scholarly journals Late Occurrence of Sphenoid Pyocele after Pituitary Surgery

2016 ◽  
Vol 06 (01) ◽  
pp. 044-046
Author(s):  
George Kovoor ◽  
Kamble Harsha ◽  
Akash George ◽  
Venkat Reddy
Keyword(s):  
Minimally Invasive ◽  
Female Patient ◽  
Rare Case ◽  
Sella Turcica ◽  
Pituitary Tumors ◽  
Pituitary Surgery ◽  
Effective Procedure ◽  
Morbidity And Mortality ◽  
Transsphenoidal Approach ◽  
Patient Morbidity

The transsphenoidal approach to lesions of the sella turcica, especially for pituitary tumors, has been favored by neurosurgeons because of decreased perioperative patient morbidity and mortality of this approach compared with others. It is widely accepted because of its minimally invasive and maximally effective procedure. We report a rare case of a 63-year-old female patient with the asymptomatic delayed occurrence of sphenoid pyocele, 6 years after the initial pituitary surgery, and remained asymptomatic during this long interval.

The Nasal Gateway for Pituitary Surgery

1988 ◽  
Vol 2 (4) ◽  
pp. 193-200 ◽  
Author(s):  
Mary D. Lekas
Keyword(s):  
Pituitary Gland ◽  
Sella Turcica ◽  
Pituitary Tumors ◽  
Pituitary Surgery ◽  
Transsphenoidal Approach ◽  
External Rhinoplasty

There has been an evolution in the transseptal transsphenoidal approach for pituitary surgery. The nasal approach to the pituitary gland can be from the sublabial transseptal transsphenoidal; the transseptal transsphenoidal; the alotomy transseptal transsphenoidal; the external rhinoplasty transsphenoidal; the transnasal by mobilizing the whole nose on a pedicle; the transseptal infranasal; the midline columellar incision; all types of nasofacial incisions; and transethmoidal approach with nasal instrumentation. The transsphenoidal hypophysectomy surgery has become a safe and effective approach for pituitary tumors. We are mainly concerned with the transnasal and not the transethmoidal approach to the sella turcica at this time.

scholarly journals Trans-nasal Trans-sphenoidal Endoscopic Hypophysectomy

2017 ◽  
Vol 53 (04) ◽  
pp. 210-221
Author(s):  
Saurabh Varshney
Keyword(s):  
Sella Turcica ◽  
Pituitary Tumors ◽  
Pituitary Surgery ◽  
Transsphenoidal Approach ◽  
Sinus Surgery ◽  
Subtotal Resection ◽  
Transnasal Approach ◽  
Average Hospital ◽  
Invasive Approach ◽  
Female Ratio

ABSTRACTAdvances in optics, miniaturization, and endoscopic instrumentation have revolutionized surgery in the past decades. Current progress in the field of endoscopy promises to further this evolution: endoscopic telescopes and instruments have improved upon the optical and technical limitations of the microscope, and require an even less invasive approach to the sella. The minimally invasive endoscopic pituitary surgery is performed through the natural nasal pathway without any incisions and is performed via Trans-nasal Trans-sphenoidal approach. pituitary surgery is traditionally within the realm of the neurosurgeon. However, since the introduction of the endoscopic transnasal transsphenoidal approach to the sella turcica for resection of pituitary adenoma, otolaryngologists have been active partners in the surgical management of these patients. Otolaryngologists have lent their expertise in nasal and sinus surgery, assisting the neurosurgeon with the operation. The otolaryngologist has the advantage of familiarity with the techniques and instruments used to gain exposure of the sella turcica by transnasal approach. Hence, the otolaryngologist provides the exposure, and the neurosurgeon resects the tumour. Such collaboration has resulted in decreased rates of complication and morbidity.We hereby discuss our experience of treating 72 cases of pituitary tumour by endoscopic trans-nasal trans-sphenoidal approach. In our study, conducted from 2005 to 2016, the mean age of patients was 32.5 years (18-56 years), Male and female ratio was 1.3:1.0, MRI was done in all the cases, CT scan was done in 94.44 % cases, 9.72% cases had Intra op./ post op. complications which were managed successfully. Subtotal resection could be done in 6.94% cases, recurrence was seen in 7.46% cases and lumbar drain was required in 4.17 % cases. Average hospital stay was 4.4 days and average surgery time was 120 minutes. Close follow-up was maintained for an average period of 09 months. In our experience of 10 years, adopting the endoscope heightens the surgeons' visualization of pituitary tumors, thus no external incision, no nasal packing and minimal stay with minimal complications. Endoscopic transsphenoidal approach is the less traumatic route to the sella turcica, avoiding brain retraction, and also permitting good visualization, with lower rates of morbidity and mortality.

Endoscopic Transnasal Pituitary Surgery: Report on 180 Cases

2001 ◽  
Vol 15 (4) ◽  
pp. 281-287 ◽  
Author(s):  
Shawn S. Nasseri ◽  
Jan L. Kasperbauer ◽  
Scott E. Strome ◽  
Thomas V. McCaffrey ◽  
John L. Atkinson ◽  
...  
Keyword(s):  
Operative Time ◽  
Operative Procedure ◽  
Full Range ◽  
Sella Turcica ◽  
Length Of Hospital Stay ◽  
Pituitary Surgery ◽  
Transsphenoidal Approach ◽  
Transnasal Approach ◽  
Endoscopic Transnasal Approach ◽  
Revision Operations

The endoscopic transnasal approach is an evolving technique for treating lesions in the sella turcica. Since this method was introduced at our institution 4 years ago, the majority of transsphenoidal procedures are performed with it. The records of all patients having endoscopic transnasal hypophysectomy at the Mayo Clinic during the last 4 years were reviewed retrospectively. The criteria analyzed were safety, functional and cosmetic outcome, and complications. During the 4-year period, the operative procedure was modified to improve operative exposure and safety. The results of our review showed a significant decrease in length of hospital stay, reduced operative time, reduced need for nasal packing, and elimination of a sublabial incision. The complication rate was equivalent to that reported for the traditional transseptal transsphenoidal approach. As the neurosurgeons at our institution gained experience with this approach, an increasing number of pituitary microadenomas were resected safely and successfully. In addition, because of the limited septal dissection, this approach is particularly helpful for revision operations. This approach also can be used for the full range of pituitary lesions and in conjunction with adjunctive techniques, including frontal craniotomy and -knife irradiation. Currently, the endoscopic transsphenoidal approach is the method preferred for surgically treating pituitary lesions in adults at our institution.

A novel transnasal transsphenoidal speculum: a design for both microscopic and endoscopic transsphenoidal pituitary surgery

2011 ◽  
Vol 114 (5) ◽  
pp. 1380-1385 ◽  
Author(s):  
Richard A. Chole ◽  
Chris Lim ◽  
Brian Dunham ◽  
Michael R. Chicoine ◽  
Ralph G. Dacey
Keyword(s):  
Transsphenoidal Surgery ◽  
Sella Turcica ◽  
Pituitary Surgery ◽  
Transsphenoidal Approach ◽  
Surgical Approaches ◽  
Surgical Experience ◽  
Endoscopic Techniques ◽  
Minimally Invasive Surgical ◽  
Transsphenoidal Pituitary Surgery ◽  
Microscopic Techniques

Over the last several years minimally invasive surgical approaches to the sella turcica and parasellar regions have undergone significant change. The transsphenoidal approach to this region has evolved from a sublabial transnasal, to transnasal, to pure endonasal approaches with the increasing popularity of endoscopic over microscopic techniques. Endoscopic and microscopic techniques individually or in combination have their own unique advantages, and the preference of one over the other awaits further technological refinements and surgical experience. In parallel with this evolution in techniques for transsphenoidal surgery, the authors designed an adaptable versatile speculum for the endonasal/transnasal transsphenoidal approach to the sella turcica and parasellar regions that can be used equally effectively with a microscope or an endoscope. The development of this instrument and its unique features are described, and its initial clinical use is summarized. This transnasal transsphenoidal speculum has interchangeable blades, unique blade angulations, and independent blade opening mechanisms and allows safe, optimal exposure in all patients regardless of the size and anatomical aberrations of individual nasal and endonasal regions. An attached endoscope carrier further allows it to be used interchangeably with microscopic or endoscopic techniques without having to remove the speculum; likewise, a single surgeon can use both hands without need of an assistant. A forehead headrest component adds further stabilization. This device has been used successfully in 90 transsphenoidal procedures.

Hermann Schloffer and the origin of transsphenoidal pituitary surgery

2012 ◽  
Vol 33 (2) ◽  
pp. E5 ◽  
Author(s):  
Richard F. Schmidt ◽  
Osamah J. Choudhry ◽  
Ramya Takkellapati ◽  
Jean Anderson Eloy ◽  
William T. Couldwell ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Skull Base Surgery ◽  
Sella Turcica ◽  
Pituitary Surgery ◽  
Transsphenoidal Approach ◽  
Harvey Cushing ◽  
Transsphenoidal Pituitary Surgery ◽  
Transsphenoidal Operation ◽  
Technological Limitations ◽  
The University

A little over a century ago, in 1907, at the University of Innsbruck, Hermann Schloffer performed the first transsphenoidal surgery on a living patient harboring a pituitary adenoma. Schloffer used a superior nasal route via a transfacial lateral rhinotomy incision. This was perhaps his greatest academic contribution to neurosurgery. Despite the technological limitations of that time, Schloffer's operation was groundbreaking in that it laid the foundation for future development and refinement of transsphenoidal pituitary surgery, influencing prominent surgeons such as Oskar Hirsch and Harvey Cushing. Even after undergoing multiple modifications and a brief fall into obscurity, the transsphenoidal approach has endured through generations of surgeons and remains the preferred approach for lesions of the sella turcica to this day. Although Schloffer performed primarily abdominal surgery in his practice, his contributions to the transsphenoidal approach have had a lasting impact in the field of pituitary and skull base surgery. The authors review the life and career of Hermann Schloffer, the surgical details of his transsphenoidal operation, and the legacy that it has left on the field of pituitary surgery.

The history and evolution of transsphenoidal surgery

2001 ◽  
Vol 95 (6) ◽  
pp. 1083-1096 ◽  
Author(s):  
James K. Liu ◽  
Kaushik Das ◽  
Martin H. Weiss ◽  
Edward R. Laws ◽  
William T. Couldwell
Keyword(s):  
Mortality Rate ◽  
Sella Turcica ◽  
Pituitary Tumors ◽  
Transsphenoidal Approach ◽  
Surgical Morbidity ◽  
Content Type ◽  
Antibiotic Drugs ◽  
Initial Stage ◽  
Transcranial Approach ◽  
Fine Print

✓ Initial attempts at transcranial approaches to the pituitary gland in the late 1800s and early 1900s resulted in a mortality rate that was generally considered prohibitive. Schloffer suggested the use of a transsphenoidal route as a safer, alternative approach to the sella turcica. He reported the first successful removal of a pituitary tumor via the transsphenoidal approach in 1906. His procedure underwent a number of modifications by interested surgeons, the culmination of which was A. E. Halstead's description in 1910 of a sublabial gingival incision for the initial stage of exposure. From 1910 to 1925, Cushing, combining a number of suggestions made by previous authors, refined the transsphenoidal approach and used it to operate on 231 pituitary tumors, with a mortality rate of 5.6%. As he developed increasing expertise with transcranial surgery, however, Cushing reduced his mortality rate to 4.5%. With the transcranial approach, he was able to verify suprasellar tumors and achieve better decompression of the optic apparatus, resulting in better recovery of vision and a lower recurrence rate. As a result he and most other neurosurgeons at the time abandoned the transnasal in favor of the transcranial approaches. Norman Dott, a visiting scholar who studied with Cushing in 1923, returned to Edinburgh, Scotland, and continued to use the transsphenoidal procedure while others pursued transcranial approaches. Dott introduced the procedure to Gerard Guiot, who published excellent results with the transsphenoidal approach and revived the interest of many physicians throughout Europe in the early 1960s. Jules Hardy, who used intraoperative fluoroscopy while learning the transsphenoidal approach from Guiot, then introduced the operating microscope to further refine the procedure; he thereby significantly improved its efficacy and decreased surgical morbidity. With the development of antibiotic drugs and modern microinstrumentation, the transsphenoidal approach became the preferred route for the removal of lesions that were confined to the sella turcica. The evolution of the transsphenoidal approaches and their current applications and modifications are discussed.

scholarly journals Multiple Splenic Artery Aneurysms: A Case Report and Review of the Literature

2022 ◽  
Vol 8 ◽  
Author(s):  
Wen Chun Chen ◽  
Tie hao Wang ◽  
Ding Yuan ◽  
Ji Chun Zhao
Keyword(s):  
Case Report ◽  
Minimally Invasive ◽  
Female Patient ◽  
Rare Case ◽  
Splenic Artery ◽  
Endovascular Embolization ◽  
Clinical Findings ◽  
Review Of The Literature ◽  
Invasive Treatment

Background: Multiple splenic artery aneurysms (MSAAs) are rare and there are few reports about their treatment. We herein present a rare case of MSAAs treated with splenectomy combined with endovascular embolization.Methods: A 51-year-old female patient was incidentally diagnosed with MSAAs. Splenectomy combined with endovascular embolization was the chosen treatment.Outcomes: The patient recovered uneventfully and was discharged from the hospital 5 days after splenectomy. The patient has been doing well during the 27-months of follow-up.Conclusion: Combined with the experience of the previous literature, we think splenectomy combined with endovascular embolization is a safe, reliable and minimally invasive treatment for some selected multiple SAAs, depending on several patient parameters, such as the age, sex, aneurysm dimension, aneurysm location, complications, and severity of the clinical findings.

scholarly journals Erythema Gyratum Repens in Long-Term Smoker

2019 ◽  
Vol 11 (3) ◽  
pp. 268-272
Author(s):  
Andrew P. Sauvageau ◽  
Jacob Mojeski ◽  
Thomas W. Fiorica ◽  
Craig C. Miller
Keyword(s):  
Female Patient ◽  
Skin Condition ◽  
Morbidity And Mortality ◽  
Cancer Growth ◽  
Internal Malignancy ◽  
Adenocarcinoma Of The Lung

Erythema gyratum repens (EGR) is a rare paraneoplastic skin condition characterized by the eruption of expanding, concentric, erythematous patches and plaques. The condition may precede a symptomatic appearance of internal malignancy, and therefore provides a unique opportunity to prevent additional morbidity and mortality secondary to undetectable cancer growth. We report the case of a 71-year-old female patient clinically diagnosed with EGR and subsequently diagnosed with otherwise asymptomatic adenocarcinoma of the lung.

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