Effect of Intraoperative Lumbar Drainage on Gross Total Resection and Cerebrospinal Fluid Leak Rates in Endoscopic Transsphenoidal Surgery of Pituitary Macroadenomas

The detailed surgical procedure of the transsphenoidal surgery for pituitary abscess has scarcely been described previously because it is a very rare clinical entity. The authors reported two cases of primary pituitary abscess. In case 1, the anterior wall of the sella turcica was reconstructed with the vomer bone after irrigating the abscess cavity, but the sella was not packed by fat for fear of the persistent infection by devascularized tissues. This led to the postoperative meningocele, the cerebrospinal fluid leak, and bacterial meningitis despite the successful abscess drainage. In case 2, tight sellar packing and reconstruction of the sellar wall were performed to avoid these postoperative complications, which resulted in complete drainage and uneventful postoperative course. Although accumulation of more cases is obviously needed to establish the definitive surgical technique in pituitary abscess surgery, our experience might suggest that packing of the sella is not impeditive for postoperative sufficient drainage.

Download Full-text

Corridor-Based Endonasal Endoscopic Surgery for Pediatric Skull Base Pathology With Detailed Radioanatomic Measurements

Operative Neurosurgery ◽

10.1227/neu.0000000000000252 ◽

2013 ◽

Vol 10 (2) ◽

pp. 273-293 ◽

Cited By ~ 15

Author(s):

Matei A. Banu ◽

Allison Rathman ◽

Kunal S. Patel ◽

Mark M. Souweidane ◽

Vijay K. Anand ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Pediatric Population ◽

Visual Fields ◽

Age Groups ◽

Cerebrospinal Fluid Leak ◽

Gross Total Resection ◽

Benign Tumors ◽

Minimal Risk ◽

Total Resection

Abstract BACKGROUND: Pediatric anatomy is more restricted, and the propagation of endonasal endoscopic approaches in the pediatric population has been limited. OBJECTIVE: To demonstrate the feasibility of the endonasal endoscopic approach in a variety of age groups and to perform measurements of the corridors and spaces available for surgery as a guide for case selection. METHODS: Only patients <18 years were included. The choice of operative corridor/approach is described in relation to pathological entity and location. Preoperative/postoperative visual fields and endocrine panels, extent of resection, as well as postoperative long-term complications are described. Prospective magnetic resonance image-based anatomic measurements of key distances were performed to determine age-dependent surgical indications and limitations. RESULTS: Forty purely endoscopic procedures were performed in 33 pediatric patients (5-18 years of age) harboring a variety of skull base lesions, from benign tumors to congenital malformations. For the 20 patients in whom gross total resection was the intended goal of surgery, gross total resection was attained in 15 (75%). There were 2 infections (5%) and no cerebrospinal fluid leaks. Significant improvement was shown in 58.3% of patients with visual deficits. Hormone overproduction resolved in 75% of patients, while preoperative hormone insufficiency only improved in 29.2%. Wider intercarotid distance at the superior clivus (P = .01) and shorter nare-dens working distance (P = .001) predicted improved outcomes and fewer postoperative complications. CONCLUSION: Endonasal endoscopic skull base approaches are viable in the pediatric population, they are not impeded by sphenoid sinus aeration, and they have minimal risk of cerebrospinal fluid leak and meningitis. Outcomes and complications can be predicted based on specific radio anatomical skull base measurements rather than age.

Download Full-text

Dural suturing for repair of cerebrospinal fluid leak in transnasal transsphenoidal surgery

Acta Neurochirurgica ◽

10.1007/s00701-009-0406-2 ◽

2009 ◽

Vol 151 (11) ◽

pp. 1427-1430 ◽

Cited By ~ 26

Author(s):

Hiroshi Nishioka ◽

Hitoshi Izawa ◽

Yukio Ikeda ◽

Hiroaki Namatame ◽

Shinjiro Fukami ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Transsphenoidal Surgery ◽

Cerebrospinal Fluid Leak ◽

Dural Suturing ◽

Fluid Leak

Download Full-text

The Awake Endoscope-Guided Sealant Technique with Fibrin Glue in the Treatment of Postoperative Cerebrospinal Fluid Leak After Extended Transsphenoidal Surgery: Technical Note

World Neurosurgery ◽

10.1016/j.wneu.2013.01.017 ◽

2014 ◽

Vol 82 (3-4) ◽

pp. e479-e485 ◽

Cited By ~ 12

Author(s):

Luigi M. Cavallo ◽

Domenico Solari ◽

Teresa Somma ◽

Dragan Savic ◽

Paolo Cappabianca

Keyword(s):

Cerebrospinal Fluid ◽

Fibrin Glue ◽

Transsphenoidal Surgery ◽

Cerebrospinal Fluid Leak ◽

Technical Note ◽

Fluid Leak

Download Full-text

Early outcomes of endoscopic transsphenoidal surgery for adult craniopharyngiomas

Neurosurgical FOCUS ◽

10.3171/2010.1.focus09319 ◽

2010 ◽

Vol 28 (4) ◽

pp. E9 ◽

Cited By ~ 66

Author(s):

John A. Jane ◽

Erin Kiehna ◽

Spencer C. Payne ◽

Stephen V. Early ◽

Edward R. Laws

Keyword(s):

Mr Imaging ◽

Transsphenoidal Surgery ◽

Tumor Resection ◽

Imaging Study ◽

High Rate ◽

Transsphenoidal Approach ◽

Gross Total Resection ◽

Csf Leak ◽

Total Resection ◽

Endoscopic Transsphenoidal Surgery

Object Although the transsphenoidal approach for subdiaphragmatic craniopharyngiomas has been performed for many years, there are few reports describing the role of the endoscopic transsphenoidal technique for suprasellar craniopharyngiomas. The purpose of this study was to report the outcomes of the endoscopic transsphenoidal approach for adults with craniopharyngiomas in whom the goal was gross-total resection. Methods Twelve patients were identified who were older than 18 years at the time of their pure endoscopic transsphenoidal surgery. Their medical records and imaging studies were retrospectively reviewed. Results Gross-total resection was achieved in 42% of cases when assessed by intraoperative impression alone and in 75% when assessed by the first postoperative MR imaging study. However, 83% of patients achieved at least a 95% resection when assessed by both intraoperative impression and the first postoperative MR imaging study. Permanent diabetes insipidus occurred postoperatively in 44% of patients. Six (67%) of 9 patients who had a functioning hypothalamic-pituitary axis preoperatively developed panhypopituitarism after surgery. Visual improvement or normalization occurred in 78% of patients with preoperative visual deficits. Although no patient experienced a postoperative CSF leak, 1 patient was treated for meningitis. Conclusions The authors have achieved a high rate of radical resection and symptomatic improvement with the endoscopic transsphenoidal technique for both subdiaphragmatic (sellar/suprasellar) and supradiaphragmatic (suprasellar) craniopharyngiomas. However, this is also associated with a high incidence of new endocrinopathy. Endoscopic assessment of tumor resection may be more sensitive for residual tumor than the first postoperative MR imaging study.

Download Full-text