Sellar Floor Bone Flap With a Pedicled Nasoseptal Flap in Endoscopic Transnasal Pituitary Adenoma Surgery

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Mengyang Xing ◽  
Wenming Lv ◽  
Jing Wang ◽  
Sheng Liu ◽  
Pengfei Liu ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Bone Flap ◽  
Nasoseptal Flap ◽  
Sellar Floor

Universal Sellar Anatomical Reconstruction Using the Sellar Floor Flap after Endoscopic Pituitary Adenoma Surgery

2018 ◽  
Vol 158 (4) ◽  
pp. 774-776 ◽  
Author(s):  
Zixiang Cong ◽  
Kaidong Liu ◽  
Guodao Wen ◽  
Liang Qiao ◽  
Handong Wang ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Csf Leak ◽  
Anatomical Reconstruction ◽  
Endoscopic Endonasal ◽  
Reconstructive Technique ◽  
Sellar Reconstruction ◽  
Sellar Floor ◽  
Csf Leaks

Postoperative cerebrospinal fluid (CSF) leaks still occur in patients without intraoperative CSF leaks after endoscopic endonasal pituitary adenoma surgery. We propose a reconstructive technique, the sellar floor flap (SFF), for universal sellar anatomical reconstruction. A total of 113 patients without intraoperative CSF leaks after endoscopic endonasal pituitary adenoma surgery from July 2013 to June 2016 were reviewed: 43 underwent sellar reconstruction with the SFF (the SFF group) and 70 underwent sellar packing only (the nonreconstruction group). No case of postoperative CSF leak was reported in the SFF group, whereas 7 cases were reported in the nonreconstruction group ( P < .05). The SFF is suitable for universal reconstruction after endoscopic endonasal pituitary adenoma surgery and may decrease postoperative CSF leak.

scholarly journals Anatomical Considerations of the Endonasal Transsphenoidal Approach

2018 ◽  
Vol 19 (2) ◽  
pp. 48-53
Author(s):  
Alvaro Campero ◽  
Abraham Campero ◽  
Carolina Martins ◽  
Alexandre Yasuda ◽  
Albert Rhoton
Keyword(s):  
Pituitary Adenoma ◽  
Third Ventricle ◽  
The Other ◽  
Transsphenoidal Approach ◽  
Lateral Expansion ◽  
Sphenoidal Sinus ◽  
The Third ◽  
Lateral Distance ◽  
Sellar Floor ◽  
Diaphragm Sellae

The sellar contents are separated from the sphenoidal sinus by a tiny sheath of bone that compris es the sellar floor, making the transsphenoidal approach the most used surgical route to intrasellar lesions. The transsphenoidal approach can be initiated in three different ways: 1) cutting the mucosa over the alveolar part of maxilla (sublabial transsphenoidal), 2) cutting along the anterior nasal mucosa adjacent to the columella (transeptal transsphenoidal), and 3) cutting the mucosa over the sphenoidal rostrum (endonasal transsphenoidal). Each cavernous sinus has four dural walls. The lateral, superior and posterior walls are composed of endosteal and periosteal dura leaflets. Unlike the other dural walls, the medial wall is formed of a single, thin dural sheath, an anatomical fact that help explains the lateral expansion of a pituitary adenoma. In the center, the diaphragm sellae has an opening through which the infundibulum courses, linking the pituitary gland to the floor of the third ventricle. The morphology of this opening is quite variable among individuals. On average, the anteroposterior distance of the diaphragm opening was 7.26 mm + 1.99 mm, varying from 3.4 mm up to 10.7 mm. The lateral distance of the diaphragm opening was 7.33 mm + 2.79 mm, varying from 2.8 mm up to 14.1 mm.

scholarly journals CS-11 PITUITARY EPENDYMOMA: A CASE REPORT

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii40-ii40
Author(s):  
Tadateru Fukami ◽  
Yayoi Yoshimura ◽  
Ryoko Fujikawa ◽  
Kazuhiko Nozaki
Keyword(s):  
Pituitary Adenoma ◽  
Transsphenoidal Surgery ◽  
Residual Tumor ◽  
Final Diagnosis ◽  
Polyglycolic Acid ◽  
Ophthalmological Examination ◽  
Endoscopic Transsphenoidal Surgery ◽  
Normal Pituitary Gland ◽  
Field Of Vision ◽  
Sellar Floor

Abstract INTRODUCTION Neoplasms of the sellar region generally includes pituitary adenoma, craniopharyngioma, meningioma. We report a case of pituitary ependymoma. CASE A 39 years-old man. He experienced the sense of discomfort of the inside upper part field of vision of the left eye for a few months since May, 201X. Ophthalmological examination showed right homonymous hemianopia of right upper 1/4. He was introduced to the department of neurosurgery of nearby hospital. MRI showed intrasellar tumor and the lesion was partially removed because of solidness by endoscopic transsphenoidal surgery on July, 201X. Postoperative pathological diagnosis was pituitary adenoma. The residual tumor was followed up, but the compression to the left optic nerve was not resolved. So he was introduced to our hospital in January, 201X+1 and endoscopic transsphenoidal surgery was performed on May, 201X+1. OPERATION Supposing the change to extended transsphenoidal surgery, we prepared rescue flap. Enlarging the window of sellar floor and removing the tuberculum sellae, the tumor was totally removed. The boundary between the tumor and the normal pituitary gland was obscure. We inserted fat piece to the intrasellar space, and reconstructed the sellar floor with the absorbable plate following fixation with a polyglycolic acid sheet, fibrin glue, and sinus balloon. PATHOLOGY Fusiform cells having an oval or a short spindle shape nucleus multiplied in strand and palisading pattern through capillary vessels were the main findings, and ependymal rosettes were confirmed. Immunohistchemical study showed chromograninA(focally+), synaptophysin (-), EMA (+, dot and ring pattern), CAM5.2(+), bcl-2(+), TTF-1(-), S100(focally+), GFAP(-). Final diagnosis was pituitary ependymoma. Mild diabetes insipidus was occurred postoperatively but it was controlled medically. Now he is followed up in outpatient department. DISCUSSION Pituitary ependymoma was reported only eight cases in the past literatures. Though it is extremely rare, pituitary ependymoma should be included as a differential diagnosis of the sellar tumors.

scholarly journals Endoscopic combined “transseptal/transnasal” approach for pituitary adenoma: reconstruction of skull base using pedicled nasoseptal flap in 91 consecutive cases

2015 ◽  
Vol 73 (7) ◽  
pp. 611-615 ◽  
Author(s):  
Yasunori Fujimoto ◽  
Leonardo Balsalobre ◽  
Fábio P. Santos ◽  
Eduardo Vellutini ◽  
Aldo C. Stamm
Keyword(s):  
Pituitary Adenoma ◽  
Skull Base ◽  
Bed Rest ◽  
Pituitary Surgery ◽  
Nasoseptal Flap ◽  
Transnasal Approach ◽  
Skull Base Reconstruction ◽  
Reliable Technique ◽  
Csf Fistula ◽  
Nasal Bleeding

Objective The purpose of this study was to describe the endoscopic combined “transseptal/transnasal” approach with a pedicled nasoseptal flap for pituitary adenoma and skull base reconstruction, especially with respect to cerebrospinal fluid (CSF) fistula.Method Ninety-one consecutive patients with pituitary adenomas were retrospectively reviewed. All patients underwent the endoscopic combined “transseptal/transnasal” approach by the single team including the otorhinolaryngologists and neurosurgeons. Postoperative complications related to the flap were analyzed.Results Intra- and postoperative CSF fistulae were observed in 36 (40%) and 4 (4.4%) patients, respectively. Among the 4 patients, lumbar drainage and bed rest healed the CSF fistula in 3 patients and reoperation for revision was necessary in one patient. Other flap-related complications included nasal bleeding in 3 patients (3.3%).Conclusion The endoscopic combined “transseptal/transnasal” approach is most suitable for a two-surgeon technique and a pedicled nasoseptal flap is a reliable technique for preventing postoperative CSF fistula in pituitary surgery.

Large Pituitary Adenomas with Extension into the Nasopharynx

1989 ◽  
Vol 98 (8) ◽  
pp. 618-624 ◽  
Author(s):  
Andel G. L. van der Mey ◽  
Johan H. J. M. van Krieken ◽  
Hans van Dulken ◽  
Arnoud P. van Seters ◽  
Jan Vielvoye ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Pituitary Adenoma ◽  
Magnetic Resonance ◽  
Pituitary Tumor ◽  
Immunohistochemical Analysis ◽  
Pituitary Hormones ◽  
Rare Tumor ◽  
Definite Diagnosis ◽  
Resonance Imaging ◽  
Sellar Floor

Three cases of pituitary adenoma with extension into the nasopharynx and nasal cavity are reported. The occurrence of this rare tumor underscores the need to consider a pituitary tumor whenever a patient presents with rhinologic complaints and destruction of the sellar floor. Epistaxis, although exceptional, may be the first manifestation of a pituitary tumor. Immunohistochemical analysis combined with staining for the pituitary hormones proved to be essential for reaching a definite diagnosis. Magnetic resonance imaging seems to be the modality of choice for differentiation between tumorous and nontumorous sinus obstruction.

scholarly journals Long-Term Quality of Life after Endoscopic Pituitary Adenoma Surgery with Nasoseptal Flap Reconstruction

2021 ◽  
Vol 12 (2) ◽  
pp. e0013
Author(s):  
Shadi Shinnawi ◽  
◽  
Ilya Kopaev ◽  
Shorook Na'ara ◽  
Ayelet Eran ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pituitary Adenoma ◽  
Flap Reconstruction ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Entire Cohort ◽  
Surgery Outcome ◽  
Snot 22

Introduction: Endoscopic endonasal transsphenoidal surgery (EETS) on the pituitary gland is considered safe and efficacious. The nasoseptal flap (NSF) is sometimes used to prevent or repair postoperative cerebrospinal fluid (CSF) leaks. Few investigators have quantified long-term quality-of-life (QOL) outcomes regarding sinonasal measures after EETS, with or without involvement of the NSF. This study assesses whether the septal flap affects sinonasal QOL outcomes for patients receiving EETS for pituitary adenoma. Methods and Materials: This is a retrospective study of patients who underwent EETS between 2013 and 2018. A total of 62 adults completed the Sinonasal Outcome Test-22 (SNOT-22) at least one year after the surgery. Outcome measures were compared between patients who underwent EETS with and without septal flap reconstruction. Results: For the entire cohort, there were 14 patients (22.6%) who had septal flap reconstruction and 48 patients (77.4%) who did not. Patient demographics, tumor characteristics, surgical outcomes, and duration between surgery and completion of the questionnaire were similar for both groups. The mean SNOT-22 scores in the no reconstruction (NR) group and the nasoseptal flap reconstruction (NSFR) group were similar (P=0.9). In terms of SNOT-22 subdomains (rhinologic symptoms, extranasal rhinologic symptoms, ear/facial symptoms, psychological dysfunction, and sleep dysfunction), no significant differences were found when comparing the groups. Conclusion: As compared with no reconstructive involvement, NSF utilization does not affect the QOL and nasal symptoms of patients undergoing EETS.

Association of pituitary adenoma with neuronal christoma: A TEM study

1994 ◽  
Vol 52 ◽  
pp. 232-233
Author(s):  
Eva Horvath ◽  
Kalman Kovacs ◽  
B. W. Scheithauer ◽  
R. V. Lloyd ◽  
H. S. Smyth
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Pituitary Tumor ◽  
Nervous Tissue ◽  
Alternative Explanation ◽  
Growth Hormone Releasing Hormone ◽  
Cell Hyperplasia ◽  
Releasing Hormone ◽  
Secretory Neurons

The association of a pituitary adenoma with nervous tissue consisting of neuron-like cells and neuropil is a rare abnormality. In the majority of cases, the pituitary tumor is a chromophobic adenoma, accompanied by acromegaly. Histology reveals widely variable proportions of endocrine and nervous tissue in alternating or intermingled patterns. The lesion is perceived as a composite one consisting of two histogenetically distinct parts. It has been suggested that the neuronal component, morphologically similar to secretory neurons of the hypothalamus, may initiate adenoma formation by releasing stimulatory substances. Immunoreactivity for growth hormone releasing hormone (GRH) in the neuronal component of some cases supported this view, whereas other findings such as consistent lack of growth hormone (GH) cell hyperplasia in the lesions called for alternative explanation.Fifteen tumors consisting of a pituitary adenoma and a neuronal component have been collected over a 20 yr. period. Acromegaly was present in 11 patients, was equivocal in one, and absent in 3.

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