Operative treatment of prolactinomas: indications and results in a current consecutive series of 212 patients

ObjectiveMedical therapy with dopamine agonists (DA) is the primary treatment of choice in most patients with prolactinomas. ‘Classical’ surgical indications are intolerance or lack of efficiency of DA therapy. Focusing on a possible shift of recent indications, we retrospectively analyzed our results of surgical treatment in prolactinomas.Patients and methodsBetween 1990 and 2005, we have operated on 212 consecutive patients with prolactinomas. Surgical indications were divided into ‘classical’ indications and ‘modern’ indications defined as cystic prolactinomas or patients with microprolactinomas who individually decided on a primary surgical treatment.ResultsInitial overall remission was accomplished in 53.2% including giant prolactinomas. However, in microadenomas, the remission rate was significantly higher with 91.3%. Overall remission at the latest follow-up was 42.7%, but 72.5% in intrasellar tumors, 80% in cystic prolactinomas, and 84.8% in microprolactinomas. The overall recurrence rate was 18.7%. Relapse of hyperprolactinemia in microprolactinomas was 7.1%. In our series, continually less patients were surgically treated for ‘classical’ indications. By contrast, the number of patients who individually decided on a primary surgical therapy has increased considerably.ConclusionRemission rates after surgical treatment of prolactinomas remain excellent, particularly in microadenoma and intrasellar macroadenomas, whereas morbidity of transsphenoidal surgery is low in the hands of experienced pituitary surgeons. Our remission rates not only confirm the already interdisciplinarily accepted surgical indications, but also emphasize the value of primary transsphenoidal surgery as a discussion-worthy alternative to dopaminergic therapy in young patients with microprolactinomas or cystic tumors.

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Outcomes of endoscopic transsphenoidal surgery for Cushing's disease

BMC Endocrine Disorders ◽

10.1186/s12902-021-00679-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zarina Brady ◽

Aoife Garrahy ◽

Claire Carthy ◽

Michael W. O’Reilly ◽

Christopher J. Thompson ◽

...

Keyword(s):

Diabetes Insipidus ◽

Cushing’S Disease ◽

Transsphenoidal Surgery ◽

Remission Rate ◽

Cushing's Disease ◽

Endoscopic Transsphenoidal Surgery ◽

Endocrine Society ◽

Csf Leakage ◽

Remission Rates

Abstract Background Transsphenoidal surgery (TSS) to resect an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma is the first-line treatment for Cushing’s disease (CD), with increasing usage of endoscopic transsphenoidal (ETSS) technique. The aim of this study was to assess remission rates and postoperative complications following ETSS for CD. Methods A retrospective analysis of a prospective single-surgeon database of consecutive patients with CD who underwent ETSS between January 2012–February 2020. Post-operative remission was defined, according to Endocrine Society Guidelines, as a morning serum cortisol < 138 nmol/L within 7 days of surgery, with improvement in clinical features of hypercortisolism. A strict cut-off of < 50 nmol/L at day 3 post-op was also applied, to allow early identification of remission. Results A single surgeon (MJ) performed 43 ETSS in 39 patients. Pre-operative MRI localised an adenoma in 22 (56%) patients; 18 microadenoma and 4 macroadenoma (2 with cavernous sinus invasion). IPSS was carried out in 33 (85%) patients. The remission rates for initial surgery were 87% using standard criteria, 58% using the strict criteria (day 3 cortisol < 50 nmol/L). Three patients had an early repeat ETSS for persistent disease (day 3 cortisol 306-555 nmol/L). When the outcome of repeat early ETSS was included, the remission rate was 92% (36/39) overall. Remission rate was 94% (33/35) when patients with macroadenomas were excluded. There were no cases of CSF leakage, meningitis, vascular injury or visual deterioration. Transient and permanent diabetes insipidus occurred in 33 and 23% following first ETSS, respectively. There was one case of recurrence of CD during the follow-up period of 24 (4–79) months. Conclusion Endoscopic transsphenoidal surgery produces satisfactory remission rates for the primary treatment of CD, with higher remission rates for microadenomas. A longer follow-up period is required to assess recurrence rates. Patients should be counselled regarding risk of postoperative diabetes insipidus.

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The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’

Acta Endocrinologica ◽

10.1530/eje.1.01863 ◽

2005 ◽

Vol 152 (3) ◽

pp. 379-387 ◽

Cited By ~ 312

Author(s):

Panagiotis Nomikos ◽

Michael Buchfelder ◽

Rudolf Fahlbusch

Keyword(s):

Transsphenoidal Surgery ◽

Tumour Size ◽

Secretory Activity ◽

Primary Treatment ◽

Oral Glucose ◽

Consecutive Series ◽

Primary Therapy ◽

Cure Rate ◽

Repeat Surgery ◽

Biochemical Cure

Background and aim: The aim of this study was to illustrate the present role of transsphenoidal surgery as primary therapy in GH-secreting adenomas, and to compare the results concerning control of disease with previous series using older criteria of cure. Method: We report on a consecutive series of 688 acromegalic patients treated over a time period of 19 years. Biochemical cure was defined as normalisation of basal GH level, suppression of GH levels to below 1 ng/ml during an oral glucose load and normalisation of IGF-I levels. Of the 506 patients undergoing primary transsphenoidal surgery, a total of 57.3% postoperatively fulfilled the criteria used. Results: The rate of biochemical ‘cure’ correlated with the magnitude of the initial GH levels, the tumour size and invasion. The overall complication rate was below 2%. Mortality in this series was 0.1% (1 of 688). During a follow-up period of 10.7 years only two recurrences (0.4%) occurred. However, in the patients treated by transcranial surgery and by repeat surgery the cure rate was found to be relatively low (5.2 and 21.3% respectively). Conclusions: These data suggest that surgery remains with very few exceptions the primary treatment of acromegaly for (i) a high cure rate, (ii) low morbidity, (iii) low recurrence rate and (iv) immediate decline of GH. Based on current criteria of cure, recurrences are uncommon. However, cure by surgery alone is improbable in patients harbouring extended, invasive tumours with high secretory activity, in whom further adjuvant treatment is mandatory.

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Endoscopic surgical treatment of bilateral coronal craniosynostosis

Neurosurgical Focus: Video ◽

10.3171/2021.1.focvid20136 ◽

2021 ◽

Vol 4 (2) ◽

pp. V13

Author(s):

Yasser Jeelani ◽

Mark R. Proctor

Keyword(s):

Surgical Treatment ◽

Endoscopic Surgery ◽

Multimodal Treatment ◽

Primary Treatment ◽

Consecutive Series ◽

Long Term Outcomes ◽

Treatment Paradigm ◽

Single Suture ◽

Over Time

Endoscopic surgery for single-suture synostosis has been widely adopted since its introduction over 2 decades ago. Its role in syndromic synostosis is emerging, both as a primary treatment and as the first stage in a multimodal treatment paradigm aimed at preventing the vexing turribrachycephaly seen in these children. In this video, the authors review the technique for endoscopic treatment of bilateral coronal craniosynostosis and discuss both the benefits and some of the concerns to look out for over time. They also review the long-term outcomes in a consecutive series of patients treated in this fashion. The video can be found here: https://vimeo.com/516351348.

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Modern Methods of Treating Erectile Dysfunction in Young Men

Health of Man ◽

10.30841/2307-5090.4.2020.225602 ◽

2021 ◽

pp. 49-58

Author(s):

Oleksandr Knigavko ◽

Viktoriia Dorina

Keyword(s):

Erectile Dysfunction ◽

Surgical Treatment ◽

Chronic Prostatitis ◽

Young Patients ◽

Young Men ◽

Sexual Life ◽

Modern World ◽

Subjective Data ◽

Results Of Treatment ◽

Number Of Patients

Traditionally, the incidence of erectile dysfunction (ED) increases with the age of a man, evolutionarily protecting him from passing on old, defective genes to his offspring by limiting his participation in sexual activity. Nevertheless, in the modern world, only 1 % of sexual contacts are carried out for the purpose of reproduction, the rest – with a recreational and social purpose. In addition, there has been an increasing number of cases of ED in young men lately. The problem of treating ED in young patients (up to 45 years old) requires an etiological approach. The objective: to determine the effectiveness of etiological non-surgical (treatment of prostatitis, psychotherapy) or minimally invasive (Marmara operation, veno-occlusive surgery, PRP-therapy) treatment of young men with ED. Materials and methods. On the basis of the Kharkiv Regional Medical Clinical Center for Urology and Nephrology named after V.I. Shapoval and on the basis of the P. Mogila Black Sea National University (Nikolaev) during 2014–2020. a comprehensive examination and treatment of 563 patients was carried out, which were divided into three supergroups (A, B and C) according to the prevailing factor: 156 patients with venoocclusive erectile dysfunction – supergroup A, 353 patients with chronic prostatitis – supergroup B and 54 patients with predominant psychoneurological disorders and the absence of organic pathology - supergroup C. Results. The effectiveness of surgical treatment in supergroup A according to subjective data after 2 months was almost equal in groups and subgroups, but after 18 months it was significantly higher in subgroups 1b and 2b (65.4 % and 83.7 %) according to ICEF results, and according to objective data after 18 months – 73.4 % and 91.4 %, respectively. After 1 and 7 months, the effectiveness of treatment in supergroup B was determined by the indices of satisfaction with sexual intercourse on the IIEF scale, the number of patients satisfied with the results of treatment, the absence of prostatic complaints and the eradication of infectious agents. Convincing results were obtained when assessing the quality of life of patients in supergroup C. Conclusion. Chronic prostatitis is the most common cause of erectile dysfunction ED in young men. Three-week antibacterial etiological treatment demonstrates the highest rates of infection eradication and ICEF recovery in patients with prostatitis. Operation Marmara reduces venous hyperemia of the prostate, lowers the IPSS score, and improves erectile function in patients with comorbid pathology. The use of an etiological approach allows to improve the sexual function of young patients, returning them to a normal sexual life, creating an alternative to falloprosthetics.

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One thousand laryngectomies performed at the Novi Sad University ENT clinic: Historical review and important data on treatment of laryngeal tumors

Medicinski pregled ◽

10.2298/mpns0502089j ◽

2005 ◽

Vol 58 (1-2) ◽

pp. 89-93

Author(s):

Rajko Jovic

Keyword(s):

Surgical Treatment ◽

Malignant Disease ◽

Surgical Techniques ◽

Historical Review ◽

Primary Treatment ◽

Important Data ◽

Number Of Patients ◽

Reconstructive Operations ◽

Laryngeal Tumors ◽

Novi Sad

Introduction. The first EKT Department in Novi Sad was established in 1926. In I960 the ENT Clime became a part of the Facility of medicine Novi Sad and treatment of malignant disease started in 1973 at the Laryngology Department. Surgical treatment of malignant laryngeal tumors. Treatment of laryngeal cancers in Novi Sad started in 1960's. Until 1971, the treatment of choice was radiotherapy, and surgical treatment started in 1971, when the first laryngectomy was performed. After the first surgery, 31 years have passed until we have reached the number of one thousand performed laryngectomies at ENT Clinic in Novi Sad. Period: 1971-1988. During this period, 138 laryngectomies were performed at ENT Clinic. Total laryngectomies were done as salvage surgeries in 136 cases, and 2 patients underwent functional partial lariigectomies. Direct laryngomicroscopy was introduced by Zivko Majdevac in 1972. Oncology consilium was founded. Period: 1990-2002. New protocol was adopted. Surgery became me primary treatment of laryngeal carcinoma, while radiotherapy remained a valid therapeutic alternative. All known surgical techniques were introduced, including Pearson's near-total laryngectomy. In this period 834 patients were operated, and 873 laryngectomies were performed, out of which 388 total laryngectomies. Year after year the number of patients increased and in 2002. 90 laryngectomies were performed. The number of functional reconstructive operations has increased to 67.8% in comparison to 32.2 % of total laryngectomies. .

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Long-term outcomes of transsphenoidal surgery for management of growth hormone–secreting adenomas: single-center results

Journal of Neurosurgery ◽

10.3171/2019.6.jns191187 ◽

2020 ◽

Vol 133 (5) ◽

pp. 1360-1370 ◽

Cited By ~ 2

Author(s):

Mohammed J. Asha ◽

Hirokazu Takami ◽

Carlos Velasquez ◽

Selfy Oswari ◽

Joao Paulo Almeida ◽

...

Keyword(s):

Growth Hormone ◽

Recurrence Rate ◽

Transsphenoidal Surgery ◽

Remission Rate ◽

Repeat Surgery ◽

Significant Difference ◽

Remission Rates ◽

Biochemical Remission

OBJECTIVETranssphenoidal surgery is advocated as the first-line management of growth hormone (GH)–secreting adenomas. Although disease control is defined by strict criteria for biochemical remission, the length of follow-up needed is not well defined in literature. In this report, the authors present their long-term remission rate and identify various predictive factors that might influence the clinical outcome.METHODSThe authors conducted a single-institute retrospective analysis of all transsphenoidal procedures for GH-secreting adenomas performed from January 2000 to June 2016. The primary outcome was defined as biochemical remission according to the 2010 consensus criteria and measured at the 1-year postoperative mark as well as on the last recorded follow-up appointment.Secondary variables included recurrence rate, patterns of clinical presentation, and outcome of adjuvant therapy (including repeat surgery). Subgroup analysis was performed for patients who had biochemical or radiological “discordance”—patients who achieved biochemical remission but with incongruent insulin-like growth factor 1 (IGF-1)/GH or residual tumor on MRI. Recurrence-free survival analysis was conducted for patients who achieved remission at 1 year after surgery.RESULTSEighty-one patients (45 female and 36 male) with confirmed acromegaly treated with transsphenoidal surgery were included. In 62 cases the patients were treated with a pure endoscopic approach and in 19 cases an endoscopically assisted microscopic approach was used.Primary biochemical remission after surgery was achieved in 59 cases (73%) at 1 year after surgery. However, only 41 patients (51%) remained in primary surgical remission (without any adjuvant treatment) at their last follow-up appointment, indicating a recurrence rate of 31% (18 of 59 patients) over the duration of follow-up (mean 100 ± 61 months). Long-term remission rates for pure endoscopic and endoscopically assisted cases were not significantly different (48% vs 52%, p = 0.6). Similarly, no significant difference in long-term remission was detected between primary surgery and repeat surgery (54% vs 33%, p = 0.22).Long-term remission was significantly influenced by extent of resection, cavernous sinus invasion (radiologically as well as surgically reported), and preoperative and early postoperative GH and IGF-1 levels (within 24–48 hours after surgery) as well as by clinical grade, with lower remission rates in patients with dysmorphic features and/or medical comorbidities (grade 2–3) compared to minimally symptomatic or silent cases (grade 1).CONCLUSIONSThe long-term surgical remission rate appears to be significantly less than “early” remission rates and is highly dependent on the extent of tumor resection. The authors advocate a long-term follow-up regimen and propose a clinical grading system that may aid in predicting long-term outcome in addition to the previously reported anatomical factors. The role of repeat surgery is highlighted.

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Transsphenoidal Surgery for Cushing's Disease: Endocrinological Follow-up Monitoring of 82 Patients

Neurosurgery ◽

10.1097/00006123-200207000-00008 ◽

2002 ◽

Vol 51 (1) ◽

pp. 57-62 ◽

Cited By ~ 109

Author(s):

Ilan Shimon ◽

Zvi Ram ◽

Zvi R. Cohen ◽

Moshe Hadani

Keyword(s):

Cushing’S Disease ◽

Transsphenoidal Surgery ◽

Adrenocorticotropic Hormone ◽

Remission Rate ◽

The United States ◽

Cushing's Disease ◽

Free Cortisol ◽

Remission Rates ◽

Surgical Failure

Abstract OBJECTIVE Transsphenoidal surgery is the preferred treatment modality for adrenocorticotropic hormone-secreting pituitary adenomas. In the past 2 decades, several institutions in the United States and Europe have reported remission rates of 70 to 85% after transsphenoidal surgery for treatment of Cushing's disease. We analyzed our postoperative results for a large cohort of patients with Cushing's disease. METHODS Eighty-two patients with adrenocorticotropic hormone-secreting adenomas (79 microadenomas and 3 macroadenomas) underwent transsphenoidal surgery between 1990 and 2000. Seventy-seven patients were surgically treated for the first time, and 13 patients underwent reoperations (5 had undergone the first operation elsewhere) because of previous surgical failure (10 patients) or recurrence (3 patients). The mean postoperative follow-up period was 4.2 ± 2.8 years. Biochemical remission was defined as postoperative normalization of elevated 24-hour urinary free cortisol secretion and suppression of morning cortisol levels with 1 mg of dexamethasone. RESULTS Remission was achieved for 78% of all patients after one operation and for 62% of patients who underwent a second operation. The recurrence rate was 5%. Ten patients did not exhibit a visible tumor on magnetic resonance imaging scans, and the other patients were divided according to adenoma size (2–5 or 6–10 mm). Remission rates were similar for the three groups of patients (78–80%). Pituitary tumor stained for adrenocorticotropic hormone was detected in 78% of resected pituitary tissue specimens obtained from patients who achieved remission, compared with 53% from patients who experienced surgical failure (P = 0.06). CONCLUSION Our series demonstrates the efficacy of transsphenoidal surgery for Cushing's disease resulting from pituitary microadenomas. Microadenoma size had no effect on the remission rate. Reoperations are indicated after initial surgical failures.

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Surgical outcomes and prognostic factors of transsphenoidal surgery for prolactinoma in men: a single-center experience with 87 consecutive cases

Acta Endocrinologica ◽

10.1530/eje-10-0961 ◽

2011 ◽

Vol 164 (4) ◽

pp. 499-504 ◽

Cited By ~ 28

Author(s):

Xin Qu ◽

Min Wang ◽

Guodong Wang ◽

Tao Han ◽

Chengzhi Mou ◽

...

Keyword(s):

Predictive Factors ◽

Tumor Invasion ◽

Transsphenoidal Surgery ◽

Remission Rate ◽

Academic Medical Center ◽

Entire Group ◽

Initial Surgery ◽

Remission Rates ◽

Male Patients

ContextLittle systematic data on male prolactinomas treated with surgery are available.ObjectiveTo clarify the clinical features and confirm the efficacy of transsphenoidal surgery for male prolactinomas and predictive factors after initial surgery.Patients and methodsThis retrospective study included 87 male patients with prolactinoma treated by transsphenoidal surgery at an academic medical center. Hormonal and visual status, remission rates, and the rate of tumor relapse, as well as predictive factors, were evaluated.ResultsPostoperative initial remission was achieved in 52.9% of patients. The remission rate was markedly higher in microadenomas (83.3%) than in macroadenomas (44.9%). Logistic regression analysis showed that the predictive factors of the early negative outcomes were high preoperative prolactin (PRL) levels and tumor invasion. After a median follow-up of 45 months, the long-term remission rate was 42.5%, and relapse of hyperprolactinemia occurred in 19.6% of the cured patients. The 5-year recurrence-free survival was 78.2% (95% confidence interval, 62.3–88.1%). When surgery was followed by adjuvant treatment in uncured and recurrent patients, 78.8% of patients in the entire group in the absence of dopamine agonists obtained biochemical remission at the end of follow-up.ConclusionTranssphenoidal surgery is a viable treatment alternative for male prolactinomas. The remission rates of male patients with microadenomas and/or intrasellar macroprolactinomas by surgery alone remain excellent, and surgery followed by adjuvant therapy as necessary is required for optimizing management of male prolactinomas, especially for extrasellar macroprolactinomas. The early negative results are associated with preoperative PRL levels and tumor invasion.

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Safety of surgical treatment of hemorrhoids in elderly patients

Journal of Health Sciences ◽

10.17532/jhsci.2016.282 ◽

2015 ◽

Vol 5 (3) ◽

pp. 99-103

Author(s):

Mustafa Cellalettin Haksal ◽

Murat Burc Yazicioglu ◽

Cagri Tiryaki ◽

Ali Ciftci ◽

Murat Coskun ◽

...

Keyword(s):

Surgical Treatment ◽

Postoperative Complications ◽

Elderly Patients ◽

Surgical Procedures ◽

Young Patients ◽

Fourth Degree ◽

Operative Duration ◽

Number Of Patients ◽

Significant Difference

Introduction: The aim of this study was to compare the outcomes following surgical treatment of hemorrhoids between elderly (≥60 years old) and young patients (<60 years old).Methods: A total of 365 patients who underwent surgical procedures for the treatment of third or fourth degree hemorrhoids between January 01, 2009 and January 31, 2014 were retrospectively screened.Results: Among the 365 participants, 316 and 49 patients were younger and older than 60 years of age, respectively. No statistically significant differences with regard to the gender, operative duration, hospitalization time, incapacity to work, hemoglobin levels at admission or discharge, number of hemorrhoid packages, presence of thrombosis prior to the surgery, reoperation requirement, or the number of patients complaining of long-term pain were observed between the groups. Moreover, there was no statistically significant difference in the rate of early or late postoperative complications between the groups.Conclusions: In conclusion, we found that the surgical treatment of hemorrhoids is equally safe in the younger and elderly patients. Therefore, surgeons can be confident in performing surgical treatment of hemorrhoids in elderly patients.

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Hämophilie-Zentrum Bonn 1980 – 2009

Hämostaseologie ◽

10.1055/s-0037-1619741 ◽

2011 ◽

Vol 31 (S 01) ◽

pp. S4-S10 ◽

Cited By ~ 2

Author(s):

I. Besmens ◽

H.-H. Brackmann ◽

J. Oldenburg

Keyword(s):

Young Patients ◽

Severe Form ◽

Coagulation Disorder ◽

Care Providers ◽

Long Distance ◽

Patient Age ◽

Patient Âgé ◽

Number Of Patients ◽

Clotting Disorder ◽

Regional Character

SummaryThe Bonn Haemophilia Care Center provides patient care on a superregional level. The centre’s large service area is, in part, due to the introduction of haemophilia home treatment and related to this the individualized prophylaxis in children and adults by Egli and Brack-mann in Bonn in the early 1970s, that represented a milestone in German haemophilia therapy. Epidemiologic patient data from the two selected time points, 1980 and 2009, are evaluated to illustrate the change in the composition of the patient clientele. In 1980 a total of 639 patients were treated at the Bonn Haemophilia Center. 529 patients exhibited a severe form and 110 a non-severe form of the respective clotting disorder. In 2009 the Bonn Haemophilia Center took care for a total of 837 patients. There were 445 patients who suffered from a severe form of the considered clotting disorder while 392 showed a non-severe course. The number of less severely affected patients has increased significantly in 2009. Patients in 1980 were predominantly suffering from a severe form and most had to travel more than 150 km from their homes to the treatment center. In 2009 the number of patients living a medium-long distance from the care provider has significantly increased while the number of patients living more than 150km from the center has decreased. Comparing 2009 to 1980 a growth of the center’s regional character becomes apparent, especially when patient age and severity of the coagulation disorder are taken into consideration. The regional character was more strongly pronounced with milder disease severity and lower patient age. Due to the existence of well established primary haemophilia care in CCCs in Germany, the trend for the recent years is that the proportion of young patients that choose haemophilia care providers closer to their homes is increasing.

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