scholarly journals P.055 Epidemiologic features of pituitary adenoma patients requiring surgical treatment: large North American patient population based study

2018 ◽  
Vol 45 (s2) ◽  
pp. S30-S30
Author(s):  
F Alkherayf ◽  
F Banaz ◽  
A Lasso ◽  
S Mohajeri ◽  
P Masoudian ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pituitary Adenoma ◽  
North American ◽  
Patient Population ◽  
Hormone Replacement ◽  
Tumor Resection ◽  
Pituitary Tumors ◽  
Tumor Type ◽  
Complete Excision ◽  
American Patient

Background: The surgical treatment of pituitary adenoma has evolved greatly over the decades. In order to better understand the patient population and their surgical treatment, we conducted an institutional review for pituitary adenoma surgery using the endoscopic endonasal trans-sphenoidal (EETS) approach. Methods: A retrospective review of all EETS cases for pituitary tumor resection was performed between November 2009 and June 2016. Patient characteristics, tumor type, endocrine data, operation characteristics were extracted from medical records. Preoperative MRI images were reviewed. The SIPAP classification was applied to the pituitary tumors. Postoperative patient data were extracted for the available follow-up period. Results: 232 cases were identified. Functional tumors were present in 29% of the cohort. Complete excision was most common for functioning tumors (49%) compared to nonfunctioning tumors (26%). There were no major vascular injuries. Hormone replacement with cortisol was required transiently in 70% of patients, with thyroid hormone replacement occurring in 40% of the cohort. Conclusions: From this large North American cohort nearly 30% of operated pituitary tumors were functioning. More commonly, these tumors were completely resected compared to the nonfunctioning group. The most commonly replaced hormone following EETS surgery was cortisol and this was largely transient.

scholarly journals Why Patients Undergo Endoscopic Endonasal Transsphenoidal Pituitary Adenoma Surgery: Characterization of a Large North American Patient Population

2018 ◽  
Vol 79 (S 01) ◽  
pp. S1-S188
Author(s):  
Fatmahalzahra Banaz ◽  
Fahad Alkherayf ◽  
Andrea Lasso ◽  
Sepideh Mohajeri ◽  
Pourya Masoudian ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
North American ◽  
Patient Population ◽  
Endoscopic Endonasal ◽  
American Patient

Evaluation of Complications and Costs During Overlapping Transsphenoidal Surgery in the Treatment of Pituitary Adenoma

Neurosurgery ◽  
2018 ◽  
Vol 84 (5) ◽  
pp. 1104-1111 ◽  
Author(s):  
Michael Karsy ◽  
Christian A Bowers ◽  
Jonathan Scoville ◽  
Bornali Kundu ◽  
Mohammed A Azab ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Improve Patient Safety ◽  
Surgical Complication ◽  
Tumor Resection ◽  
Healthcare Delivery ◽  
Complication Rates ◽  
Tumor Type ◽  
Presenting Symptoms ◽  
Transsphenoidal Resection

Abstract BACKGROUND Pituitary adenomas are among the most common primary brain tumors. Recently, overlapping surgery has been curbed in many institutions because of the suggestion there might be more significant adverse events, despite several studies showing that complication rates are equivalent. OBJECTIVE To assess complications and costs associated with overlapping surgery during the transsphenoidal resection of pituitary adenomas. METHODS A single-center, retrospective cohort study was performed to evaluate the cases of patients who underwent a transsphenoidal approach for pituitary tumor resection. Patient, surgical, complication, and cost (value-driven outcome) variables were analyzed. RESULTS A total of 629 patients (302 nonoverlapping, 327 overlapping cases) were identified. No significant differences in age (P = .6), sex (P = .5), tumor type (P = .5), or prior rates of pituitary adenoma resection (P = .5) were seen. Similar presenting symptoms were observed in the 2 groups, and follow-up length was comparable (P = .3). No differences in tumor sizes (P = .5), operative time (P = .4), fat/fascia use (P = .4), or cerebrospinal fluid diversion (P = .8) were seen between groups. The gross total resection rate was not significantly different (P = .9), and no difference in recurrence rate was seen (P = .4). A comparable complication rate was seen between groups (P = .6). No differences in total or subtotal costs were seen either. CONCLUSION The results of this study offer additional evidence that overlapping surgery does not result in worsened complications, lengthened surgery, or increased patient cost for patients undergoing transsphenoidal resection of pituitary adenomas. Thus, studies and policy aiming to improve patient safety and cost should focus on optimizing other aspects of healthcare delivery.

scholarly journals Perioperative Course of Transsphenoidal Pituitary Surgery through Endoscopic versus Microscopic Approach: Interim Concerns for Neurosurgical Anesthesiology

2018 ◽  
Vol 09 (03) ◽  
pp. 336-343 ◽  
Author(s):  
Varun Jain ◽  
Arvind Chaturvedi ◽  
Mihir Prakash Pandia ◽  
Parmod Kumar Bithal
Keyword(s):  
Pituitary Adenoma ◽  
Blood Loss ◽  
Tumor Resection ◽  
Standard Technique ◽  
Electrolyte Imbalance ◽  
Tumor Type ◽  
Microscopic Approach ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Less Invasive ◽  
Duration Of Surgery

ABSTRACT Background: Endonasal endoscopic approach for transsphenoidal excision of pituitary adenoma has undergone remarkable evolution in the last two decades. It is considered less invasive and less stressful, with results comparable to the previous “gold standard” technique of microscopic transsphenoidal excision of pituitary adenoma. The aim of this study was to compare the various perioperative anesthetic and surgical factors which differ in the two approaches (endoscopic vs. microscopic) for pituitary adenoma excision, during the period when surgeons increasingly started using endoscope at our center. Materials and Methods: Data of 307 patients from January 2011 to December 2013 were reviewed in this retrospective study. Various parameters were divided and compared on the basis of the type of approach for pituitary tumor resection vis-à-vis microscope-assisted sublabial transsphenoidal (MSLTS) resection or microscope-assisted transnasal transsphenoidal (MTNTS) resection or endoscope-assisted endonasal transsphenoidal (ETSS) resection. Results: Demographic variables (except age); tumor type, dimensions, and invasiveness; patients’ comorbidities; postoperative nausea/vomiting, electrolyte imbalance, respiratory, and cardiovascular problems were comparable among three groups. Duration of surgery and anesthesia were shortest for MTNTS group and longest for ETSS group (P < 0.001). Blood loss was higher in ETSS technique (median 300 mL) and least in MTNTS (median 100 mL), and the difference was significant across all three groups (P = 0.0003). Postoperative cerebrospinal fluid rhinorrhea was 17% in the MSLTS group compared to 6.5% in MTNTS and 7.9% in ETSS (P = 0.047). Conclusion: ETSS with the expected advantage of being less invasive offers a better chance for complete resection of adenoma. Neuroanesthesiologist must be prepared for longer surgical time and more blood loss as compared to previous microscopic approach, at least till the surgeons expertise in this newer technique.

scholarly journals Pituitary Macroadenoma: A Case of Balanced Deficiencies

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A600-A601
Author(s):  
Robert Leimbach ◽  
Mohamed K M Shakir ◽  
Thanh Duc Hoang
Keyword(s):  
Diabetes Insipidus ◽  
Vision Loss ◽  
Hormone Replacement ◽  
Tumor Resection ◽  
Free Water ◽  
Pituitary Tumors ◽  
Pituitary Macroadenoma ◽  
Acth Stimulation ◽  
Central Hypothyroidism ◽  
Water Excretion

Abstract Introduction: Diabetes insipidus (DI) rarely occurs in pituitary tumors although some patients may develop DI following pituitary tumor resection. However DI is known to occur in patients with tumors metastatic to the pituitary or in infiltrative disorders of the pituitary gland. We are reporting a patient with a 2 cm pituitary macroadenoma whose DI was unmasked by glucocorticoid therapy. Case Presentation: A 61-year-old male with a history of non-functioning pituitary macroadenoma, incidentally discovered on imaging in 2015 and stable at 1.6cm for 4 years, was referred to endocrinology for interval enlargement of his macroadenoma. He had presented to primary care due to new headache during extreme physical exertion, but otherwise denied any symptoms such as vision loss, fatigue, decreased libido, weight loss, or urinary frequency. Repeat MRI indicated growth to 2.1cm in the suprasellar component, no cavernous sinus involvement, and abutting the optic chiasm. Laboratory results revealed new onset central hypothyroidism (FT4 0.21 ng/dL (ref 0.78-2.19) with triiodothyronine 68 ng/dL (ref 80-200) and TSH 1.61 mIU/L (ref 0.47-4.68), central hypogonadism (Testosterone Free 1.3 pg/mL (ref 6.6-18.1)) and concern for adrenal insufficiency with a cortisol of 4.4 mcg/dL. He was empirically started on hydrocortisone replacement until an ACTH stimulation test could be completed, and after 3 days instructed to begin low dose levothyroxine replacement. At close followup, patient revealed that he developed new hourly nocturia causing significant distress. An overnight water deprivation test yielded a serum sodium 152 mmol/L with a urine osmolality 191 mOsm/kg, both rapidly improving with intravenous desmopressin. Copeptin was 4.6 pmol/L. Discussion Diabetes insipidus occurring in pituitary tumors including macroadenomas is extremely rare. Secretion of AVP occurs in the hypothalamic osmoreceptors, supraoptic or paraventricular nuclei, and the superior portion of the supraopticohypophyseal tract. AVP deficiency is most commonly due to damage to these areas either through neurosurgery or trauma, and more rarely tumors or infiltrative disease. However, glucocorticoid and thyroid replacement each may precipitate the development of diabetes insipidus. Well described in literature, glucocorticoid deficiency and hypothyroidism each independently impairs free water excretion. Low cortisol stimulates release of antidiuretic hormone, but this secretion is then inhibited by exogenous steroid replacement. Cortisol interferes with AVP signaling through unclear mechanisms either at the V2 receptor or post-receptor level, decreasing translocation of type 2 aquaporins and therefore reducing free water reabsorption. It is important to recognize that CDI can be unmasked after glucocorticoid or thyroid hormone replacement.

Periodontitis-Associated Marker Bacteria in an Urban North American Patient Population: Application of a Commercial Immunoassay

1998 ◽  
Vol 69 (12) ◽  
pp. 1382-1391 ◽  
Author(s):  
F.-Michael Eggert ◽  
M. Herbert McLeod ◽  
Gordon Flowerdew ◽  
Edward W. McIntyre ◽  
Jason Wasylyk ◽  
...  
Keyword(s):  
North American ◽  
Patient Population ◽  
American Patient

scholarly journals Pituitary Adenomas: Presentations and Outcomes in a South Asian Country

2008 ◽  
Vol 35 (2) ◽  
pp. 198-203 ◽  
Author(s):  
Muhammad Shahzad Shamim ◽  
Muhammad Ehsan Bari ◽  
Faraz Khursheed ◽  
Rashid Jooma ◽  
Syed Ather Enam
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Hormone Replacement ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Asian Country ◽  
Developed Countries ◽  
P Value ◽  
Tumor Diameter ◽  
Giant Pituitary Adenoma

Objective:: The purpose of this retrospective review of all operated cases of pituitary adenomas in the last decade, is to define the demographic patterns and characteristics of such tumors and to assess surgical outcomes with regards to safety and efficacy of trans–sphenoidal tumor removal in our institution.Methods:Surgically treated pituitary adenomas presenting from 1995 till 2005 were reviewed for different variables. Results were expressed as mean, standard deviation and median for continuous and number with percentage for categorical data. Chi square test was applied to measure differences and significance was taken at p value < 0.05.Results:One hundred and twenty–five patients were operated for pituitary adenoma. Sixty–three percent were male and mean age was 37 years. Sixty percent of the patients presented with headache and/or visual symptoms. Twelve percent presented with pituitary apoplexy and 28% presented with symptoms due to pituitary hyperfunction. Fifty–five percent of patients had functioning and 44% had nonfunctioning adenomas. Mean pre operative tumor diameter from 86 pre op MRI scans was 26.76 mm (3–78 mm). Eighty–four percent of patients underwent trans–sphenoidal tumor resection and three percent had craniotomy. Mean size of post op residual tumor as calculated from 76 available post operative scans was 5.3 mm (range 0–31 mm). 17.6% of the patients required hormone replacement beyond three months and 10% were re–operated. Overall mortality was 1.6%.Conclusion:In Pakistan, patients are more likely to present either with apoplexy or with a giant pituitary adenoma than patients reported from developed countries. Overall, our results have been satisfactory and comparable with the literature.

Fully Endoscopic Transsphenoidal Resection of Pituitary Tumors: Technique and Results

2007 ◽  
Vol 21 (4) ◽  
pp. 510-514 ◽  
Author(s):  
Brent Uren ◽  
Nick Vrodos ◽  
Peter-John Wormald
Keyword(s):  
Remission Rate ◽  
Hormone Replacement ◽  
Tumor Resection ◽  
Pituitary Tumors ◽  
Retrospective Chart Review ◽  
Pituitary Surgery ◽  
Presenting Symptoms ◽  
Cerebrospinal Fluid Leaks ◽  
Tumor Remission

Background The aim of this study was to describe our two-surgeon fully endoscopic approach to pituitary surgery and to report results in terms of tumor remission, improvement in vision, and complications. A retrospective chart review was performed. Methods Our prospectively recorded surgical database was searched for all endoscopic transsphenoidal procedures between January 2001 and December 2005. Those patients who had surgery had their medical charts reviewed and presenting symptoms and signs, lesion characteristics, endocrine investigations, operative details, complications, and treatment outcomes recorded. Results Thirty-two patients were included in the study. Twenty-three patients had macroadenomas, five patients had microadenomas, and four patients had other pathologies. Most patients with macroadenomas had significant supra- or parasellar extension. Of the 14 patients who had visual loss at presentation, 13 had postoperative improvement. Two patients had postoperative cerebrospinal fluid leaks, which were successfully treated endoscopically. Eight patients required some form of hormone replacement after surgery. After a mean follow-up of 31 months, the overall remission rate for patients with macroadenomas was 82% and for patients with microadenomas was 100%. Conclusion The fully endoscopic transsphenoidal approach provides excellent visualization for tumor resection and results in acceptable remission rates.

scholarly journals Durability of porcine valves at fifteen years in a representative North American patient population

1992 ◽  
Vol 103 (2) ◽  
pp. 238-252 ◽  
Author(s):  
Thomas A. Burdon ◽  
D. Craig Miller ◽  
Philip E. Oyer ◽  
R. Scott Mitchell ◽  
Edward B. Stinson ◽  
...  
Keyword(s):  
North American ◽  
Patient Population ◽  
American Patient

Hypophysial transposition (hypophysopexy) for radiosurgical treatment of pituitary tumors involving the cavernous sinus

2003 ◽  
Vol 14 (5) ◽  
pp. 1-5 ◽  
Author(s):  
James K. Liu ◽  
Meic H. Schmidt ◽  
Joel D. Macdonald ◽  
Randy L. Jensen ◽  
William T. Couldwell
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Radiation Exposure ◽  
Cavernous Sinus ◽  
Tumor Resection ◽  
Pituitary Tumors ◽  
Residual Tumor ◽  
Normal Pituitary Gland ◽  
Fascia Graft ◽  
Normal Functional

Stereotactic radiosurgery (SRS) is performed with increasing frequency in the treatment of residual or recurrent pituitary adenomas. Its major associated risk in these cases of residual or recurrent pituitary tumor adjacent to normal functional pituitary gland is radiation exposure to the pituitary, which frequently leads to the development of hypopituitarism. The authors describe a technique of pituitary transposition to reduce the radiation dose to the normal pituitary gland in cases of planned radiosurgical treatment of residual pituitary adenoma within the cavernous sinus. A sellar exploration for tumor resection is performed, the pituitary gland is transposed from the region of the cavernous sinus, and a fat and fascia graft is interposed between the normal pituitary gland and the residual tumor in the cavernous sinus. The residual tumor may then be treated with SRS. The increased distance between the normal pituitary gland and the residual tumor facilitates treatment of the tumor with radiosurgery and reduces radiation exposure to the normal pituitary gland.

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