Microscopic transsphenoidal surgery for pituitary adenomas in. Transsphenoidal surgery is used to remove tumors of the pituitary gland. Endoscopic endonasal transsphenoidal surgery has the considerable total resection rates for pituitary adenomas and preventable. Discussion complications of transsphenoidal surgery.
Endoscopic treatment of the suprasellar arachnoid cyst. Clinical study incidence, risk factors and management of severe posttranssphenoidal epistaxisq kenneth m. The aim of this study was to compare and evaluate the outcomes and complications of endoscopic and microscopic transsphenoidal surgery in the. Transsphenoidal surgery in the hands of an experienced surgeon is a safe procedure with mortality rate ranging from 0. Fatal complication after transsphenoidal surgery of pituitary. In recent years, endoscopic endonasal transsphenoidal surgery has a wide application in the treatment of pituitary adenomas.
A neurosurgeon or an otolaryngologist, using an endoscope that is entered through the nose, fixes or removes brain defects or tumors in the anterior skull base. In this report we analyzed the complications in 624 procedures of endonasal transsphenoidal endoscopic surgery in the treatment of 570 patients with pituitary adenomas. History the transsphenoidal approach was first described in 1907 by schloffer, modified by. Transsphenoidal surgery an overview sciencedirect topics. The back wall of the sinus covers the pituitary gland. Normally an otolaryngologist performs the initial stage of surgery through the nasal cavity and sphenoid. Between january 2004 and june 2007 we conducted a retrospective analysis to assess postoperative complications related to endoscopic pituitary surgery in a series of 150 patients. Anatomy and surgery of the endoscopic endonasal approach.
The transseptal transsphenoidal approach to pituitary. Endoscopic endonasal transsphenoidal resection of pituitary. May 23, 2004 the primary objectives of this report were, first, to determine the number and incidence of complications of transsphenoidal surgery performed by a crosssection of neurosurgeons in the united states and, second, to ascertain the influence of the surgeons experience with the procedure on the occurrence of these complications. Your pituitary gland is a small, beanshaped structure that lies at the base bottom of. This minimally invasive route to the sella turcica allows for simpler and more rapid nasal dissection, with fewer postoperative nasal complications the endoscope was first employed in 1963 by guiot to visualize the contents of the sella turcica. Computerassisted navigation and intraoperative mri has further improved surgical outcomes.
In transnasal transsphenoidal endoscopic surgery, a surgical instrument is placed through the nostril and alongside the nasal septum to access a pituitary tumor. New endoscope shaft for endoscopic transsphenoidal. Endoscopic pituitary surgery johns hopkins medicine. Following the surgery, two children underwent radiotherapy. Transsphenoidal surgery is the mainstay of treatment for most kinds of pituitary adenomas and other sellar masses. Transsphenoidal microscopic and endoscopic surgery are the primary approaches for the vast majority 95% of sellar and parasellar lesions. Cappabianca has been a leader in this regard and has developed a set of instrumentation specific to this procedure.
Laws and lanzino, captures all of todays clinical knowledge on the multidisciplinary management of pituitary tumors, with a focus on surgical techniques. Bivariate analyses were performed to investigate the relationship of patient characteristics with complication occurrence, and a multivariate model was constructed to determine risk factors associated with these complications. Often neurosurgeons and ent ear nose and throat surgeons work together for this type of. A custommade shaft for a wolf endoscope richard wolf gmbh, knittlingen, germany was developed with a height of 10 mm and a width of 5 mm, allowing an additional working channel for the endoscope for flexible. Endoscopic endonasal transsphenoidal surgery request pdf. This is a newer technique and is called endoscopic pituitary surgery.
Endoscopic transnasal transsphenoidal surgery is a minimally invasive procedure where the pituitary tumor is removed by working through the nose. A type of surgery in which instruments are inserted through the nose and sphenoid sinus a hollow space in a bone in the nose to remove tumors that are in or near the pituitary gland. The leading author mb operated pituitary adenomas via pure endoscopic endonasal transsphenoidal. The most common surgery that is done on the pituitary is transsphenoidal surgery. Transsphenoidal hypophysectomy is a commonly used surgical approach for pituitary region masses, with many significant advantages over open craniotomy. The major complication rate following both primary and revision transsphenoidal pituitary surgery was calculated. Endoscopic pituitary surgery, also called transsphenoidal endoscopic surgery, is the most common surgery used to remove pituitary tumors. Endoscopic transsphenoidal surgery was associated with higher incidence of gross tumor removal or. Endoscopic versus microscopic transsphenoidal pituitary. A4 patient information leaflets colour template uclh. Feb 03, 2020 transsphenoidal surgery for pituitary tumors is done to remove a tumor on the pituitary gland. The complications of endoscopic transsphenoidal surgery for. Transsphenoidal abstract among the major complications of transsphenoidal surgery, less attention has been given to severe postoperative epistaxis, which can lead to devastating consequences.
The pituitary gland is attached to the brain and sits behind the bridge of the nose. Definition of transsphenoidal surgery nci dictionary of. Pituitary adenomas are noncancerous tumors that form in the pituitary gland. To investigate the evidence of an operative learning curve after the introduction of endoscopic transsphenoidal surgery in our unit. The procedure was for a long time called cgh cushingguiothardy after the three pioneers. In this minimally invasive surgery, the surgeon works through the nostrils with a tiny endoscope camera and light to remove tumors with long instruments. As old as surgery is mans need to produce medical instruments specifically dedicated to various techniques. Followup 6 months mr imaging showed this implanted fat remained with partial resorption.
Transsphenoidal surgery for pituitary tumors precare what. What to expect after transsphenoidal pituitary surgery. Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging article pdf available in neurosurgery 581 suppl. A patients guide to endonasal endoscopic surgery for pituitary. Transsphenoidal surgery is performed to remove tumors from the pituitary gland, sellar region, and sphenoid sinus of the skull. The pituitary gland is a peasized organ that lies at the base of the brain above the back of the nose. Complications following primary and revision transsphenoidal. Endoscopic transnasal transsphenoidal surgery mayo clinic. Endoscopic transsphenoidal pituitary adenoma resection. Transsphenoidal surgery is a surgical procedure that allows the surgeon to remove tumours, cysts or other abnormalities that can affect the pituitary gland and the area around it.
The pure endoscopic transsphenoidal surgery consisting of a whole procedure performed with the endoscope alone and without the use of any transsphenoidal retractor offers some advantages due. Endoscopic pituitary and skull base surgery karl storz. Pdf endoscopic transsphenoidal pituitary surgery with. Endoscopic pituitary surgery, transsphenoidal cincinnati. How well the surgery works depends on the type of tumor, its exact location, its size, and whether it has spread into nearby structures. More recently, technological advances have led to the use of rigid endoscopes in pituitary surgery. The endonasal route is being increasingly utilized for a variety of anterior skull base lesions.
Transsphenoidal surgery continued to develop during the 80s and 90s with the. Endoscopic transsphenoidal surgery has gradually come to be regarded as a preferred option in the treatment of pituitary adenomas because of its advantages of improved visualization and its minimal invasiveness. Transsphenoidal means that the surgery is done through the sphenoid sinus, a hollow space in the. If you have other questions, please write them down so we can answer them for you. Complications of endoscopic surgery of the pituitary adenomas. The pituitary tumor is taken out via the nose operation surgery. Endoscopic transsphenoidal pituitary adenoma resection 5 about endoscopic transsphenoidal pituitary adenoma resection the pituitary is a gland about the size of a pea that lies beneath the base of the brain. Arrange to have someone drive you home after surgery. Surgery for pituitary tumors american cancer society. Seventy to eighty percent of patients who have abnormal visual fields due to a gonadotroph adenoma in one series experienced improvement following.
Transsphenoidal means that the surgery is done through the sphenoid sinus, a hollow space in the skull behind the nasal passages and below the brain. The aim of this study was to compare and evaluate the outcomes and complications of endoscopic and microscopic transsphenoidal surgery in the treatment of pituitary adenomas. What will happen if i choose not to have this surgery. Transsphenoidal hypophysectomy surgery should you go for it. Feb 11, 2010 the most common surgery that is done on the pituitary is transsphenoidal surgery. On the early postoperative mr scans, 69 patients who underwent transsphenoidal resection and intrasellar packing with fat only showed high signal intensity on the precontrast t1weighted image where the tumor was located figs 1 and 2. Although there have been several reports on postoperative mr imaging of the sella, immediate postoperative changes usually within 3 days have not been extensively analyzed.
Fatal complication after transsphenoidal surgery of. Apr 11, 2014 endoscopic transsphenoidal surgery has gradually come to be regarded as a preferred option in the treatment of pituitary adenomas because of its advantages of improved visualization and its minimal invasiveness. Diabetes insipidus following resection of pituitary tumors. Transsphenoidal hypophysectomy radiology reference article. It has been used in our medical center where the correspondence author doctor zhou of this manuscript is since 2007 because the endoscopic surgery can provide better vision and result in less nasal cavity injuries than. Pituitary adenomas are benign slowgrowing tumours that. It has evolved since then to arrive at the current paraseptal techniques.
Recent findings endoscopic guidance has improved tumor visualization while minimizing the risk of nasal and dental complications and septal perforation. Nowadays, two surgical transsphenoidal techniques are used to remove pituitary tumors. Endoscopic endonasal surgery is a minimally invasive technique used mainly in neurosurgery and otolaryngology. Transsphenoidal surgery, either microscopic or endoscopic, is a safe procedure in experienced hands, but serious complications still occur and must be reduced as much as possible. Pdf endoscopic endonasal transsphenoidal approach to.
This is the most common way to remove pituitary tumors. Pdf perspectives on endoscopic transsphenoidal surgery. To describe a new endoscope shaft developed for suctionaspiration during endoscopic transsphenoidal pituitary surgery. May 23, 2004 discussion complications related to indications. The endonasal route is being increasingly utilized for. Neuroendoscopy, nasal cavity surgery, pituitary neoplasm, pituitary adenoma. Endoscopic endonasal transsphenoid surgery of pituitary adenoma.
In the field of endoscopic surgery, dedicated instruments are needed not only for neuroendoscopy of the cerebral ventricles, but also for surgery of the cranial base with the use of minimally invasive endoscopic techniques. The pituitary gland is located at the bottom of your brain and above the inside of your nose. Endoscopic transsphenoidal surgery is emerging as a minimally invasive and maximally effective procedure for pituitary adenomas. This article examines recent advancements in the preoperative assessment and anesthetic management of patients undergoing transsphenoidal pituitary surgery. Pituitary adenomas are benign slowgrowing tumours that arise within the pituitary gland. Fatal complication after transsphenoidal surgery of pituitary adenoma. In our study, disease control was achieved in all of the 5 microadenomas 23. Proposing a strategy for sellar reconstruction in endoscopic transsphenoidal transsellar approachfor pituitary adenoma. Endoscopic transsphenoidal tumor surgery sciencedirect.
Keywords endoscopic surgery endonasal, transsphenoidal surgery pituitary adenoma pituitary tumors, one of the most frequent intracranial tumors, are clinically classi. Endoscopic transsphenoidal pituitary adenoma resection nice. The development of pituitary surgery over the past century is largely credited to the pioneering work of harvey cushing in the early 1900s. Transsphenoidal surgery for pituitary tumors is done to remove a tumor on the pituitary gland. A transsphenoidal hypophysectomy is one type of operational surgery method which is generally chosen to eliminate a tumor of the pituitary gland. Diabetes insipidus di is a common complication following pituitary surgery and can be transient or permanent. The main treatment for many pituitary tumors is surgery. Anesthesia for transsphenoidal pituitary surgery anestesinorr. The transseptal transsphenoidal approach to pituitary tumors. Endoscopic transsphenoidal pituitary adenoma resection is carried out under general anaesthetic.
Surgical instruments are then inserted next to the endoscope through the same nostril. The pituitary gland, a peasized gland with two lobes, controls how hormones are made in your body. An endoscope is inserted into the nostril towards the base of the tumour at the skull base. It is responsible for regulating most of your bodys hormones, the chemical messengers that travel through your blood. Transsphenoidal surgery almost always results in a decrease in adenoma size figure 18.
Microscopic transsphenoidal surgery for pituitary adenomas. The first 125 patients who underwent endoscopic transnasal transsphenoidal surgery for pituitary fossa lesions between 2005 and 2007 performed by 1 surgeon were studied. Transsphenoidal surgery is a type of surgery in which an endoscope andor surgical instruments are inserted into part of the brain by going through the nose and the sphenoid bone a butterflyshaped bone forming the anterior inferior portion of the brain case into the sphenoidal sinus cavity. Endoscopic endonasal transsphenoidal surgery of 1,166. The purpose of this study was to establish the value of early postoperative mr imaging in differentiating residual tumor from postoperative surgical changes in the sella after transsphenoidal. What to expect after transsphenoidal pituitary surgery the following information should address your questions about your recovery.
This surgical technique can also be used to remove tumors located in other regions of the skull base. Post operative instructions after transsphenoidal surgery this information is intended to answer questions you may have after your tss pituitary surgery. Post pituitary surgery fact sheet this information has been provided for patients who have recently had pituitary surgery and to inform patients of what they could expect postoperatively. A total of 21 participants with histologically verified pituitary adenoma between. Transsphenoidal surgery for pituitary tumors precare. Transsphenoidal surgery for pituitary adenomas jon ramm. Instruments for endoscopic endonasal transsphenoidal surgery. It releases hormones which affect growth, sexual development, reproduction and metabolism. Complications of transsphenoidal surgery latest news and. Transsphenoidal surgery is traditionally performed using an operating microscope. Endoscopic endonasal transsphenoid surgery of pituitary. Thirteen patients underwent endonasal endoscopic transsphenoidal sur gery. A transsphenoidal hypophysectomy is a surgical procedure most commonly used to remove a tumour of the pituitary. Results can be excellent with minimal complications, but surgeons must have a thorough knowledge of the surrounding anatomy and potential complications.
It is called this because the surgery is done through the nose. Lawsa a department of neurological surgery, brigham and womens hospital and harvard medical school, 75 francis street, boston, ma. National hospital for neurology and neurosurgery pituitary. These tumors cause hormonal imbalance in the body by either. Complications of endoscopic surgery of the pituitary. Nose is not packed after the surgery, no lumbar drain is used even when there is a csf leak. Pituitary tumor removal, transsphenoidal surgery for uw health.
Endoscopic endonasal transsphenoidal approach request pdf. Endoscopic pituitary surgery transsphenoidal overview. Acclaimed international experts bring you detailed guidance on natural history, radiologic and clinical aspects, surgical indications, and resection techniques. Your pituitary gland is a small, beanshaped structure that lies at the base bottom of your brain behind your eyes. Endoscopic transsphenoidal tumor surgery haedongjho, md, phd endoscopic endonasal transsphenoidal surgery was developed by the author in 1993 under minimally invasive strategy. The endoscopic technique has been gaining in popularity in recent years. Journal of clinical neuroscience harvard university.
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