Endonasal Resection of Pituitary Adenomas: Comparison of Microscopic Speculum-Based Approach Versus Dual-Surgeon Endoscopic Approach

Skull Base ◽  
2009 ◽  
Vol 19 (03) ◽  
Author(s):  
Marvin Bergsneider ◽  
Marilene Wang ◽  
Neil Martin ◽  
Anthony Heaney
Keyword(s):  
Pituitary Adenomas ◽  
Endoscopic Approach

Transnasal Endoscopic Approach to the Sella Turcica

1998 ◽  
Vol 12 (4) ◽  
pp. 283-288 ◽  
Author(s):  
Michelle R. Aust ◽  
Thomas V. McCaffrey ◽  
John Atkinson
Keyword(s):  
Pituitary Gland ◽  
Pituitary Adenomas ◽  
Sphenoid Sinus ◽  
Sella Turcica ◽  
Cerebrospinal Fluid Leak ◽  
Pituitary Surgery ◽  
Endoscopic Approach ◽  
Transseptal Approach ◽  
Transnasal Endoscopic Approach ◽  
Posterior Septum

The transseptal/transsphenoidal approach to the pituitary gland has been the most commonly used approach for resection of pituitary adenomas for the last 50 years. This procedure has a low morbidity and provides direct midline access to the sella and pituitary gland. Recent advancements in endoscopic surgery, however, suggest that a lower morbidity approach to the sella would be possible via transnasal endoscopic route. Prior reports have confirmed effectiveness of this approach to the pituitary gland and we report here an early series of endoscopic transnasal pituitary surgery from our institution. We report seven cases of transnasal endoscopic pituitary surgery. Our technique consists of endoscopic exposure of the sphenoid ostium unilaterally, excision of the posterior septum anterior to the rostrum of the sphenoid sinus with resection of the sphenoid rostrum for bilateral exposure of the sphenoid sinus. A specially designed nasal speculum is positioned to displace the posterior septum and lateralize the middle turbinates, permitting direct midline exposure of the sphenoid sinus and sella. We have progressively modified the technique over the seven cases that we present and will discuss our specific instrumentation, indications, and technique for this procedure. We have encountered one cerebrospinal fluid leak in this series. Patient satisfaction has been high and hospitalization is less than with the conventional transseptal approach, averaging 1 day. Our impression is that the transnasal endoscopic approach to pituitary adenomas is a safe technique with reduced morbidity permitting shortened hospital stay.

scholarly journals DEV-18. ENDONASAL ENDOSCOPIC APPROACH TO PITUITARY ADENOMAS: SINGLE CENTER EARLY EXPERIENCE

2018 ◽  
Vol 20 (suppl_2) ◽  
pp. i48-i48
Author(s):  
Mohamed M Arnaout ◽  
Mohamed G Ammar ◽  
Mansour A Mekia ◽  
Magdy O Elshiekh ◽  
Ismail Elnashar
Keyword(s):  
Pituitary Adenomas ◽  
Early Experience ◽  
Endoscopic Approach ◽  
Single Center

Giant Pituitary Adenomas: Surgical Outcomes of 50 Cases Operated on by the Endonasal Endoscopic Approach

2014 ◽  
Vol 82 (1-2) ◽  
pp. e281-e290 ◽  
Author(s):  
Jackson A. Gondim ◽  
João Paulo C. Almeida ◽  
Lucas Alverne F. Albuquerque ◽  
Erika F. Gomes ◽  
Michele Schops
Keyword(s):  
Surgical Outcomes ◽  
Pituitary Adenomas ◽  
Endoscopic Approach ◽  
Giant Pituitary Adenomas

scholarly journals Tips and Tricks to Manage Vascular Risks Using the Transnasal Endoscopic Approach to Pituitary Adenomas

2015 ◽  
Vol 61 (4) ◽  
pp. 349-355
Author(s):  
Chinezu Rareş ◽  
Berhouma Moncef ◽  
Jacquesson Timothée ◽  
Raverot Gerard ◽  
Jouanneau Emmanuel
Keyword(s):  
Vascular Injury ◽  
Pituitary Adenomas ◽  
Vascular Complications ◽  
Minimal Invasive ◽  
Senior Author ◽  
Endoscopic Approach ◽  
Preoperative Imaging ◽  
Invasive Technique ◽  
Transnasal Endoscopic Approach ◽  
Skull Base Anatomy

AbstractObjective: The purely transnasal endoscopic approach has taken in the last decade a paramount importance in the treatment of pituitary adenomas, but some authors have been linked it to an increase in vascular complications. The aim of this paper is to provide a stepwise description of the vascular risks and steps required to avoid them.Method: We present the minimal invasive technique used by the senior author in over 900 transnasal purely endoscopic approaches focusing on the relevant vascular landmarks, preoperative and operative steps taken in order to avoid vascular injury and the management of vascular injury from a multitude of sources.Conclusion: Endoscopy has brought a wider field of view, with numerous vascular structures well inside the operating field. This represents control but also higher risk. Solid knowledge of the skull base anatomy and proper preoperative imaging coupled with an experienced surgeon can greatly reduce the vascular risks associated with surgery.

scholarly journals Surgical outcomes using a medial-to-lateral endonasal endoscopic approach to pituitary adenomas invading the cavernous sinus

2014 ◽  
Vol 120 (5) ◽  
pp. 1086-1094 ◽  
Author(s):  
Graeme F. Woodworth ◽  
Kunal S. Patel ◽  
Benjamin Shin ◽  
Jan-Karl Burkhardt ◽  
Apostolos John Tsiouris ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Extent Of Resection ◽  
Endoscopic Approach ◽  
Gross Total Resection ◽  
Csf Leak ◽  
Cranial Neuropathy ◽  
Total Resection ◽  
Aggressive Approach ◽  
Cranial Neuropathies

Object This study details the extent of resection and complications associated with endonasal endoscopic surgery for pituitary tumors invading the cavernous sinus (CS) using a moderately aggressive approach to maximize extent of resection through the medial CS wall while minimizing the risk of cranial neuropathy and blood loss. Tumor in the medial CS was aggressively pursued while tumor in the lateral CS was debulked in preparation for radiosurgery. Methods A prospective surgical database of consecutive endonasal pituitary surgeries with verified CS invasion on intraoperative visual inspection was reviewed. The extent of resection as a whole and within the CS was assessed by an independent neuroradiologist using pre- and postoperative Knosp-Steiner (KS) categorization and volumetrics of the respective MR images. The extent of resection and clinical outcomes were compared for medial (KS 1–2) and lateral (KS 3–4) lesions. Results Thirty-six consecutive patients with pituitary adenomas involving the CS who had surgery via an endonasal endoscopic approach were identified. The extent of resection was 84.6% for KS 1–2 and 66.6% for KS 3–4 (p = 0.04). The rate of gross-total resection was 53.8% for KS 1–2 and 8.7% for KS 3–4 (p = 0.0006). Six patients (16.7%) had preoperative cranial neuropathies, and all 6 had subjective improvement after surgery. Surgical complications included 2 transient postoperative cranial neuropathies (5.6%), 1 postoperative CSF leak (2.8%), 1 reoperation for mucocele (2.8%), and 1 infection (2.8%). Conclusions The endoscopic endonasal “medial-to-lateral” approach permits safe debulking of tumors in the medial and lateral CS. Although rates of gross-total resection are moderate, particularly in the lateral CS, the risk of permanent cranial neuropathy is extremely low and there is a high chance of improvement of preexisting deficits. This approach can also facilitate targeting for postoperative radiosurgery.

scholarly journals Endonasal endoscopic approach in pituitary adenomas: surgical results

2013 ◽  
Vol 1 (1) ◽  
pp. 5 ◽  
Author(s):  
Omar López Arbolay ◽  
Jorge L Rojas Manresa ◽  
Yusleni Hernández Gálvez
Keyword(s):  
Pituitary Adenomas ◽  
Endoscopic Approach ◽  
Surgical Results

Ultrastructural Investigation of Spontaneous Pituitary Adenomas in Aging Sprague-Dawley Rats

1982 ◽  
Vol 40 ◽  
pp. 216-217
Author(s):  
D. J. McComb ◽  
J. Beri ◽  
F. Zak ◽  
K. Kovacs
Keyword(s):  
Microscopic Study ◽  
Pituitary Adenomas ◽  
Wistar Rats ◽  
Microscopic Level ◽  
Sprague Dawley ◽  
Prolactin Cells ◽  
Light Microscopic Level ◽  
Ultrastructural Investigation ◽  
Sprague Dawley Rats ◽  
Long Evans

Investigation of the spontaneous pituitary adenomas in rat have been limited mainly to light microscopic study. Furth et al. (1973) described them as chromophobic, secreting prolactin. Kovacs et al. (1977) in an ul trastructural investigation of adenomas of old female Long-Evans rats, found that they were composed of prolactin cells. Berkvens et al. (1980) using immunocytochemistry at the light microscopic level, demonstrated that some spontaneous tumors of old Wistar rats could contain GH, TSH or ACTH as well as PRL.

Ultrastructural comparison of prolactin adenomas of pituitary in men and women

1988 ◽  
Vol 46 ◽  
pp. 346-347
Author(s):  
R.C. Caughey ◽  
U.P. Kalyan-Raman
Keyword(s):  
Endoplasmic Reticulum ◽  
Electron Microscope ◽  
Phosphate Buffer ◽  
Pituitary Adenomas ◽  
Osmium Tetroxide ◽  
Secretory Granules ◽  
Uranyl Acetate ◽  
En Bloc ◽  
Men And Women ◽  
Transmission Electron

Prolactin producing pituitary adenomas are ultrastructurally characterized by secretory granules varying in size (150-300nm), abundance of endoplasmic reticulum, and misplaced exocytosis. They are also subclassified as sparsely or densely granulated according to the amount of granules present. The hormone levels in men and women vary, being higher in men; so also the symptoms vary between both sexes. In order to understand this variation, we studied 21 prolactin producing pituitary adenomas by transmission electron microscope. This was out of a total of 80 pituitary adenomas. There were 6 men and 15 women in this group of 21 prolactinomas.All of the pituitary adenomas were fixed in 2.5% glutaraldehyde, rinsed in Millonig's phosphate buffer, and post fixed with 1% osmium tetroxide. They were then en bloc stained with 0.5% uranyl acetate, rinsed with Walpole's non-phosphate buffer, dehydrated with graded series of ethanols and embedded with Epon 812 epoxy resin.

Fine Structural Classification of Chromophobe Adenomas of the Human Pituitary Gland

1975 ◽  
Vol 33 ◽  
pp. 378-379
Author(s):  
K. Kovacs ◽  
E. Horvath
Keyword(s):  
Pituitary Adenomas ◽  
Secretory Activity ◽  
Microscopic Investigation ◽  
Uranyl Acetate ◽  
Electron Microscopic Investigation ◽  
Electron Microscopic ◽  
Human Pituitary ◽  
Cytoplasmic Staining ◽  
Human Pituitary Gland ◽  
Microscopic Features

Chromophobe pituitary adenomas arise from adenohypophysial cells and fail to exhibit cytoplasmic staining with conventional acid or basic dyes by light microscopy. The aim of the present work was to study the electron microscopic features of these tumors, to separate them into distinct entities and to correlate their fine structural appearances with secretory activity.Among 48 surgically removed various pituitary adenomas 30 tumors were found which, based on the tinctorial characteristics of the cytoplasm, corresponded to chromophobe adenomas. For electron microscopic investigation pieces of these tumors were fixed in 2.5 per cent glutaraldehyde in Sorensen's buffer, post fixed in 1 per cent osmium tetroxide in Millonig's buffer, dehydrated in graded ethanol and embedded in Epon 812. Ultrathin sections were stained with uranyl acetate and lead citrate.By electron microscopy it was possible to separate chromophobe adenomas into 3 distinct entities: 1) adenomas consisting of sparsely granulated growth hormone cells (7 cases).

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