Original Article Endoscopic endonasal transsphenoidal

Original Article Endoscopic Endonasal Transsphenoidal-Free PDF

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Surgical treatment of pituitary adenoma, Figure 1 Use electric knife to cut the mucosa in the. position of nasal septum NS just rostral to the ante Figure 3 A view of Sphenoid sinus cavity SS. rior head of the inferior turbinate IT,Figure 4 After the tumor was removed the nasal. mucosa on the operation side was pushed back,Figure 2 Elevation of the mucoperichondrium by. use of a dissector proceeds in an anterior to pos, terior direction to the anterior face of the sphenoid gross total removal GTR indicated the absence. sinus and sphenoid ostium to produce a submucosal of residuum on MRI whereas partial tumor. operation space,removal PTR correlated with the presence of.
tumor on MRI,postoperatively All patients received CT scans. in prior to the operation to further delineate the. anatomical relationship of the cranial base and All patients underwent a complete endocrino. the tumor Adenomas were classified as micro logical assessment 1 month and 3 months. adenoma diameter 1 cm macroadenoma postoperatively Follow up was scheduled as. diameter 1 cm The series included 7 cases required mostly on an annual basis. microadenoma 45 cases macroadenoma,Cure in secreting adenomas was established. The degree of tumor resection was judged on following the strictest modern criteria 6 7 in. the basis of the 3 month post operative MRI GH adenomas remission was defined by nor. 5138 Int J Clin Exp Med 2015 8 4 5137 5143,Surgical treatment of pituitary adenoma. Ophthalmological tests,All patients underwent full visual assessment. pre operatively in the ophthalmology depart,ment of our hospital or in the referring hospital.
Visual field and visual acuity assessments were,performed up to one month pre operatively. unless there had been a recent deterioration,and these were repeated three months post. operatively unless required more urgently,Ophthalmological results were categorized as. normalized improved unchanged and wor,Surgical method. After general anesthesia and orotracheal intu, Figure 5 In the case of obvious CSF leak from large bation the patient is placed supine while his.
arachnoid and dural defects the right septum muco,head is secured in a three pin head holder for. sal would be shaped as a vascularized septal muco,sal ap MF neuronavigation With head back 15 the. patient s head is rotated 20 towards the oper,ator Iodine was used to disinfect the face and. nasal cavity The 0 endoscope was used in the, right nostril to allow the recognition of the infe. rior and middle turbinate laterally and the iden,tification of the nasal septum and sphenoid.
ostium The unipolar electric knife was used to,cut the mucosa in the position when nasal sep. tum just rostral to the anterior head of the infe,rior turbinate Figure 1 2 2 5 cm in length. Elevation of the mucoperichondrium by use of,a dissector proceeded in an anterior to poste. rior direction to the anterior face of the sphe,noid sinus and sphenoid ostium to produce a. submucosal operation space Figure 2 The,abrasive drill was used to remove the posterior.
portion of nasal septum to expose the contra,lateral sphenoid ostium and the contralateral. Figure 6 Use the vascularized septal mucosal ap to. nasal septum mucosa Figure 3 The bone of, reconstruct the skull base the sphenoid sinus anterior wall and sphenoid. septum were removed by a rongeur The sellar,osteotomy with a range of 1 1 5 cm in diameter. mal sex and age adjusted IGF level and GH is performed with bone rongeurs The sellar. nadir 1 ng ml after oral glucose tolerance dura is then opened with a micro blade After. test In PRL secreting adenomas remission the tumor was removed the nasal mucosa on. was defined as having normal serum PRL levels the operation side was pushed back Figure 4. 30 ng ml in females 15 ng ml in males For the large pituitary adenoma which needed. without previously having had dopaminergic double nostrils four hand operation an incision. therapy for at least 2 months Hypopituitarism of 5 mm long was made open on the contralat. was evaluated by baseline hormonal assess eral nasal septum mucosa where the surgical. ment and dynamic test where required The instrument could be imported Early in this. most common used dynamic test was the series of patients the endoscopic part of the. Synacthen test and this was performed within case was performed with single nostrils. 6 8 weeks after surgery to evaluate a second approach In the latter half of the series double. ary hypoadrenalism nostrils 3 hand technique was typically used. 5139 Int J Clin Exp Med 2015 8 4 5137 5143,Surgical treatment of pituitary adenoma. Table 1 Summary of clinical details of 52 lactinomas 8 GH secreting adenomas and 1. patients used for analysis PRL GH secreting adenomas Clinical and. Percentage imaging evidence of pituitary apoplexy was. Clinical details N present in 19 2 10 52 of patients including. Total 52 100 0 20 7 35 of those with endocrine active ade. nomas and 23 5 4 17 of those with endo,crine inactive tumors Cavernous sinus inva.
male 24 46 2,sion was visualized on preoperative images. female 28 53 8 and confirmed intraoperatively in 26 9 14 52. Age range years 25 76 of patients including 28 6 10 35 of those. Endocrine active adenoma 35 67 3 with functional adenomas and 23 5 4 17 of. Endocrine inactive adenoma 17 32 7 those with nonfunctional tumors Among the. Prolactinomas 26 50 0 45 macroadenomas 11 24 4 were 10 19. GH secreting adenomas 8 15 4 mm in diameter 30 66 7 were 20 39 mm in. PRL GH secreting adenomas 1 2 0,diameter and 4 8 9 were giant that is 40. mm in maximal diameter Decreased visual,acuity or a visual eld defect was the present. Microadenomas 10 mm 7 13 5 ing complaint in 29 patients 55 8 and head. Macroadenomas 10 mm 45 86 5 ache in 10 patients 19 2. 10 19 mm 11 24 4, 20 39 mm 30 66 7 The median clinical follow up was 16 months. 40 mm 4 8 9 ranged from 6 to 24 months and the median. Visual disturbance 29 55 8,radiological follow up was 14 months ranging.
from 3 to 24 months,Headache 10 19 2,Clinical follow up months 6 24 Surgical results. Radiological follow up months 3 24,As shown in Table 2 there were 46 cases. 88 5 of total resection of tumor 6 cases, an incision of 5 mm long was made open on the 11 5 of partial resection 9 cases 90 0 of. contralateral nasal septum mucosa where the headache patients were obviously relieved. surgical instrument could be inserted In the, case of obvious CSF leak from large arachnoid Ophthalmological results. and dural defects the right septum mucosal, would be shaped as a vascularized septal Of the 29 patients who presented with visual.
mucosal ap Figure 5 just as that Kassam et disturbance 89 7 improved post operatively. al 8 described to reconstruct the skull base while in the remaining 10 3 the vision. Figure 6 remained unchanged, Wherein one patient of our cases had relatively Endocrinological results. severe intraoperative cerebrospinal fluid leak, age After the completion of tumor resection Early remission was achieved in 68 6 24 35. the mucosal incision was clipped into the pedi of endocrine active adenomas according to. cle mucosal flap the operation was based on standard early remission criteria Specifically. the description of Amin B Kassam covered at remission was achieved in 69 2 18 26 of. the bottom of the saddle to form a good repair patients with a prolactinoma and in 62 5. substrate for the skull base 5 8 of those with GH secreting adenomas all. these 5 with an OGTT confirming the remission,Results status Patients with PRL GH secreting ade. nomas had early remission,As shown in Table 1 there were 24 males and. 28 females Age was from 25 to 76 with an Complications. average age of 46 8 Overall 35 patients had, an endocrine active adenoma and 17 had 6 cases of diabetes insipidus after surgery.
endocrine inactive adenoma 45 macroadeno were all recovered with normal urine output in. mas and 7 microadenomas Among the 35 3 7 days after the administration of pituitrin. endocrine active adenomas there were 26 pro headache symptoms in 3 patients were all. 5140 Int J Clin Exp Med 2015 8 4 5137 5143,Surgical treatment of pituitary adenoma. Table 2 Surgical results for the 52 patients,Surgical results N Percentage. Total 52 100 0,Gross total removal GTR 46 88 5,Partial tumor removal PTR 6 11 5. Headache relieved 9 90 0,Vision recovered 26 89 7,Endocrinological results. endocrine active adenomas remission 24 35 68 6,prolactinoma remission 18 26 69 2.
GH secreting adenomas remission 5 8 62 5,OGTT 5 5 100 0. PRL GH secreting adenomas,Complications, diabetes insipidus recovered with normal urine output in 3 7 days 6. headache symptoms relieved in 5 10 days 3,recovered 3 months 1. relieved in 5 10 days after treatment with turbinate and sphenoid ostium was kept intact. symptomatic support Due to tumor invasion of which makes the operation less invasive This. cavernous sinus 1 patient with oculomotor approach helps neurosurgeons to avoid lacer. nerve paralysis recovered 3 months after sur ating the nasal mucosa such as middle and. gery in which a large number of gelatin sponge inferior turbinate mucosa when endoscopy and. was used to oppress the intraoperative cavern other equipment are applied This is very help. ous sinus hemorrhage There were no postop ful for patients who have small noses It also. erative complications such as nasal bleeding reduces the clouding of the endoscope lens by. sense of smell diminishing cerebrospinal fluid blood so as to make the vision of operation. rhinorrhea intracranial infection or intracranial clearer as well as reducing the time of intraop. bleeding erative endoscopic lenses cleaning Meanwhile. the mucosa contains the posterior septal, Discussions branches of the sphenopalatine artery is ele. vated from the sphenoid rostrum and the arter, Endoscopic endonasal surgery supported by ies are thereby protected.
recent technological advancements has been, increasingly used over the last decade for the In this group the early 24 patients underwent. treatment of pituitary adenoma 9 In this arti operation through a uninostril endoscopic. cle we described the surgical technique and approach Due to the small room the instru. subseptum mucosa approach as applied to ments may hinder each other and passing the. pituitary tumors This approach is simpler and instruments along the endoscope may be cum. less invasive than the previously advocated bersome There is a recent shift towards the. medial transnasal approach while the novel binostril approach by an increasing number of. method leads to comparable results in terms of neurosurgeons In the latter 28 patients of the. safety and extent in tumor removal series we adapted the double nostril approach. in which a mucosal incision was made on the, In most of previous approaches 10 the muco contralateral nasal septum mucosa during the. sa overlying the anterior wall of the sphenoid operation thus the doctors could insert the. which locates between the sphenoid osteum instruments from both nostrils The binostril. and approximately 1 cm above the choanae is approach allows easier movement and inser. usually diathermied and stripped laterally It will tion of instruments 88 5 of the cases. not only cause damage to the normal anatomi archived total removal which is similar to the. cal structure but also cause injury to the sphe results of other reports There was no more. nopalatine artery 11 In our approach the complication when compared to the previous. mucosa around both nasal septums middle results,5141 Int J Clin Exp Med 2015 8 4 5137 5143. Surgical treatment of pituitary adenoma, The most common complication of EETA was osov AB and Popugaev KA Damage to the. postoperative CSF leak 16 7 necessitating cavernous segment of internal carotid artery in. reoperation and or lumbar drain placement transsphenoidal endoscopic removal of pitu. 12 13 In our group 1 patient had intraopera itary adenomas report of 4 cases Zh Vopr. tive cerebrospinal fluid leakage after tumor Neirokhir Im N N Burdenko 2013 77 28 37. resection due to large arachnoidal dural defect discussion 38. 2 Saeki N Horiguchi K Murai H Hasegawa Y,The right septum mucosa was shaped as a vas.
Hanazawa T and Okamoto Y Endoscopic endo,cularised naso septal mucosal flap for the. nasal pituitary and skull base surgery Neurol,reconstruction of skull base There was no. Med Chir Tokyo 2010 50 756 764, postoperative CSF leak Some authors advo 3 Ceylan S Koc K and Anik I Extended endo. cated an early pedicled mucoperiosteal muco scopic approaches for midline skull base le. perichondrial flap at the beginning of the sur sions Neurosurg Rev 2009 32 309 319 dis. gery for the possible CSF leak However if cussion 318 309. there was no intraoperative CSF leak the prep 4 Yano S Kawano T Kudo M Makino K Naka. aration of flap would cause unnecessary injury mura H Kai Y Morioka M and Kuratsu J Endo. to patients On the other hand it might be dis scopic endonasal transsphenoidal approach. heartening at the end of a long skull base pro through the bilateral nostrils for pituitary ade. cedure to discover that the flap has been inad nomas Neurol Med Chir Tokyo 2009 49 1 7. vertently devascularized by injury to the pedicle 5 Dehdashti AR Ganna A Karabatsou K and. During our operation the decision of a pedicle Gentili F Pure endoscopic endonasal approach. Original Article Endoscopic endonasal transsphenoidal surgery for treating pituitary adenoma via a sub septum mucosa approach surgery in the treatment of pituitary tumors and related lesions of the sellar area 3 Previous approaches 4 5 may damage the mucosa around the nasal septum and sphenoid ostium However using the sub septum mucosa app roach we can operate in the double

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