Rhinological Consequences of Microsurgical Endonasal-Transsphenoidal Surgery for Pituitary Tumors

2020 ◽  
Author(s):  
Nikolaos Hondronikos ◽  
Ali Alomari ◽  
Martin Schrader ◽  
Ulrich J. Knappe
Keyword(s):  
Transsphenoidal Surgery ◽  
Pituitary Tumors ◽  
Final Visit ◽  
Saddle Nose ◽  
Nasal Breathing ◽  
Nasal Airways ◽  
Sellar Lesions ◽  
Saddle Nose Deformity ◽  
Almost All ◽  
Smell Function

Abstract Background Transsphenoidal surgery for sellar lesions may affect patency and function of the nasal airways, smell and sinonasal quality of life. Below is our report on otorhinolaryngological data garnered from patients undergoing endonasal transsphenoidal pituitary microsurgery. Methods In a prospective study, 68 patients scheduled for transsphenoidal operations (32 female, 36 male, age 17–72 years) underwent otorhinolaryngological evaluation of their nasal morphology, a standardized smell test (sniffin’ sticks) and rhinomanometry to analyse nasal breathing function preoperatively, 3–5 days postoperatively (without rhinomanometry), after 3–4 months and after 9 months. Results Immediately after surgery, a reduction in smell sensation was detected in almost all patients. Within 3 months, this impairment resolved in all cases except one. In 2 patients (3%) with preoperative anosmia, improvement of smell function to>6 out of 12 sniffin’ sticks was observed. At final visit no patient was noted to have new anosmia. Within 3 months, the results of the rhinomanometry revealed that all patients except one, regained their preoperative nasal breathing function. In 6 patients (8.8%) an improvement in their nose breathing abilities compared to the preoperative state was found. Three patients (4.4%) underwent a LASER transection of mucosal synechiae. In one case with persistent nasal obstruction (1.5%), secondary septoplasty had to be performed. There was no case in which perforation of the nasal septum, nasal tip deflection, or saddle nose deformity was observed. Conclusion Microsurgical resection of pituitary tumors via the endonasal transsphenoidal approach poses an acceptable risk with regards to sinonasal complications. The incidence of secondary rhinosurgical interventions is low. Standardized comparative studies between endoscopic and microsurgical transsphenoidal operations should be undertaken.

Significant headache improvement after transsphenoidal surgery in patients with small sellar lesions

2009 ◽  
Vol 110 (2) ◽  
pp. 354-358 ◽  
Author(s):  
Maria Fleseriu ◽  
Christine Yedinak ◽  
Caitlin Campbell ◽  
Johnny B. Delashaw
Keyword(s):  
Retrospective Study ◽  
Postoperative Complications ◽  
Brain Tumors ◽  
Retrospective Review ◽  
Transsphenoidal Surgery ◽  
Imaging Techniques ◽  
Pituitary Tumors ◽  
Cushing Disease ◽  
Sellar Lesions ◽  
Oregon Health

Object Pituitary adenomas represent a large proportion of brain tumors that are increasing in incidence because of improved imaging techniques. Headache is the primary symptom in patients with large tumors (macroadenomas), but is also a symptom in patients with small tumors (microadenomas, tumors < 1.0 cm). The prevalence and optimal treatment of headaches associated with pituitary tumors is still unclear, particularly in cases of microadenoma. If conventional medical management fails, transsphenoidal surgery (TSS) may be considered as an alternative treatment for intractable headaches. Methods The authors conducted a retrospective review of 512 patients who underwent TSS at Oregon Health & Science University between 2001 and 2007; patients with Cushing disease were excluded. The authors identified 41 patients with small pituitary tumors who underwent TSS, and retrospectively evaluated the resolution and/or treatment of headache. Results Ninety percent of patients who presented with nonfunctioning microadenomas and Rathke cleft cysts experienced resolution or improvement in their headaches after TSS, and 56% of patients who presented with hyperfunctioning pituitary microadenomas had improvement in their headaches. There were no postoperative complications. Conclusions In this retrospective study, the authors demonstrate the efficacy of TSS in the treatment of intractable headaches in patients who present with pituitary microadenomas (nonsecreting and hypersecretory) and Rathke cleft cysts.

The evolution of Harvey Cushing's surgical approach to pituitary tumors from transsphenoidal to transfrontal

2005 ◽  
Vol 103 (2) ◽  
pp. 372-377 ◽  
Author(s):  
Aaron A. Cohen-Gadol ◽  
Edward R. Laws ◽  
Dennis D. Spencer ◽  
Antonio A. F. De Salles
Keyword(s):  
Transsphenoidal Surgery ◽  
Pituitary Tumors ◽  
Optic Chiasm ◽  
Content Type ◽  
Intracranial Surgery ◽  
Sellar Lesions ◽  
Transsphenoidal Adenomectomy ◽  
Adequate Decompression ◽  
Tumor Recurrence Rate

✓ The evolution of transsphenoidal surgery represents a special chapter in the progress of neurosurgery. Although Cushing initially advocated a transsphenoidal approach to pituitary tumors, he became disenchanted with this approach, ultimately favoring the subfrontal or “transfrontal” route late in his career. Other neurosurgeons followed Cushing's example, and the fate of transsphenoidal surgery entered a dark era in 1929. A review of Cushing's patients' records reveals that his abandonment of the transsphenoidal route was primarily related to the limitations of this approach in providing effective resection of large pituitary lesions—the symptomatic tumor recurrence rate after this procedure was substantial. Furthermore, given the preoperative uncertainty about the suprasellar extension of pituitary tumors prior to modern neuroimaging, the transfrontal route assured Cushing an adequate decompression of the optic chiasm. By 1927, Cushing's mastery of intracranial surgery was accompanied by the use of electrosurgical methods that enabled him to remove sellar lesions through the transfrontal route safely and with timely and effective restoration of visual loss. Transsphenoidal surgery remained relatively dormant, awaiting the efforts and enthusiasm of Norman Dott who bridged the gap between Cushing and Gerard Guiot, the surgeon who revitalized transsphenoidal adenomectomy for future generations of pituitary surgeons.

Risk Factors of Saddle Nose Deformity after Septoplasty

2015 ◽  
Vol 58 (12) ◽  
pp. 859
Author(s):  
Gwan Choi ◽  
Joo Yeon Kim ◽  
Yeong Joon Kim ◽  
Seong Uk Jang ◽  
Joo-Wan Jo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Saddle Nose ◽  
Saddle Nose Deformity ◽  
Nose Deformity

The alar swing technique in the correction of the saddle nose deformity

1987 ◽  
Vol 79 (6) ◽  
pp. 1012
Author(s):  
M. J. Earley ◽  
J. Lendrum ◽  
Colin R. Rayner
Keyword(s):  
Saddle Nose ◽  
Saddle Nose Deformity ◽  
Nose Deformity

Systemic Vasculitis Syndromes

2017 ◽  
Author(s):  
Alexandra Villa-Forte ◽  
Brian F Mandell
Keyword(s):  
Kawasaki Disease ◽  
Blood Vessels ◽  
Granulomatosis With Polyangiitis ◽  
Systemic Vasculitis ◽  
Plain Radiograph ◽  
Small Vessel ◽  
Small Vessel Vasculitis ◽  
Saddle Nose ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Saddle Nose Deformity

Vasculitis is defined by histologic evidence of inflammation that involves the blood vessels. The diagnosis of a specific primary vasculitic disorder depends on the pattern of organ involvement, the histopathology, the size of affected blood vessels, and the exclusion of diseases that can cause “secondary” vasculitis. This review presents an approach to the patient suspected of having vasculitis, and goes on to discuss small vessel vasculitis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis, polyarteritis nodosa, Kawasaki disease, large vessel arteritis, and Behçet disease. Figures show classification of the systemic vasculitis syndromes, the relationships among the causes of small vessel (“hypersensitivity”) vasculitis, palpable purpura of the distal extremities, saddle nose deformity, the nodular infiltrates of the lung in granulomatosis with polyangiitis shown on plain radiograph as well as computed tomography, necrotizing scleritis, livedo reticularis, and angiograms of a patient with Takayasu arteritis. Tables list selected laboratory tests for patients with multisystem disease and possible vasculitis, practical comments on immunosuppressive therapies for vasculitis, features of vasculitis, diagnostic criteria for Kawasaki disease, and giant cell arteritis. This review contains 8 highly rendered figures, 5 tables, and 59 references.

Use of intraoperative intracavitary (direct-contact) ultrasound for resection control in transsphenoidal surgery for pituitary tumors: evaluation of a microsurgical series

2018 ◽  
Vol 161 (1) ◽  
pp. 109-117 ◽  
Author(s):  
Ali Alomari ◽  
Christian Jaspers ◽  
Wolf-Dieter Reinbold ◽  
Joachim Feldkamp ◽  
Ulrich J. Knappe
Keyword(s):  
Transsphenoidal Surgery ◽  
Direct Contact ◽  
Pituitary Tumors ◽  
Resection Control

Saddle nose deformity and septal perforation in granulomatosis with polyangiitis

2017 ◽  
Vol 43 (1) ◽  
pp. 291-299
Author(s):  
A. Coordes ◽  
S.M. Loose ◽  
V.M. Hofmann ◽  
G.S. Hamilton ◽  
F. Riedel ◽  
...  
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Saddle Nose ◽  
Septal Perforation ◽  
Saddle Nose Deformity ◽  
Nose Deformity
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