Frequency of CSF Rhinorrhoea in Patients Undergoing Endoscopic Transsphenoidal Surgery (ETSS) for Pituitary Macroadenoma (original) (raw)
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Endoscopic approach for pituitary surgery improves rhinologic outcomes
The Annals of otology, rhinology, and laryngology, 2009
We hypothesized that the endoscopic approach to pituitary surgery improves rhinology-specific quality of life and has satisfactory tumor outcomes compared with the open approach. Cases of pituitary surgery from the Department of Neurosurgery database included an inception cohort of all patients who had endoscopic procedures and consecutive patients who had open procedures between January 1998 and February 2008. The Sino-Nasal Outcome Test-22 was mailed. Since January 1998, 71 endoscopic and 122 open pituitary surgeries had been performed. The mean followup was longer for open procedures (49.3 months) than for endoscopic procedures (18.8 months). Recurrence was more common after open surgery (28.4%) than after endoscopic surgery (18.2%; p = 0.219). The most common diagnosis was macroadenoma (77.1% of endoscopic procedures and 93.4% of open procedures). The mean hospital stay was shorter for endoscopic procedures (4.1 days) than for open procedures (6.0 days; p <0.001). Of patients...
CSF Rhinorrhoea after Transsphenoidal Surgery
The Internet Journal of Neurosurgery, 2008
Objectives: The author investigated the incidence, risk factors, prevention and management of post-transsphenoidal cerebrospinal fluid (CSF) rhinorrhoea in 146 cases with sellar lesions. Patients and Methods: A review was conducted of 146 consecutive patients who underwent transsphenoidal (TSS) surgery for mainly pituitary adenomas, or other lesions such as craniopharyngioma, Rathk's cleft cyst, meningioma or chordoma in the sella turcica that performed between
Acta Oto-Laryngologica, 2012
Conclusions: Rhinosinusitis detected by preoperative osteomeatal unit computed tomography (OMU CT) may not increase the incidence of postoperative central nervous system (CNS) infections. Objectives: To evaluate the safety of endoscopic endonasal transsphenoidal pituitary surgery in patients who had rhinosinusitis detected by preoperative OMU CT. Methods: A total of 107 patients who underwent endoscopic endonasal transsphenoidal pituitary surgery were enrolled. The presence of rhinosinusitis and the location of involved sinuses were assessed by preoperative OMU CT. The extent of pituitary tumors was assessed by preoperative sellar MRI. The occurrence of intraoperative cerebrospinal fluid (CSF) leakage and postoperative central nervous system (CNS) complications were analyzed using the medical records. The correlations between these variables and postoperative CNS complications were examined. Results: After pituitary surgery, postoperative CNS complications occurred in four patients (3.7%). Twenty-eight patients (26.2%) had findings of rhinosinusitis on preoperative OMU CT. Of the 28 patients, 8 had rhinosinusitis in the anterior sinuses and 20 in the posterior sinuses. Intraoperative CSF leakage occurred in eight patients (7.5%). The occurrence of intraoperative CSF leakage showed a significant correlation with the incidence of postoperative CNS complications (p = 0.003) but not with the presence of rhinosinusitis (p = 0.134). Although not statistically significant, patients with rhinosinusitis in the posterior ethmoidal and/or sphenoidal sinuses tended to have higher incidences of postoperative CNS complications (p = 0.057).
Early Outcome of Endoscopic Trans‑nasal Trans‑sphenoidal Pituitary Surgery in Kano, Nigeria
Nigerian Journal of Basic and Clinical Sciences , 2020
Endoscopic trans-nasal trans-sphenoidal hypophysectomy is a minimally invasive surgical procedure aimed at resection of pituitary tumors. This technique is widely practiced in developed countries but is presently gaining popularity in our environment. This study was aimed at presenting our preliminary outcomes as it relates to the technique of endoscopic trans-nasal trans-sphenoidal pituitary surgery in Kano, Nigeria. This was a retrospective study of patients with pituitary tumors that presented at a government tertiary and private specialist health institutions from October 2018 to December 2019. They all had excision of varying degrees of pituitary tumors via endoscopic trans-nasal trans-sphenoidal approach under general anesthesia. There were 4 females (66.7%) and 2 males (33.3%) and their ages ranged between 25 – 60 years. They presented with varying degrees of clinical symptoms such as gynaecomastia, galactorrhea, irregular menstruation, infertility, intermittent headache and visual impairment. Four (66.7%) had complete tumor excision and 2 (33.3%) had incomplete excision. Four (66.7%) had completesymptomreliefand2(33.3%)hadsignificantimprovementinsymptoms.Thecomplicationsofsurgerywerenasalseptaladhesion 1(16.7%), CSF leak 1(16.7%) and transient diabetes insipidus 2(33.3%). All complications were resolved during admission and at follow up visits.Histopathologicalanalysisofspecimensconfirmed5casesofpituitaryadenomaandacaseofpituitaryRathkescleftcyst.Endoscopic trans-nasal trans-sphenoidal pituitary surgery is feasible and has a favorable outcome in our setting with prospects for improvement to ensure safety. Keywords: Nasal endoscopy, Sinus surgery, Pituitary tumors, Skull base, Hypophysectomy. Keywords: Hypophysectomy, nasal endoscopy, pituitary tumours, sinus surgery, skull base
The Transnasal-Transsphenoidal Approach for Pituitary Surgery
Plastic and Reconstructive Surgery, 1980
Endoscopic transnasal transsphenoidal (ETNTS) approach was first described in 1992 and is standard approach for the resection of benign pituitary adenomas. This prospective study aims in incidence and preoperative assessment of extent of the pituitary adenoma, peroperative findings of transnasal transsphenoidal excision, techniques of skull base repair, complications and its management in a tertiary centre. A prospective analysis from Jan 2017 to May 2019, of patients undergoing ETNTS approach of pituitary adenomas was made in terms of incidence in various age-groups, type of adenoma, operative findings including CSF leak, repair of the skull base defect, complications encountered and its management was done in a tertiary care centre and compared with the present literature. A total of 141 patients underwent ETNTS, with highest number of cases found in 41-50 years age-group with mean age of 42.6 years. Male: Female ratio was 1.6. Macroadenoma was in 123 patients while 18 had microadenoma, of these 63.74% were functional adenoma, highest of GH secreting, while 36.26% were non-functional. Mean surgical time was 98.4 min ± 21.2 min. Peroperative CSF leak was in 30.5% cases in various grades. Closure techniques included use of fat, multilayer techniques, Hadad's flap and gasket technique as per the type of CSF leak. Neurological and rhinological complications were 6.38% each. This study is focused on the ENT perspective of the endoscopic transnasal trans-sphenoidal approach for pituitary adenomas. The reduced rate of morbidity and complications is encouraging. The endoscopic skull base defect closure is challenging and requires skill, meticulous approach and synchronised team work in order to achieve a favourable outcome. The incidence of CSF leak can be minimised and if encountered has to be dealt in an organised manner, thus contributing to a reduced rate of complications. The complications encountered must be foreseen and managed with a proficient approach.
Journal of neurosurgery, 2015
OBJECT Despite the widespread adoption of endoscopic transsphenoidal surgery for pituitary adenomas, the sinonasal quality of life (QOL) and health status in patients who have undergone this technique have not been compared with these findings in patients who have undergone the traditional direct uninostril microsurgical technique. In this study, the authors compared the sinonasal QOL and patient-reported health status after use of these 2 surgical techniques. METHODS The study design was a nonblinded prospective cohort study. Adult patients with sellar pathology and planned transsphenoidal surgery were screened at 4 pituitary centers in the US between October 2011 and August 2013. The primary end point of the study was postoperative patient-reported sinonasal QOL as measured by the Anterior Skull Base Nasal Inventory-12 (ASK Nasal-12). Supplementary end points included patient-reported health status estimated by the 8-Item Short Form Health Survey (SF-8) and EuroQol (EQ)-5D-5L inst...
Turkish neurosurgery, 2008
The aim of this presentation is to show that the sublabial transseptal transsphenoidal approach to pituitary adenomas is the least invasive anatomic route with the lowest postoperative complication rates. This study was based on a retrospective analysis of 276 patients with a diagnosis of pituitary adenoma who were surgically treated via the sublabial transsphenoidal route. The overall complication rate of the presented series was 14.8%. The recurrence rate was 14.1%; there were no deaths or intranasal complications in this series. Postoperative rhinological complications, such as septal perforation, synechiae, and mucosal tear which impaired nasal function, occur rarely with this approach compared to other approaches. Besides the technical advantages of this approach, performance of the initial phase of the operation by an otorhinolaryngologic surgeon is the basis of the low intranasal complication rate in our series.
2008
The aim of this presentation is to show that the sublabial transseptal transsphenoidal approach to pituitary adenomas is the least invasive anatomic route with the lowest postoperative complication rates. PATIENTS and METHOD: This study was based on a retrospective analysis of 276 patients with a diagnosis of pituitary adenoma who were surgically treated via the sublabial transsphenoidal route. RESULTS: The overall complication rate of the presented series was 14.8%. The recurrence rate was 14.1%; there were no deaths or intranasal complications in this series. Postoperative rhinological complications, such as septal perforation, synechiae, and mucosal tear which impaired nasal function, occur rarely with this approach compared to other approaches. CONCLUSION: Besides the technical advantages of this approach, performance of the initial phase of the operation by an otorhinolaryngologic surgeon is the basis of the low intranasal complication rate in our series.
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
Objective The transsphenoidal surgery is a safe and effective technique to manage different skull base pathologies, such as pituitary adenomas. The purpose of the present study is to describe the initial experience with endoscopic transsphenoidal surgery in the treatment of pituitary adenoma patients at a tertiary hospital that is a reference in neurosurgery in Southern Brazil. Materials and Methods We retrospectively analyzed data from 60 patients with pituitary adenoma who underwent endoscopic transsphenoidal surgery between 2012 and 2019. Demographic characteristics, type of tumor, baseline hormonal changes, and clinical presentation were reported, as well as postoperative outcomes, tumor resection rate, and complications. Results The male/female ratio was of 0.53:1, and the mean age of the sample was of 54 (range: 26 to 79) years. In total, 34 patients (57%) presented the non-functioning adenoma subtype, and 26 (43%), the functioning adenoma subtype. In the non-functioning and f...