Tension Pneumoventricle After Endoscopic Transsphenoidal Surgery for Rathke Cleft Cyst

2020 ◽  
Vol 135 ◽  
pp. 228-232 ◽  
Author(s):  
Yu-Hsiang Lin ◽  
Hung-Lin Lin ◽  
Der-Yang Cho
Keyword(s):  
Transsphenoidal Surgery ◽  
Endoscopic Transsphenoidal Surgery ◽  
Rathke Cleft Cyst

Diabetes Insipidus After Endoscopic Transsphenoidal Surgery

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. 949-955 ◽  
Author(s):  
William T Burke ◽  
David J Cote ◽  
David L Penn ◽  
Sherry Iuliano ◽  
Katie McMillen ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Transsphenoidal Surgery ◽  
Regression Models ◽  
Pituitary Tumors ◽  
Inclusion Criteria ◽  
Endoscopic Transsphenoidal Surgery ◽  
Logistic Regression Models ◽  
Rathke Cleft Cyst ◽  
Underlying Pathology

Abstract BACKGROUND Diabetes insipidus (DI) is a recognized transient or permanent complication following transsphenoidal surgery (TSS) for pituitary tumors. OBJECTIVE To describe significant experience with the incidence of DI after TSS, identifying predictive characteristics and describing our diagnosis and management of postoperative DI. METHODS A retrospective analysis was performed of 700 patients who underwent endoscopic TSS for resection of pituitary adenoma (PA), Rathke cleft cyst (RCC), or craniopharyngioma. Inclusion criteria included at least 1 wk of follow-up for diagnosis of postoperative DI. Permanent DI was defined as DI symptoms and/or need for desmopressin more than 1 yr postoperatively. All patients with at least 1 yr of follow-up (n = 345) were included in analyses of permanent DI. Multivariable logistic regression models were constructed to identify predictors of transient or permanent postoperative DI. RESULTS The overall rate of any postoperative DI was 14.7% (103/700). Permanent DI developed in 4.6% (16/345). The median follow-up was 10.7 mo (range: 0.2-136.6). Compared to patients with PA, patients with RCC (odds ratio [OR] = 2.2, 95% CI: 1.2-3.9; P = .009) and craniopharyngioma (OR = 7.0, 95% CI: 2.9-16.9; P ≤ .001) were more likely to develop postoperative DI. Furthermore, patients with RCC (OR = 6.1, 95% CI: 1.8-20.6; P = .004) or craniopharyngioma (OR = 18.8, 95% CI: 4.9-72.6; P ≤ .001) were more likely to develop permanent DI compared to those with PA. CONCLUSION Although transient DI is a relatively common complication of endoscopic and microscopic TSS, permanent DI is much less frequent. The underlying pathology is an important predictor of both occurrence and permanency of postoperative DI.

Middle Turbinate Preservation in Endoscopic Transsphenoidal Surgery of the Anterior Skull Base

Skull Base ◽  
2008 ◽  
Vol 18 (S 01) ◽  
Author(s):  
Seth Brown ◽  
Abtin Tabaee ◽  
Vijay Anand ◽  
Ameet Singh ◽  
Theodore Schwartz
Keyword(s):  
Skull Base ◽  
Transsphenoidal Surgery ◽  
Middle Turbinate ◽  
Anterior Skull Base ◽  
Endoscopic Transsphenoidal Surgery

Endoscopic transsphenoidal surgery for Cushing's disease; a single surgeon experience

2019 ◽  
Author(s):  
Aoife Garrahy ◽  
Zarina Brady ◽  
Mark Sherlock ◽  
Christopher J Thompson ◽  
Amar Agha ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Transsphenoidal Surgery ◽  
Cushing's Disease ◽  
Endoscopic Transsphenoidal Surgery ◽  
Surgeon Experience

scholarly journals Outcomes of endoscopic transsphenoidal surgery for Cushing's disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zarina Brady ◽  
Aoife Garrahy ◽  
Claire Carthy ◽  
Michael W. O’Reilly ◽  
Christopher J. Thompson ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Cushing’S Disease ◽  
Transsphenoidal Surgery ◽  
Remission Rate ◽  
Cushing's Disease ◽  
Endoscopic Transsphenoidal Surgery ◽  
Endocrine Society ◽  
Csf Leakage ◽  
Remission Rates

Abstract Background Transsphenoidal surgery (TSS) to resect an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma is the first-line treatment for Cushing’s disease (CD), with increasing usage of endoscopic transsphenoidal (ETSS) technique. The aim of this study was to assess remission rates and postoperative complications following ETSS for CD. Methods A retrospective analysis of a prospective single-surgeon database of consecutive patients with CD who underwent ETSS between January 2012–February 2020. Post-operative remission was defined, according to Endocrine Society Guidelines, as a morning serum cortisol < 138 nmol/L within 7 days of surgery, with improvement in clinical features of hypercortisolism. A strict cut-off of < 50 nmol/L at day 3 post-op was also applied, to allow early identification of remission. Results A single surgeon (MJ) performed 43 ETSS in 39 patients. Pre-operative MRI localised an adenoma in 22 (56%) patients; 18 microadenoma and 4 macroadenoma (2 with cavernous sinus invasion). IPSS was carried out in 33 (85%) patients. The remission rates for initial surgery were 87% using standard criteria, 58% using the strict criteria (day 3 cortisol < 50 nmol/L). Three patients had an early repeat ETSS for persistent disease (day 3 cortisol 306-555 nmol/L). When the outcome of repeat early ETSS was included, the remission rate was 92% (36/39) overall. Remission rate was 94% (33/35) when patients with macroadenomas were excluded. There were no cases of CSF leakage, meningitis, vascular injury or visual deterioration. Transient and permanent diabetes insipidus occurred in 33 and 23% following first ETSS, respectively. There was one case of recurrence of CD during the follow-up period of 24 (4–79) months. Conclusion Endoscopic transsphenoidal surgery produces satisfactory remission rates for the primary treatment of CD, with higher remission rates for microadenomas. A longer follow-up period is required to assess recurrence rates. Patients should be counselled regarding risk of postoperative diabetes insipidus.

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