Comparative Resource Utilization in Patients Undergoing Endoscopic and Microscopic Transsphenoidal Surgery for Pituitary Tumors

Background The endoscopic transsphenoidal approach is an efficient minimally invasive procedure for removal of pituitary tumors that can be accomplished through a one-hand or two-hand approach. The one-hand procedure through one nostril is more intuitive for surgeons, but maneuvering the instruments can be restrictive. The two-hand procedure using a one-and-half nostril approach provides more precise manipulation. This study aimed to compare the surgical outcomes of one-hand/mono-nostril and two-hand/one-and-half nostril surgeries for resection of large pituitary tumors by a single neurosurgeon. Materials and methods The surgical data of 78 consecutive cases with pituitary macroadenoma (diameter >1 cm) were reviewed retrospectively. Altogether, 30 cases received one-hand/mono-nostril surgery, while 48 cases received two-hand/one-and-half nostril surgery. Postoperative outcomes of the two operations were compared. Results The operative time, hospital stay, residual rate of pituitary macroadenoma, visual field, surgical complications, and re-operative rates were slightly improved in the two-hand/one-and-half nostril surgery group compared with that in the one-hand/mono-nostril surgery group (all p>0.05). However, postoperative hypopituitarism was less frequent (1/48; 2.0%) with the two-hand/one-and-half nostril approach than with the mono-nostril approach (p = 0.004). Similar surgical outcomes were found in all patients with either small or large pituitary tumors, except that the difference in postoperative improvement in visual field change reached statistical significance (p = 0.044). Conclusion A single-surgeon endoscopic endonasal transsphenoidal surgery with two-hand/one-and-half nostril approach is an effective and safe procedure for removal of large pituitary tumors.

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Rhinological Consequences of Microsurgical Endonasal-Transsphenoidal Surgery for Pituitary Tumors

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-1155-6269 ◽

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.

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Bevacizumab in Aggressive Pituitary Adenomas – Experience with 3 Patients

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-1260-3975 ◽

2020 ◽

Author(s):

Katharina Osterhage ◽

Roman Rotermund ◽

Michael Droste ◽

Judith Dierlamm ◽

Wolfgang Saeger ◽

...

Keyword(s):

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Pituitary Tumors ◽

Considerable Effect ◽

General Statement ◽

Patient Deterioration ◽

Short Period ◽

Acth Secreting ◽

Design And Methods ◽

Current Stage

Abstract Objective To investigate bevacizumab as alternative treatment of aggressive pituitary adenomas after exhaustion of standard therapies. Design and Methods Retrospectively, 3 patients undergoing microscopic transsphenoidal surgery of aggressive pituitary adenomas from 2008 till 2018 that were treated with bevacizumab were identified. Development of disease and treatment were evaluated. Results Two patients suffered from ACTH-secreting adenomas, one from a non-functioning adenoma. All patients underwent multiple surgical, chemo- and radiotherapeutical approaches including temozolomide, showing favorable results in one patient. Deterioration of clinical condition in all patients led to an individual, palliative attempt of bevacizumab. Patients 1 and 2 showed a decrease of ACTH after first administrations, but therapy had to be ended shortly after due to a further deterioration of their condition. Patient 3 showed a stabilization of the disease for 18 months. Patients died 8, 15 and 7 years after initial diagnosis, respectively, and 2, 4, and 24 months after initiation of bevacizumab therapy, respectively. Conclusion The demonstrated results suggest a considerable effect of bevacizumab in aggressive pituitary adenomas. The advanced stage of disease in all three patients, the overall short period of administration and just one patient showing a clinical benefit do not allow a general statement on the effectiveness. At the current stage of clinical experience, an approach with bevacizumab can be considered as an individual palliative attempt of treatment, when standard treatments are exhausted. Our results underline the need for further studies to evaluate this drug as potential player in therapy resistant aggressive pituitary tumors.

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Corrigendum to 'Predictive Factors for Delayed Hyponatremia After Endoscopic Transsphenoidal Surgery in Patients with Non-Functioning Pituitary Tumors: A Retrospective Observational Study' [World Neurosurgery 122 (2019) e1457-e1464]

World Neurosurgery ◽

10.1016/j.wneu.2019.09.146 ◽

2020 ◽

Vol 133 ◽

pp. 484 ◽

Cited By ~ 1

Author(s):

Hyun-Kyu Yoon ◽

Hyung-Chul Lee ◽

Yong Hwy Kim ◽

Young-Jin Lim ◽

Hee-Pyoung Park

Keyword(s):

Observational Study ◽

Predictive Factors ◽

Transsphenoidal Surgery ◽

Pituitary Tumors ◽

Retrospective Observational Study ◽

Endoscopic Transsphenoidal Surgery

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Propofol Requirement in Patients with Growth Hormone-Secreting Pituitary Tumors Undergoing Transsphenoidal Surgery

Journal of Clinical Medicine ◽

10.3390/jcm8050571 ◽

2019 ◽

Vol 8 (5) ◽

pp. 571

Author(s):

Seung Hyun Kim ◽

Namo Kim ◽

Eui Hyun Kim ◽

Sungmin Suh ◽

Seung Ho Choi

Keyword(s):

Growth Hormone ◽

General Anesthesia ◽

Transsphenoidal Surgery ◽

Pituitary Tumors ◽

Aminobutyric Acid ◽

Loss Of Consciousness ◽

Gamma Aminobutyric Acid ◽

Gh Secretion ◽

Effect Site ◽

Effect Site Concentration

Growth hormone (GH) secretion is regulated by various hormones or neurotransmitters, including gamma-aminobutyric acid. The aim of this study was to determine the propofol requirement in patients with GH-secreting pituitary tumors undergoing transsphenoidal surgery. General anesthesia was induced in 60 patients with GH-secreting tumors (GH group, n = 30) or nonfunctioning pituitary tumors (NF group, n = 30) using an effect-site target-controlled intravenous propofol infusion. The effect-site concentrations were recorded at both a loss of consciousness and a bispectral index (BIS) of 40, along with the effect-site concentration after extubation, during emergence from the anesthesia. The effect-site concentration of propofol was higher in the GH group than in the NF group at a loss of consciousness and a BIS of 40 (4.09 ± 0.81 vs. 3.58 ± 0.67, p = 0.009 and 6.23 ± 1.29 vs. 5.50 ± 1.13, p = 0.025, respectively) and immediately after extubation (1.60 ± 0.27 vs. 1.40 ± 0.41, p = 0.046). The total doses of propofol and remifentanil during anesthesia were comparable between the groups (127.56 ± 29.25 vs. 108.64 ± 43.16 µg/kg/min, p = 0.052 and 6.67 ± 2.89 vs. 7.05 ± 1.96 µg/kg/h, p = 0.550, respectively). The propofol requirement for the induction of a loss of consciousness and the achievement of a BIS of 40 is increased during the induction of general anesthesia in patients with GH-secreting tumors.

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