The experience with transsphenoidal surgery and its importance to outcomes

Honegger, Jürgen; Grimm, Florian

doi:10.1007/s11102-018-0904-4

Cited by 77 publications

(43 citation statements)

References 128 publications

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“…The rates of major complications, including postoperative hypopituitarism, intraoperative CSF leakage and transient diabetes insipidus, in our study are similar to those in other studies (43)(44)(45).…”

Section: Resultssupporting

confidence: 91%

Outcomes of Transsphenoidal Surgery in Cushing Disease Patients with Negative Pituitary Magnetic Resonance Imaging Findings: A Single-Center Experience

et al. 2020

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Section: Resultssupporting

confidence: 91%

Outcomes of Transsphenoidal Surgery in Cushing Disease Patients with Negative Pituitary Magnetic Resonance Imaging Findings: A Single-Center Experience

et al. 2020

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“…A thorough review of outcomes in persistent versus recurrent CD can be found in Rubinstein et al [ 54 ]. Pituitary surgery should be conducted in a center with high experience (more than 25 surgeries per year [ 55 ])—this applies both for persistent, recurrent, and surgery-naïve CD as well. A second pituitary surgery seems to be currently the first-line therapy in recurrent CD with a mean remission rate of 64%, but high rates of variability (38–90%) is reported in the literature [ 54 ].…”

Section: Treatment Options After Recurrence and In Persistent Cushingmentioning

confidence: 99%

Recurrence after pituitary surgery in adult Cushing’s disease: a systematic review on diagnosis and treatment

et al. 2020

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Purpose Recurrence after pituitary surgery in Cushing’s disease (CD) is a common problem ranging from 5% (minimum) to 50% (maximum) after initially successful surgery, respectively. In this review, we give an overview of the current literature regarding prevalence, diagnosis, and therapeutic options of recurrent CD. Methods We systematically screened the literature regarding recurrent and persistent Cushing’s disease using the MESH term Cushing’s disease and recurrence. Of 717 results in PubMed, all manuscripts in English and German published between 1980 and April 2020 were screened. Case reports, comments, publications focusing on pediatric CD or CD in veterinary disciplines or studies with very small sample size (patient number < 10) were excluded. Also, papers on CD in pregnancy were not included in this review. Results and conclusions Because of the high incidence of recurrence in CD, annual clinical and biochemical follow-up is paramount. 50% of recurrences occur during the first 50 months after first surgery. In case of recurrence, treatment options include second surgery, pituitary radiation, targeted medical therapy to control hypercortisolism, and bilateral adrenalectomy. Success rates of all these treatment options vary between 25 (some of the medical therapy) and 100% (bilateral adrenalectomy). All treatment options have specific advantages, limitations, and side effects. Therefore, treatment decisions have to be individualized according to the specific needs of the patient.

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“…This is supported by others. However, in their metaanalysis, rhinological complications were not considered [6]. We expect that by a prospective, comparative multicenter study it will be shown that surgical experience will also have a positive effect on the rate of rhinological complications independent of microsurgical or endoscopic technique.…”

Section: Discussionmentioning

confidence: 99%

Rhinological Consequences of Microsurgical Endonasal-Transsphenoidal Surgery for Pituitary Tumors

Hondronikos

Alomari

Schrader

et al. 2020

Exp Clin Endocrinol Diabetes

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Background Transsphenoidal surgery for sellar lesions may affect patency and function of the nasal airways, smell and sinonasal quality of life. Below is our report on otorhinolaryngological data garnered from patients undergoing endonasal transsphenoidal pituitary microsurgery. Methods In a prospective study, 68 patients scheduled for transsphenoidal operations (32 female, 36 male, age 17–72 years) underwent otorhinolaryngological evaluation of their nasal morphology, a standardized smell test (sniffin’ sticks) and rhinomanometry to analyse nasal breathing function preoperatively, 3–5 days postoperatively (without rhinomanometry), after 3–4 months and after 9 months. Results Immediately after surgery, a reduction in smell sensation was detected in almost all patients. Within 3 months, this impairment resolved in all cases except one. In 2 patients (3%) with preoperative anosmia, improvement of smell function to>6 out of 12 sniffin’ sticks was observed. At final visit no patient was noted to have new anosmia. Within 3 months, the results of the rhinomanometry revealed that all patients except one, regained their preoperative nasal breathing function. In 6 patients (8.8%) an improvement in their nose breathing abilities compared to the preoperative state was found. Three patients (4.4%) underwent a LASER transection of mucosal synechiae. In one case with persistent nasal obstruction (1.5%), secondary septoplasty had to be performed. There was no case in which perforation of the nasal septum, nasal tip deflection, or saddle nose deformity was observed. Conclusion Microsurgical resection of pituitary tumors via the endonasal transsphenoidal approach poses an acceptable risk with regards to sinonasal complications. The incidence of secondary rhinosurgical interventions is low. Standardized comparative studies between endoscopic and microsurgical transsphenoidal operations should be undertaken.

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The experience with transsphenoidal surgery and its importance to outcomes

Cited by 77 publications

References 128 publications

Outcomes of Transsphenoidal Surgery in Cushing Disease Patients with Negative Pituitary Magnetic Resonance Imaging Findings: A Single-Center Experience

Outcomes of Transsphenoidal Surgery in Cushing Disease Patients with Negative Pituitary Magnetic Resonance Imaging Findings: A Single-Center Experience

Recurrence after pituitary surgery in adult Cushing’s disease: a systematic review on diagnosis and treatment

Rhinological Consequences of Microsurgical Endonasal-Transsphenoidal Surgery for Pituitary Tumors

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