Results and risk factors for recurrence following endoscopic endonasal transsphenoidal surgery for pituitary adenoma

2014 ◽  
Vol 119 ◽  
pp. 75-79 ◽  
Author(s):  
Imithri Bodhinayake ◽  
Malte Ottenhausen ◽  
Michael A. Mooney ◽  
Kartik Kesavabhotla ◽  
Paul Christos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pituitary Adenoma ◽  
Transsphenoidal Surgery ◽  
Endoscopic Endonasal ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Risk Factors For Recurrence

scholarly journals Risk factors for postoperative intracranial infections in patients with pituitary adenoma after endoscopic endonasal transsphenoidal surgery: pneumocephalus deserves further study

2019 ◽  
Vol 47 (2) ◽  
pp. E5 ◽  
Author(s):  
Kang Guo ◽  
Lijun Heng ◽  
Haihong Zhang ◽  
Lei Ma ◽  
Hui Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Bubble Diameter ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Cns Infections ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Intracranial Infections

OBJECTIVEThe authors sought to identify the relevance between pneumocephalus and postoperative intracranial infections, as well as bacteriological characteristics and risk factors for intracranial infections, in patients with pituitary adenomas after endoscopic endonasal transsphenoidal surgery.METHODSIn total, data from 251 consecutive patients with pituitary adenomas who underwent pure endoscopic endonasal transsphenoidal surgeries from 2014 to 2018 were reviewed for preoperative comorbidities, intraoperative techniques, and postoperative care.RESULTSThis retrospective study found 18 cases of postoperative pneumocephalus (7.17%), 9 CNS infections (3.59%), and 12 CSF leaks (4.78%). Of the patients with pneumocephalus, 5 (27.8%) had CNS infections. In patients with CNS infections, the culture results were positive in 7 cases and negative in 2 cases. The statistical analysis suggested that pneumocephalus (maximum bubble diameter of ≥ 1 cm), diaphragmatic defects (intraoperative CSF leak, Kelly grade ≥ 1), and a postoperative CSF leak are risk factors for postoperative CNS infections.CONCLUSIONSIn pituitary adenoma patients who underwent pure endoscopic endonasal transsphenoidal surgeries, intraoperative saddle reconstruction has a crucial role for patients with postoperative intracranial infections. Additionally, postoperative pneumocephalus plays an important role in predicting intracranial infections that must not be neglected. Therefore, neurosurgeons should pay close attention to the discovery of postoperative intracranial pneumocephalus because this factor is as important as a postoperative CSF leak. Pneumocephalus (maximum bubble diameter of ≥ 1 cm), diaphragmatic defects (an intraoperative CSF leak, Kelly grade ≥ 1), and a postoperative CSF leak were risk factors predictive of postoperative intracranial infections. In addition, it is essential that operative procedures be carefully performed to avoid diaphragmatic defects, to reduce exposure to the external environment, and to decrease patients’ suffering.

Opiate Use After Endoscopic Endonasal Transsphenoidal Surgery

2021 ◽  
pp. 194589242110619
Author(s):  
Tara J. Wu ◽  
Reza Kianian ◽  
Emmanuel G. Villalpando ◽  
Morcos N. Nakhla ◽  
Christine Wells ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Transsphenoidal Surgery ◽  
Endoscopic Endonasal ◽  
Opiate Use ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Cerebrospinal Fluid Leaks ◽  
Grade 3

Background The literature on opiate use after endoscopic endonasal transsphenoidal surgery (EETS) is limited. Objective To determine the risk factors for higher opiate use following EETS and the quantity of opiates used after discharge. Methods A retrospective review of 144 patients undergoing EETS from July 2018 to July 2020 was conducted. Patient, tumor, and surgical factors were documented. Pain scores and medications used on postoperative days (POD) 0 and 1, and discharge prescriptions, were recorded. Opiate use was quantified using morphine milligram equivalents (MME) dose. Multiple linear regression determined risk factors independently associated with POD0 to 1 opiate use. Results On POD 0 to 1, mean pain score was 4.9/10 (standard deviation [SD] ± 2.0). Mean acetaminophen use was 3.4 tablets (SD ± 1.6; 650 mg per tablet). Mean opiate use was 35.6 MME (SD ± 36.3), equivalent to 4.7 tablets (SD ± 4.8) of oxycodone 5 mg. Multiple linear regression showed that current smokers required an additional 37.1 MME ( P = .011), and patients with grade 3 intraoperative cerebrospinal fluid leaks required an additional 36.7 MME ( P = .046) on POD0 to 1. On discharge, mean opiate prescription was 117.7 MME (SD ± 102.1), equivalent to 15.7 tablets (SD ± 13.6) of oxycodone 5 mg. Thirty-nine patients (27.1%) did not require prescriptions. Only 10 patients (6.9%) required opiate refill(s) within 30 days after surgery. Conclusion Patients undergoing EETS have higher opiate needs compared to those undergoing endoscopic sinus surgery, although the overall requirements are still considered low. Independent risk factors associated with higher opiate use in the immediate postoperative period included current smokers and grade 3 intraoperative cerebrospinal fluid leaks.

Endoscopic endonasal transsphenoidal surgery for invasive pituitary adenoma

2008 ◽  
Vol 15 (3) ◽  
pp. 241-245 ◽  
Author(s):  
Xiang Zhang ◽  
Zhou Fei ◽  
Wei Zhang ◽  
Jian-ning Zhang ◽  
Wei-ping Liu ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Transsphenoidal Surgery ◽  
Endoscopic Endonasal ◽  
Endoscopic Endonasal Transsphenoidal Surgery

scholarly journals Endoscopic endonasal transsphenoidal surgery using the iArmS operation support robot: initial experience in 43 patients

2017 ◽  
Vol 42 (5) ◽  
pp. E10 ◽  
Author(s):  
Toshihiro Ogiwara ◽  
Tetsuya Goto ◽  
Alhusain Nagm ◽  
Kazuhiro Hongo
Keyword(s):  
Pituitary Adenoma ◽  
Transsphenoidal Surgery ◽  
Arm Movement ◽  
Clinical Results ◽  
Initial Experience ◽  
Robotic Device ◽  
Endoscopic Endonasal ◽  
Arm Support ◽  
Study Population ◽  
Endoscopic Endonasal Transsphenoidal Surgery

ObjectiveThe intelligent arm-support system, iArmS, which follows the surgeon’s arm and automatically fixes it at an adequate position, was developed as an operation support robot. iArmS was designed to support the surgeon’s forearm to prevent hand trembling and to alleviate fatigue during surgery with a microscope. In this study, the authors report on application of this robotic device to endoscopic endonasal transsphenoidal surgery (ETSS) and evaluate their initial experiences.MethodsThe study population consisted of 43 patients: 29 with pituitary adenoma, 3 with meningioma, 3 with Rathke’s cleft cyst, 2 with craniopharyngioma, 2 with chordoma, and 4 with other conditions. All patients underwent surgery via the endonasal transsphenoidal approach using a rigid endoscope. During the nasal and sphenoid phases, iArmS was used to support the surgeon’s nondominant arm, which held the endoscope. The details of the iArmS and clinical results were collected.Results iArmS followed the surgeon’s arm movement automatically. It reduced the surgeon’s fatigue and stabilized the surgeon’s hand during ETSS. Shaking of the video image decreased due to the steadying of the surgeon’s scope-holding hand with iArmS. There were no complications related to use of the device.ConclusionsThe intelligent armrest, iArmS, seems to be safe and effective during ETSS. iArmS is helpful for improving the precision and safety not only for microscopic neurosurgery, but also for ETSS. Ongoing advances in robotics ensure the continued evolution of neurosurgery.

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