scholarly journals Endoscopic Endonasal Transsphenoidal Approach for the Surgical Treatment of Pituitary Apoplexy and Clinical Outcomes

2021 ◽  
Vol 20 ◽  
pp. 153303382110430
Author(s):  
Zhixiang Sun, MD ◽  
Xintao Cai, MD ◽  
Yu Li, MD ◽  
Dongqi Shao, MD ◽  
Zhiquan Jiang, PhD
Keyword(s):  
Surgical Treatment ◽  
Pituitary Apoplexy ◽  
Clinical Manifestations ◽  
Transsphenoidal Approach ◽  
Endoscopic Endonasal ◽  
Medical College ◽  
Telephone Interviews ◽  
Vision Defects ◽  
Visual Disturbances

Purpose: This study investigated the clinical manifestations, surgical method, and treatment outcomes of patients with pituitary apoplexy and evaluated the safety and effectiveness of the endoscopic endonasal transsphenoidal approach in the treatment of pituitary adenomas. Patients and methods: In this retrospective study, were analyzed the data of patients with symptomatic pituitary apoplexy who received surgical treatment by endoscopic endonasal transsphenoidal approach from January 2017 to June 2020 at the Department of Neurosurgery of the First Affiliated Hospital of Bengbu Medical College. Patients were followed up through outpatient visits and telephone interviews. Results: Data for 24 patients including 13 males and 11 females with an average age of 46.46 years were analyzed. Headache (83.33%) and visual disturbances (75.00%) were the most common preoperative manifestations. In the 24 patients, 21 (87.50%) tumors were completely removed and 3 (12.50%) were partly removed. Intractable headache improved in all patients over a mean follow-up time of 25.16 months, and postoperative improvement in visual acuity was achieved in 17 of 18 patients (94.44%) with vision defects. Four patients (16.67%) experienced transient urinary collapse after the operation. No intracranial infection, carotid artery injury, or death occurred. Conclusion: The endoscopic endonasal transsphenoidal approach is a safe and effective method for the treatment of pituitary apoplexy.

scholarly journals The substantiation of chronic pancreatitis surgical treatment method selection

2007 ◽  
Vol 6 (3) ◽  
pp. 43-50
Author(s):  
V. A. Koubyshkin ◽  
I. A. Kozlov ◽  
N. I. Yashina ◽  
T. V. Shevchenko
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Gastric Resection ◽  
Clinical Manifestations ◽  
Pancreatic Head ◽  
Pain Syndrome ◽  
Treatment Method ◽  
Pancreas Head ◽  
Resection Of The Pancreas

The experience of surgical treatment of 154 patients having chronic pancreatitis with preferential injury of the pancreas head which underwent different operative interventions: isolated resection of pancreatic head ( based upon Berger surgery - 24, Frey surgery - 39), pancreatoduodenal resection ( with gastric resection - 22, with preserved pylorus - 43) and drainage surgeries - 26 is presented in the article. The surgery of isolated resection of pancreatic head has less number of nearest unfavorable results compared with pancretoduodenal resection with preserved pylorus. Proximal resection of the pancreas the variants of which are different isolated resection of pancreatic head is superior upon surgeries with full or partly resection of the duodenum due to fast normalization of the motor-evacuation function, less rate of the intestinal reflux and portion character of duodenal evacuation. In the follow-up period after pancreatoduodenal resection, atrophic processes occur in distal areas of the pancreas which are followed by clinical manifestations of exo- and endocrinous insufficiency. The surgery of longitudinal pancreatic jejunostomy does not avoid pathologic changes in the organ head and pain syndrome.

scholarly journals Alveolar Echinococcosis in Children

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Emilija Jonaitytė ◽  
Martynas Judickas ◽  
Eglė Tamulevičienė ◽  
Milda Šeškutė
Keyword(s):  
Surgical Treatment ◽  
Current Literature ◽  
Echinococcus Multilocularis ◽  
Cystic Echinococcosis ◽  
Alveolar Echinococcosis ◽  
Pediatric Patients ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Diagnostic Methods

Alveolar echinococcosis (AE) is an infectious zoonotic disease that is caused by Echinococcus multilocularis. The disease is generally identified accidentally because of the long asymptomatic period, has a malignant behaviour, and mainly occurs in the liver. Usually it is diagnosed in adults and is very rare in pediatric patients. We report two cases of AE and 1 differential case between AE and cystic echinococcosis (CE) in children: two of them had lesions in the liver and one had rare extrahepatic presentation of a cyst in the spleen. All our patients received chemotherapy with albendazole because surgical treatment was not recommended. The children were followed-up from 10 to 30 months and no significant improvement was seen. In this report we discuss the difficulties we faced in the treatment and follow-up of these patients. We also review the main clinical manifestations, general diagnostic methods, and treatment options of AE according to the current literature.

scholarly journals Current state of the art in the diagnosis and surgical treatment of Cushing disease: early experience with a purely endoscopic endonasal technique

2007 ◽  
Vol 23 (3) ◽  
pp. 1-8 ◽  
Author(s):  
Amir R. Dehdashti ◽  
Fred Gentili
Keyword(s):  
Surgical Treatment ◽  
Cavernous Sinus ◽  
Pituitary Surgery ◽  
Magnetic Resonance Images ◽  
Primary Therapy ◽  
Cushing Disease ◽  
Endoscopic Endonasal ◽  
Number Of Patients ◽  
Free Cortisol

Object Transsphenoidal pituitary surgery is the primary therapy for Cushing disease because of its potential to produce lasting remission without the need for long-term drug or hormone replacement therapy. The authors evaluated the current role of pure endoscopic endonasal pituitary surgery in the treatment of Cushing disease. Methods Twenty-five patients underwent pure endoscopic surgery for confirmed Cushing disease. Thirteen patients had microadenomas and seven had macroadenomas; magnetic resonance images obtained in five patients were only suspicious or nondiagnostic, and thus they underwent inferior petrosal sinus sampling. Two patients had evidence of cavernous sinus involvement. Final histological results were consistent with adrenocorticotropin hormone (ACTH)–secreting adenoma in 20 patients. Results Twenty patients (80%) had clinical remission and laboratory confirmation of hypocortisolemia (serum cortisol < 100 nmol/L requiring substitution therapy), suppression to low-dose dexamethasone, and normal 24-hour urinary free cortisol. The median follow-up period was 17 months (range 3–32 months). There was no recurrence at the time of the last follow-up. Three patients presented with new anterior pituitary deficiency, but no one had permanent diabetes insipidus. In one patient a cerebrospinal fluid leak developed but later resolved following lumbar drainage. Treatment failure was attributable to involvement of the cavernous sinus in two patients, incomplete tumor removal in one, negative exploration in one, and nodular corticotroph hyperplasia of the pituitary gland in one. Conclusions Early results indicated that endoscopic endonasal surgery is a safe and effective treatment for ACTH-producing adenomas. The rate of remission in this study is comparable to those in previous series, and the rate of major postoperative complications is extremely low. Further studies with a larger number of patients and longer follow-ups are required to determine whether this more minimally invasive pure endoscopic approach should become the standard of care for the surgical treatment of Cushing disease.

scholarly journals Endoscopic endonasal resection of midline cranial base tumors

2018 ◽  
Vol 19 (2) ◽  
pp. 7-17
Author(s):  
Enrico De Divitiis ◽  
Felice Esposito ◽  
Paolo Cappabianca ◽  
Luigi M. Cavallo ◽  
Oreste De Divitiis ◽  
...  
Keyword(s):  
Skull Base ◽  
Cranial Base ◽  
Transsphenoidal Approach ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Visual Deficits ◽  
Extended Transsphenoidal Approach ◽  
Anterior Cranial Base ◽  
Subtotal Removal

Objective: The advent of the endoscope in transsphenoidalsurgery has permitted to expand the indications of such approach also for the treatment of on tumors located in supra, para, retro and infrasellar regions, enabling the neurosurgeon to work under direct visual control in a minimally invasive way. Since 2004 we have started to use the extended endonasal transsphenoidal approach for a variety of lesions involving the midline skull base and, in particular, the suprasellar area, the cavernous sinus and the retroclival prepontine region. Methods: Over a 36-month period, sixty-four procedures have been performed. The series consisted of 29 males and 35 females, aged from 24 to 80 years (median 49.8 years). The mean follow-up was of 18 months (ranging from 3 to 36 months). Among the patients with midline lesions, who were 90.6 % of the total, seven patients had a pituitary adenoma, sixteen patients were affected by a craniopharyngioma, six patients had a suprasellar Rathke’s cleft cyst, seven subjects had a tuberculum sellae meningioma, four had an olfactorygroove meningioma, and six a clival tumor. Other lesions ofthe midline skull base were, 1 chiasmatic astrocytoma, 1 neuroendocrine tumor, 4 post-traumatic cerebro-spinal fluid rhinorrhea, and one optic nerve glioma. Three other patients had anterior cranial base meningoencephaloceles. Results: Overall, gross total removal of the lesion was achieved in 30/49 tumoral lesions (61.2%); subtotal removal was achieved in 12/49 cases (24.5%). The three cases of meningoencephaloceles were all successfully treated. Among the patients with preoperative visual deficits, most of them fully recovered or improved and only two worsened in one eye. Major complications consisted in 2 deaths (one not directly related with the surgical procedure), 6 postoperative CSF leak (one complicated with bacterial meningitis), one ICA injury, and 6 cases of permanent diabetes insipidus.Conclusion: The extended transsphenoidal approach tothe supra and parasellar lesions seems Endoscopy; Transsphenoidal surgery; Extended approach; Parasellar; Tumors; Anterior skull base. A promising minimally invasivetechnique for the removal of lesions affecting these areas,once thought to be suitable only of the transcranial routes.Concerning the lesion removal and the recurrence rate compared with the transcranial routes, it is too early to pose a definitive word, since the follow-up is still too short.

scholarly journals Endoscopic Endonasal Approach for Clival Chordomas

2018 ◽  
Vol 23 (1) ◽  
pp. 61-64
Author(s):  
Flávio Ramalho Romero ◽  
Sérgio Listik
Keyword(s):  
Surgical Treatment ◽  
Radical Resection ◽  
Transsphenoidal Approach ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Clival Chordoma

Chordomas of the clivus are aggressive lesions which arise from the remnants of the primitive notochord and pose unique diagnostic and management challenges. Radical resection of chordomas has been recommended for better outcomes and their surgical treatment has been challenging to neurosurgeons for many years. Transbasal, orbitozygomatic, subtemporal,transcondylar, transmaxillary, and extended transsphenoidal techniques have been proposed. We report a case of clival chordoma treated by endonasal endoscopic transsphenoidal approach. 

scholarly journals Experience of surgical treatment of infective endocarditis in children

2019 ◽  
pp. 67-83
Author(s):  
L. Prokopovуch ◽  
O. Golovenko ◽  
Y. Truba ◽  
M. Rudenko ◽  
O. Senyko ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Heart Defects ◽  
Subcutaneous Fat ◽  
Clinical Manifestations ◽  
Infectious Endocarditis ◽  
Average Weight ◽  
Kaplan Meier ◽  
The Mean

Surgical treatment of infectious endocarditis in children, single-center experience. The paper analyzes the experience of surgical treatment of infectious endocarditis (IE) in children. In the period from January 1999 to July 2019, 69 children with IE were operated at National Amosov Institute of Cardiovascular Surgery of NAMS of Ukraine, 44 of them (63.8%) developed the disease on the background of congenital heart defects (CHD). The mean age of the patients at the time of surgery was 9.1 ± 6.1 years. The average weight is 31.5 ± 21.7 (3.6 to 85 kg). The duration of the disease at the time of hospitalization was 5.3 ± 1.1 months. The average duration of the fever before hospitalization was 10.2 ± 8.5 weeks. Among the causes of IE, we observed three groups of inflammatory diseases: infections of the skin and subcutaneous fat in 15 (21.7%) cases, pathology of ENT – organs – 14 (20.2%) and broncho-pulmonary diseases – 9 (13.1%) cases. The risk factors were: presence of CHD – 44 (63.7%) and also nosocomial factors. The microbiological spectrum of pathogens included gram-positive microorganisms – 33 (71.7%), gram-negative microorganisms 4 (8.7%) and fungal microflora 9 (19.6%). The mean values of bypass circulation were 111.5 ± 62.4 minutes, and the time of aortic clamping was 71.4 ± 43.9 minutes, respectively. Hospital mortality in the general group of patients was 4 (5.8%) cases. In the follow-up period, 59 patients were examined, representing 90.7% of those discharged at the hospital stage. The observation period lasted from one month to 19.4 years (9.6 ± 5.7 years). According to the Kaplan-Meier analysis, the cumulative survival rate of patients in the CHD group at one year after surgery was 97.1%, at 10 years – 93.5%; after 15 years – 93.5%. Survival in the non-CHD group at 5, 10, and 15 years was 100%. In the long term, two patients died (3.4%). The recurrence rate of IE in the distant period was 2 (3.4%) cases. The incidence of long-term reoperation was 8 (13.6%) cases, three were recurrent IE and five were non-recurrent. According to Kaplan-Meier analysis, the proportion of patients without recurrent surgery in the long-term follow-up at 5 years was 87.9%, at 10 years – 84.1%, after 15 years – 77.1% in the CHD group. In the group without CHD 5 years – 95.2%, 10 years – 95.2%, 15 years – 81.6%. In the long term, as a result of performed surgical interventions, the regression of clinical manifestations of heart failure was noted in the majority of patients.

Frontal Lobe Cavernous Malformations in Pediatric Patients: Clinical Features and Surgical Outcomes

2018 ◽  
Vol 33 (8) ◽  
pp. 512-518 ◽  
Author(s):  
Chengjun Wang ◽  
Meng Zhao ◽  
Jia Wang ◽  
Shuo Wang ◽  
Zhongli Jiang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Frontal Lobe ◽  
Clinical Manifestations ◽  
Case Series ◽  
Motor Deficits ◽  
Cavernous Malformations ◽  
Rehabilitative Treatment ◽  
Neurologic Outcomes ◽  
The Mean

The purpose of this study is to investigate the clinical manifestations, surgical treatment, and neurologic outcomes of frontal lobe cavernous malformations in children. A retrospective analysis of 23 pediatric frontal lobe cavernous malformation patients who underwent surgical treatment in Beijing Tiantan Hospital was performed. The case series included 16 boys and 7 girls. Gross total removal without surgical mortality was achieved in all patients. The mean follow-up period after surgery was 33.1 months. Two patients who left hospital with motor deficits gradually recovered after rehabilitative treatment, and other patients were considered to be in excellent clinical condition. For symptomatic frontal lobe cavernous malformations, neurosurgical management should be the treatment of choice. Conservative treatment may be warranted in asymptomatic frontal lobe cavernous malformations, especially the deep-seated or eloquently located cases.

scholarly journals Surgical treatment of 125 cases of congenital diaphragmatic eventration in a single institution

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shengliang Zhao ◽  
Zhengxia Pan ◽  
Yonggang Li ◽  
Yong An ◽  
Lu Zhao ◽  
...  
Keyword(s):  
Body Weight ◽  
Surgical Treatment ◽  
Open Surgery ◽  
Clinical Manifestations ◽  
Operation Time ◽  
Diaphragmatic Eventration ◽  
Diaphragmatic Plication ◽  
First Choice ◽  
Surgical Methods

Abstract Background This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. Methods We retrospectively analyzed the clinical data of 125 children with CDE (90 boys, 35 girls; median age: 12.2 months, range: 1 h-7 years; body weight: 1.99–28.5 kg, median body weight: 7.87 ± 4.40 kg) admitted to our hospital in the previous 10 years, and we statistically analyzed their clinical manifestations and surgical methods. Results A total of 108 children in this group underwent surgery, of whom 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication. A total of 107 patients recovered well postoperatively, except for 1 patient who died due to respiratory distress after surgery. After 1–9.5 years of follow-up, 107 patients had significantly improved preoperative symptoms. During follow-up, the location of the diaphragm was normal, and no paradoxical movement was observed. Eleven of the 17 children who did not undergo surgical treatment did not have a decrease in diaphragm position after 1–6 years of follow-up. The index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P < 0.05). Conclusions The clinical symptoms of congenital diaphragmatic eventration vary in severity. Patients with severe symptoms should undergo surgery. Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of a short operation time, less trauma, and a rapid recovery. Thus, thoracoscopic diaphragmatic plication should be the first choice for children with congenital diaphragmatic eventration.

scholarly journals Airway Malacia: Clinical Features and Surgical Related Issues, a Ten-Year Experience from a Tertiary Pediatric Hospital

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 613
Author(s):  
Michele Ghezzi ◽  
Enza D’Auria ◽  
Andrea Farolfi ◽  
Valeria Calcaterra ◽  
Alessandra Zenga ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Surgical Treatment ◽  
Acute Respiratory Failure ◽  
Chronic Cough ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Diagnostic Work ◽  
Work Up ◽  
Cardiovascular Anomalies

Background: Few studies have been carried out with the aim of describing the clinical course and follow-up of patients with tracheomalacia. We aim to describe the symptoms at diagnosis and the post-treatment clinical course of patients affected by airway malacia. Methods: We retrospectively analyzed characteristics of pediatric patients with a diagnosis of airway malacia. Patients were classified into three groups: bronchomalacia (BM), tracheomalacia (TM) and tracheo-bronchomalacia (TBM). Demographic and clinical data, diagnostic work-up and surgical treatment were recorded. Results: 13/42 patients were affected by congenital syndromes (30.9%). Esophageal atresia with or without tracheal-esophageal fistula (EA/TEF) was detected in 7/42 patients (16.7%). Cardiovascular anomalies were found in 9/42 (21.4%) and idiopathic forms in 13/42 (30.9%). BM occurred in 7/42 (16.6%), TM in 23/42 (54.7%) and TBM in 12/42 (28.6%). At the diagnosis stage, a chronic cough was reported in 50% of cases with a higher prevalence in EA/TEF (p = 0.005). Surgery was performed in 16/42 (40%) of children. A chronic cough and acute respiratory failure were correlated to the need for surgery. During follow-up, there was no difference in persistence of symptoms between conservative vs surgical treatment (p = 0.47). Conclusion: the management of tracheomalacia remains a challenge for pediatricians. Clinical manifestations, such as a barking cough and acute respiratory failure may suggest the need for surgery. Follow-up is crucial, especially in those patients affected by comorbidities, so as to be able to manage effectively the possible persistence of symptoms, including those that may continue after surgical treatment.

scholarly journals Surgical treatment of 125 cases of congenital diaphragmatic eventration in a single institution

2020 ◽  
Author(s):  
Shengliang Zhao ◽  
Zhengxia Pan ◽  
Yonggang Li ◽  
Yong An ◽  
Lu Zhao ◽  
...  
Keyword(s):  
Body Weight ◽  
Surgical Treatment ◽  
Open Surgery ◽  
Clinical Manifestations ◽  
Operation Time ◽  
Diaphragmatic Eventration ◽  
Diaphragmatic Plication ◽  
First Choice ◽  
Surgical Methods

Abstract Background: This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE.Methods: We retrospectively analyzed the clinical data of 125 children with CDE (90 boys, 35 girls; median age: 12.2 months, range: 1 h-7 years; body weight: 1.99-28.5 kg, median body weight: 7.87±4.40 kg) admitted to our hospital in the previous 10 years,　and we statistically analyzed their clinical manifestations and surgical methods.Results: A total of 108 children in this group underwent surgery, of whom 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication. A total of 107 patients recovered well postoperatively, except for 1 patient who died due to respiratory distress after surgery. After 1-9.5 years of follow-up, 107 patients had significantly improved preoperative symptoms. During follow-up, the location of the diaphragm was normal, and no paradoxical movement was observed. Eleven of the 17 children who did not undergo surgical treatment did not have a decrease in diaphragm position after 1-6 years of follow-up. The index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P<0.05).Conclusions: The clinical symptoms of congenital diaphragmatic eventration vary in severity. Patients with severe symptoms should undergo surgery. Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of a short operation time, less trauma, and a rapid recovery.　Thus, thoracoscopic diaphragmatic plication should be the first choice for children with congenital diaphragmatic eventration.

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