenomas on visual outcomes.MethodsA meta-analysis was conducted according to the PRISMA guidelines. Pooled prevalence was calculated for complete recovery, improvement, and deterioration of visual field deficits, visual acuity and unspecified visual function in fixed- and random-effect models, including assessment of heterogeneity (I2) and publication bias (Begg’s test).ResultsOut of 2636 articles, 35 case series were included in the meta-analysis. Results are described for fixed-effect models. For patients with impaired visual acuity, only one study reported complete recovery (27.2%). Pooled prevalence for improvement was 67.5% (95% CI = 59.1–75.0%), but with considerable heterogeneity (I2: 86.0%), and 4.50% (95% CI = 1.80–10.8%) for patients experiencing deterioration. For patients with visual field deficits, the prevalence was 40.4% (95% CI = 34.8–46.3%) for complete recovery, 80.8% (95% CI = 77.7–83.6%) for improvement, and 2.3% (95% CI = 1.1–4.7%) for deterioration. For the unspecified visual outcomes, pooled prevalence of complete recovery was 32.9% (95% CI: 28.5–37.7%), but with considerable heterogeneity (I2 = 84.2%). The prevalence was 80.9% (95% CI = 77.9–83.6) for improvement and 2.00% (95% CI = 1.10–3.40%) for deterioration. Random-effect models yielded similar results. Publication bias was non-significant for all the outcomes.ConclusionWhile visual deficits improved after EETS in the majority of patients, complete recovery was only achieved in less than half of the patients and some patients even suffered from visual deterioration.Electronic supplementary materialThe online version of this article (doi:10.1007/s11102-017-0815-9) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis

et al. 2017

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“…First, they should make sure that the middle turbinate is retained; the lateral nasal wall should be adopted for a direct surgical approach when the patient has deviated nasal septum. [16] Second, the surgeons should pay attention to the conservation of the nasal mucosa. Third, the postoperative nasal packing should be performed precisely and gently; the middle turbinate should be fixed at the normal position, and the packing should be removed within 48 hours.…”

Section: Discussionmentioning

confidence: 99%

Analyses and treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms

Cheng

Wang

et al. 2017

Medicine

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In this study, we analyze and discuss the treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms (PNs). We performed 129 endonasal transsphenoidal resections of PNs and analyzed and treated cases with nasal complications. After endonasal transsphenoidal resection of PNs, there were 26 cases of postoperative nasal complications (20.1%), including nasal hemorrhage (4.8%), cerebrospinal fluid rhinorrhea (6.9%), sphenoid sinusitis (2.3%), atrophic rhinitis (1.6%), olfactory disorder (1.6%), perforation of nasal septum (0.8%), and nasal adhesion (2.3%). All patients clinically recovered after therapy, which included treatment of the cavity through nasal endoscopy, intranasal corticosteroids, and nasal irrigation. We propose that regular nasal endoscopic review, specific nasal medications, and regular nasal irrigation can effectively clear nasal mucosal hyperemia-induced edema and nasal/nasoantral secretions, as well as promote regeneration of nasal mucosa, prevent nasal adhesion, maintain the sinus cavity drainage, and accelerate the recovery of the physiological function of the paranasal sinus. Timely treatment of patients with nasal complications after endonasal transsphenoidal resections of PNs could greatly relieve the clinical symptoms. Nasal cleaning is very beneficial to patients after surgery recovery.

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“…In addition, patients who already lost vision from these tumors can even achieve recovery following surgery. In literature reviews visual improvement after endoscopic endonasal Transphenoidal approach for large and giant pituitary adenomas excision ranges in between 32.1%-97.7% [13][14][15][16][17][18][19][20] respectively showing better results of endoscopic endonasal Transphenoidal approach for management of pituitary tumors in terms of visual outcome improvement.…”

Section: Discusssionmentioning

confidence: 99%

Visual Improvement after Endoscopic Endonasal Transsphenoidal Excision of Pituitary Gland Tumor

et al. 2019

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Objective: To evaluate the frequency of improved visual acuity after Endoscopic Endonasal Transsphenoidal excision of pituitary gland tumor.Study Design: Descriptive case series.Materials and Methods: In our study, Pre-operative visual acuity was noted by using the Snellen’s chart. Then patients underwent pituitary gland excision though Endoscopic Endonasal Transsphenoidal approach under general anesthesia. After surgery, patients were shifted in postsurgical wards and then will be discharged from there and were examinedfor 3 months in OPD. Snellen’s chart was used to evaluate patents for visual acuity after 3 months by an experienced ophthalmologist having at least 4 years residency experience If visual acuity increased ≥ 1 line, then improved visual acuity was labeled.Results: Improved visual acuity after pituitary gland tumor excision was seen in 59(89.39%) patients. Age and gender of patients did not show any statistically significant association for improved visual acuity.Conclusions: Results of this study showed that pituitary gland tumor excision through Endoscopic Endonasal Transsphenoidal approach is effective in terms of visual acuity improvement. Our main objectives in pituitary surgery are protection and reinstatement of vision and this surgical approach give maximum cover to vision restoration.

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Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications

Cited by 40 publications

References 26 publications

Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis

Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis

Analyses and treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms

Visual Improvement after Endoscopic Endonasal Transsphenoidal Excision of Pituitary Gland Tumor

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