Complications of Interstitial Radioactive Iodine Implants for Recurrent Pituitary Adenomas

1992 ◽  
Vol 71 (7) ◽  
pp. 306-310 ◽  
Author(s):  
Gary F. Moore ◽  
John Massey ◽  
Anthony J. Yonkers ◽  
Lyal G. Leibrock
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Radioactive Iodine ◽  
Intensive Therapy ◽  
Csf Rhinorrhea ◽  
The Third

Three cases of recurrent pituitary adenoma elected to be treated with I125 implants are presented. The I125 implants caused significant delayed changes in the tissues surrounding the sella tursica which lead to the development of refractory cerebrospinal fluid (CSF) rhinorrhea. All three cases developed meningitis and two had pneumocephalus. This complication lead to the death of two patients and required intensive therapy in the third to achieve recovery.

scholarly journals Identification and repair of intraoperative cerebrospinal fluid leaks in endonasal transsphenoidal pituitary surgery: surgical experience in a series of 1002 patients

2018 ◽  
Vol 129 (2) ◽  
pp. 425-429 ◽  
Author(s):  
Ben A. Strickland ◽  
Joshua Lucas ◽  
Brianna Harris ◽  
Edwin Kulubya ◽  
Joshua Bakhsheshian ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenomas ◽  
Transsphenoidal Approach ◽  
Csf Leak ◽  
Sellar Region ◽  
Inclusion Criteria ◽  
Csf Rhinorrhea ◽  
Sellar Lesions ◽  
Sellar Reconstruction ◽  
Csf Leaks

OBJECTIVECerebrospinal fluid (CSF) rhinorrhea is among the most common complications following transsphenoidal surgery for sellar region lesions. The aim of this study was to review the authors’ institutional experience in identifying, repairing, and treating CSF leaks associated with direct endonasal transsphenoidal operations.METHODSThe authors performed a retrospective review of cases involving surgical treatment of pituitary adenomas and other sellar lesions at the University of Southern California between December 1995 and March 2016. Inclusion criteria included all pathology of the sellar region approached via a direct microscopic or endoscopic endonasal transsphenoidal approach. Demographics, pathology, intraoperative and postoperative CSF leak rates, and other complications were recorded and analyzed. A literature review of the incidence of CSF leaks associated with the direct endonasal transsphenoidal approach to pituitary lesions was conducted.RESULTSA total of 1002 patients met the inclusion criteria and their cases were subsequently analyzed. Preoperative diagnoses included pituitary adenomas in 855 cases (85.4%), Rathke’s cleft cyst in 94 (9.4%), and other sellar lesions in 53 (5.2%). Lesions with a diameter ≥ 1 cm made up 49% of the series. Intraoperative repair of an identified CSF leak was performed in 375 cases (37.4%) using autologous fat, fascia, or both. An additional 92 patients (9.2%) underwent empirical sellar reconstruction without evidence of an intraoperative CSF leak. Postoperative CSF leaks developed in 26 patients (2.6%), including 13 (1.3% of the overall group) in whom no intraoperative leak was identified. Among the 26 patients who developed a postoperative CSF leak, 13 were noted to have intraoperative leak and underwent sellar repair while the remaining 13 did not have an intraoperative leak or sellar repair. No patients who underwent empirical sellar repair without an intraoperative leak developed a postoperative leak. Eight patients underwent additional surgery (0.8% reoperation rate) for CSF leak repair, and 18 were successfully treated with lumbar drainage or lumbar puncture alone. The incidence of postoperative CSF rhinorrhea in this series was compared with that in 11 other reported series that met inclusion criteria, with incidence rates ranging between 0.6% and 12.1%.CONCLUSIONSIn this large series, half of the patients who developed postoperative CSF rhinorrhea had no evidence of intraoperative CSF leakage. Unidentified intraoperative CSF leaks and/or delayed development of CSF fistulas are equally important sources of postoperative CSF rhinorrhea as the lack of employing effective CSF leak repair methods. Empirical sellar reconstruction in the absence of an intraoperative CSF leak may be of benefit following resection of large tumors, especially if the arachnoid is thinned out and herniates into the sella.

Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature

2012 ◽  
Vol 32 (6) ◽  
pp. E2 ◽  
Author(s):  
Grace Lam ◽  
Vivek Mehta ◽  
Gabriel Zada
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Somatostatin Analogs ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Review Of The Literature ◽  
Csf Rhinorrhea ◽  
Clinical Scenarios ◽  
Csf Leakage ◽  
Csf Leaks

Object Spontaneous and medically induced CSF leaks are uncommonly associated with pituitary adenomas. The aim of this study was to further characterize the clinical scenarios most closely associated with this phenomenon. Methods A review of the literature was conducted to identify all cases of nonsurgical CSF leaks associated with pituitary adenomas. The authors aimed to identify associated risk factors and management strategies used to treat these tumors and repair the CSF leak site. Results Fifty-two patients with spontaneous or medically induced CSF leaks in the setting of a pituitary adenoma were identified from 29 articles published from 1980 through 2011. In 38 patients (73%), CSF rhinorrhea developed following initiation of medical therapy, whereas spontaneous CSF leakage developed as the presenting symptom in 14 patients (27%). The patients' mean age was 42.8 years (range 23–68 years). There were 35 males and 17 females. Forty-two patients (81%) had a prolactinoma, with the remaining patients having the following tumors: nonfunctioning pituitary adenoma (6 patients), growth hormone–secreting adenoma (2 patients), mammosomatotroph cell adenoma (1 patient), and ACTH-secreting adenoma (1 patient). Infrasellar tumor invasion into the paranasal sinuses was specifically reported in 56% of patients. The medical agents associated with CSF leakage were dopamine agonists (97%) and somatostatin analogs (3%). The average time from initialization of medical treatment to onset of rhinorrhea was 3.3 months (range 3 days–17 months). Nonsurgical management was successful in 4 patients, including 1 who had successful resolution with a temporary lumbar drain. Forty-six patients (88%) underwent surgical intervention to treat the CSF leak and/or resect the tumor. In 2 patients, surgery was not performed due to medical contraindications or patient preference. Conclusions Nonsurgical development of CSF rhinorrhea may occur in the setting of pituitary adenomas, especially following favorable response of invasive prolactinomas to initiation of dopamine agonist therapy. Additional cases have been reported as the presenting symptom of a pituitary adenoma and are likely to be related to decreased tumor volume due to intrinsic infarction or hemorrhage, ongoing invasion, and/or increases in intracranial pressure. Surgical repair, preferentially via a transsphenoidal approach, is the recommended initial treatment for definitive repair of the CSF leak and achievement of maximal tumor resection.

Clipping Technique for the Repair of the Intraoperative Cerebrospinal Fluid Leakage during Transsphenoidal Pituitary Tumor Surgery

2019 ◽  
Vol 17 (4) ◽  
pp. 382-388
Author(s):  
Eui Hyun Kim ◽  
Ju Hyung Moon ◽  
Sun Ho Kim
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Anterior Pituitary ◽  
Pituitary Function ◽  
Cerebrospinal Fluid Leakage ◽  
Arachnoid Membrane ◽  
Csf Rhinorrhea ◽  
Csf Leakage ◽  
Anterior Pituitary Function ◽  
Clipping Technique

Abstract BACKGROUND During transsphenoidal surgery (TSS) for a pituitary adenoma with a large suprasellar extension, cerebrospinal fluid (CSF) leakage commonly develops from a defect in the arachnoid recess or the arachnoid membrane. OBJECTIVE To evaluate the usefulness of a newly developed clipping technique for the repair of intraoperative CSF leakage. METHODS Between September 2012 and November 2016, 698 patients with pituitary adenoma were operated on with TSS. Intraoperative CSF leakage was encountered in 301 patients (43.1%). The clipping technique was used to repair CSF leakage in 144 patients: from the arachnoid recess in 100 patients and from the arachnoid membrane in 44 patients. The clipping technique used titanium clips and a newly designed clip applier. We evaluated anterior pituitary function of the patients whose CSF leakage was closed by clipping, and compared this with function in another patient group treated with different repair techniques. RESULTS We successfully applied clip technique in 140 out of 144 patients. This clipping technique was faster and easier for repairing CSF leakage than our previously published suture technique. In our early series, 4 patients developed unexpected CSF rhinorrhea after TSS. We found no difference in anterior pituitary function between a clipping group and others. Although titanium clip was identified on postoperative MRI, its metallic scattered artifact was very minimal and did not hinder the detection of possible remnant and recurrent tumors. CONCLUSION This clipping technique is a very simple and reliable method for repairing intraoperative CSF leakage when properly applied with caution.

scholarly journals Cerebrospinal fluid fistula as the presenting manifestation of pituitary adenoma: case report with a 4-year follow-up

2001 ◽  
Vol 59 (2A) ◽  
pp. 263-265 ◽  
Author(s):  
Ricardo Alexandre Hanel ◽  
Daniel Monte Serrat Prevedello ◽  
Alceu Correa ◽  
Affonso Antoniuk ◽  
João Cândido Araújo
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Sella Turcica ◽  
Rare Condition ◽  
Normal Serum ◽  
Cerebrospinal Fluid Fistula ◽  
Csf Rhinorrhea ◽  
Csf Leakage ◽  
Bony Erosion

We report the case of a young woman who presented with cerebrospinal fluid (CSF) rhinorrhea due to an undiagnosed and untreated pituitary adenoma. The tumor had extended well beyond sella turcica and caused bony erosion. The patient initially refused surgery and was treated with bromocriptine and a radiation therapy. CSF leakage did not improved and she was submitted to surgery by the transsphenoidal approach with removal of a tumor mass located in sphenoid sinus and sellar region. Origin of the leak was localized and repaired with fascia lata and a lumbar subarachnoid drain was left in place for 5 days. After 4 years she has normal serum PRL levels and no rhinorrhea. The management, complications and mechanisms involved in this rare condition are discussed.

Untreated Non-Functioning Pituitary Adenoma Causing Spontaneous Cerebrospinal Fluid Rhinorrhea: A Case Report

2020 ◽  
Vol 103 (9) ◽  
pp. 960-963
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Transsphenoidal Surgery ◽  
Case Reports ◽  
Medical Attention ◽  
Nasal Discharge ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Presenting Symptoms ◽  
Csf Leakage

Cerebrospinal fluid (CSF) leakage is common with traumatic brain injury or after transsphenoidal surgery (TSS). In contrast, spontaneous rhinorrhea caused by pituitary adenoma (PA) without prior treatment is rather unusual. Moreover, cases of non-functioning PA (NFPA) who seek medical attention without visual or hormonal symptoms but with watery nasal discharge, mistaken for rhinitis, and misled to delayed diagnosis, are extremely rare. The authors presented a case of spontaneous CSF rhinorrhea, confirmed by clinical, laboratory, and radiographic studies, caused by NFPA. Endoscopic TSS came across a typical PA, and subsequently, the sellar defect was successfully repaired. Pathological diagnosis of NFPA was established. The patient had an uncomplicated postoperative course and complete resolution of her presenting symptoms. A short review of prior case reports is also provided. Keywords: Spontaneous cerebrospinal fluid rhinorrhea, Pituitary adenoma, Non-functioning, Endoscopic transsphenoidal surgery

Incidence and Management of Complications of Transsphenoidal Operation for Pituitary Adenomas

Neurosurgery ◽  
1987 ◽  
Vol 20 (6) ◽  
pp. 920-924 ◽  
Author(s):  
Peter McL. Black ◽  
Nicholas T. Zervas ◽  
Guillermo L. Candia
Keyword(s):  
Cerebrospinal Fluid ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
International Survey ◽  
Common Complication ◽  
Csf Rhinorrhea ◽  
Management Of Complications ◽  
Transsphenoidal Operation

Abstract Two hundred fifty-five consecutive transsphenoidal procedures for pituitary adenomas were reviewed to evaluate complications and their management. There were no operative deaths. Cerebrospinal fluid (CSF) rhinorrhea was the most common complication, occurring in 2.7% of cases; diabetes insipidus was next, lasting less than 1 year in 1.6% of patients and over a year in 0.4%. Sinusitis occurred in 1.2% of patients, and delayed epistaxis occurred in 0.8%. Postoperative hematomas, meningitis, hydrocephalus, and deep venous thrombosis each occurred in 0.4% of cases. These results are discussed in the context of previous reports, including an international survey of pituitary surgeons. Although transsphenoidal surgery has a low morbidity and mortality, it is nevertheless associated with potentially serious difficulties that should be expeditiously recognized and managed.

scholarly journals Preoperative radiographic and clinical factors associated with the visualization of intraoperative cerebrospinal fluid during endoscopic transsphenoidal resection of pituitary adenomas

2020 ◽  
Vol 11 ◽  
pp. 59
Author(s):  
Lauren E. Rotman ◽  
Elizabeth N. Alford ◽  
Matthew C. Davis ◽  
T. Brooks Vaughan ◽  
Bradford A. Woodworth ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenomas ◽  
Third Ventricle ◽  
Univariate Analysis ◽  
Fold Increase ◽  
Linear Increase ◽  
The Third ◽  
Preoperative Factors ◽  
Increase In Risk ◽  
Transsphenoidal Resection

Background: Intraoperative visualization of cerebrospinal fluid (CSF) during endoscopic endonasal resection of skull base tumors is the most common factor contributing to the development of postoperative CSF leaks. No previous studies have solely evaluated preoperative factors contributing to intraoperative CSF visualization. The purpose of this study was to identify preoperative factors predictive of intraoperative CSF visualization. Methods: Retrospective review of patients who underwent transsphenoidal resection of pituitary adenomas was conducted. Clinical and radiographic variables were compared for those who had CSF visualized to those who did not. Nominal logistic regression models were built to determine predictive variables. Results: Two hundred and sixty patients were included in the study. All significant demographic and radiographic variables on univariate analysis were included in multivariate analysis. Two multivariate models were built, as tumor height and supraclinoid extension were collinear. The first model, which considered tumor height, found that extension into the third ventricle carried a 4.60-fold greater risk of CSF visualization (P = 0.005). Increasing tumor height showed a stepwise, linear increase in risk; tumors >3 cm carried a 19.02-fold greater risk of CSF visualization (P = 0.003). The second model, which considered supraclinoid tumor extension, demonstrated that extension into the third ventricle carried a 4.38-fold increase in risk for CSF visualization (P = 0.010). Supraclinoid extension showed a stepwise, linear increase in intraoperative CSF risk; tumors with >2 cm of extension carried a 9.26-fold increase in risk (P = 0.017). Conclusion: Our findings demonstrate that tumor height, extension into the third ventricle, and extension above the clinoids are predictive of intraoperative CSF visualization.

scholarly journals Risk Factors Impacting Intra- and Postoperative Cerebrospinal Fluid Rhinorrhea on the Endoscopic Treatment of Pituitary Adenomas: Retrospective Experience From 250 Patients

2020 ◽  
Author(s):  
Ming Wang ◽  
Cai Yang ◽  
Yugang Jiang ◽  
Yong Peng
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Risk Factor ◽  
Respiratory Disease ◽  
Pituitary Adenomas ◽  
Independent Risk Factor ◽  
Chronic Respiratory Disease ◽  
Csf Rhinorrhea ◽  
Factors Associated ◽  
Csf Leakage

Abstract Aim: We aimed to identify the risk factors associated with intra- and postoperative cerebrospinal fluid leakage in pituitary adenomas treated by endoscopic transsphenoidal surgery. Material and methods: A retrospective analysis of 250 pituitary adenoma cases from January 2017 to December 2019 at our hospital was conducted; all patients underwent endoscopic endonasal transsphenoidal surgeries. A univariate analysis and multivariate analysis was performed to investigate the risk factors associated with intra- and postoperative CSF rhinorrhea.Results: Eighty(32.0%) and nine(3.6%) patients had intraoperative and postoperative CSF leakages, respectively. Tumor size was an independent risk factor for intraoperative CSF leakage (OR, 1.229; 95% CI, 1.133–1.334; P<0.001); intraoperative CSF leakage was an independent risk factor for postoperative CSF leakage (OR, 7.707; 95% CI, 1.336–44.455; P=0.022). Chronic respiratory disease (OR, 57.500; 95% CI, 8.031–411.682; P<0.001) was also an independent risk factor for postoperative CSF leakage; vascularized septal mucosal flap was a protective factor for such (OR, 0.107; 95% CI, 0.013–0.894; P=0.039).Conclusion: Intraoperative CSF leakages are more likely to occur in large pituitary adenomas; in the presence of intraoperative CSF leakages, postoperative CSF rhinorrhea is very likely to occur. Patients with chronic respiratory disease are also more likely to develop postoperative CSF leakages. However, the sellar base reconstructed using vascularized nasal septal flaps can significant decrease the risk for such. Knosp grade, degree of tumor resection, postoperative lumbar subarachnoid drain use did not seem to have effect on the postoperative CSF rhinorrhea.

Ectopic pituitary adenoma of the third ventricle

1990 ◽  
Vol 72 (1) ◽  
pp. 139-142 ◽  
Author(s):  
B. K. Kleinschmidt-DeMasters ◽  
Ken R. Winston ◽  
David Rubinstein ◽  
Mary H. Samuels
Keyword(s):  
Pituitary Adenoma ◽  
Neurological Examination ◽  
Pituitary Adenomas ◽  
Sphenoid Sinus ◽  
Third Ventricle ◽  
Electron Microscopic ◽  
Content Type ◽  
The Third ◽  
Ectopic Pituitary Adenoma ◽  
Fine Print

✓ Ectopic pituitary adenomas without associated intrasellar adenomas are rare and are usually located in the sphenoid sinus. Most have been reported without modern radiological, endocrinological, or electron microscopic (EM) documentation. The case of a 47-year-old man with a third ventricular, ectopic, clinically non-secretory pituitary adenoma, which was shown to be a gonadotrophic adenoma by immunohistochemical and EM study, is reported. Neurological examination, extensive neurodiagnostic imaging, surgical anatomical observation, and endocrinological evaluation showed no evidence of neoplasia outside the third ventricle.

scholarly journals Clinical, Immunological And Molecular-Genetic Characteristic Of Aggressive Pituitary Adenomas

2021 ◽  
Vol 03 (04) ◽  
pp. 88-100
Author(s):  
Khalimova Zamira Yusufovna ◽  
Keyword(s):  
Pituitary Adenoma ◽  
General Population ◽  
Pituitary Adenomas ◽  
Molecular Genetic ◽  
Intracranial Tumor ◽  
Intracranial Tumors ◽  
Genetic Characteristic ◽  
The Third ◽  
Primary Intracranial Tumor

Pituitary adenomas (PA) are monoclonal tumors arising from the cells of the adenohypophysis and represent approximately 10-15% of all intracranial tumors and 90% of the tumors of the sellaturcica. Pituitary adenomas occur in almost 20% of the general population. The estimated annual morbidity of pituitary adenoma is approximately 20 cases per 100,000of population, making it the third most common primary intracranial tumor after gliomas and meningiomas [9].

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