Efficacy of Hypertonic Saline Solution to Achieve Persistent Intraoperative Intracranial Hypotension in Endoscopic Endonasal Transsphenoidal Surgery

Abstract. The use of endoscopic transsphenoidal access is an effective and safe method for the surgical treatment of pituitary adenomas (PA). In endoscopic transsphenoidal surgeries, there is a need to control intracranial pressure (ICP) for reposition and expansion of the tumor capsule. Currently, the main method for reducing ICP in transsphenoidal surgery is installation of an external lumbar drainage, which is associated with a number of complications.Aim of study. To improve the results of surgical treatment of patients with hypertension using hypertonic saline solution (HSS).Material and methods. The study included 89 patients, who were devided into two groups: Group A — control group (n=25), where the lumbar drainage was installed for invasive intraoperative measurement of the dynamics of ICP parameters at the main stages of the operation (HSS was not administered in these patients); Group B — study group (n=64), where the efficacy of noninvasive regulation of the tumor capsule position using intravenous HSS was assessed, in addition, lumbar drainage was installed in 25 patients of group B, as well as in group A, for invasive measurement of ICP (the dynamics of ICP changes at the main stages of the operation was measured), and the dynamics of changes in the electrolyte composition of the plasma during the first days after the administration of the HSS was monitored as well.Results. In Group B, there was a more significant decrease in ICP in the course of HSS (on average by 22.49 mm Hg) compared to Group A, where the decrease in ICP was 14.23–8,46 mm Hg (from 13.62±1.36 mm Hg, p<0.05). After intravenous administration of HSS, the plasma composition changed as expected (the concentrations of Na+ and Cl increased on average to 150±0.71 mmol/L and 118.3±1.06 mmol/L, respectively, which slightly exceeded the average statistical norm, K + slightly decreased within the average statistical norm), during the first day there was a normalization of the above laboratory parameters .This technique was used to obtain patent No. 2669924 “A method for regulating the position of a tumor capsule in endoscopic transsphenoidal surgery of pituitary adenoma”.Conclusion. The use of HSS is a safe noninvasive technique for expansion of the tumor capsule during operations to remove pituitary adenomas using transsphenoidal endoscopic access. It should be noted that this method is most appropriate in situations not associated with the risk of developing intraoperative liquorrhea.

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Treatment strategies for giant pituitary adenomas in the era of endoscopic transsphenoidal surgery: a multicenter series

Journal of Neurosurgery ◽

10.3171/2021.1.jns203982 ◽

2021 ◽

pp. 1-10

Author(s):

Alexander Micko ◽

Matthew S. Agam ◽

Andrew Brunswick ◽

Ben A. Strickland ◽

Martin J. Rutkowski ◽

...

Keyword(s):

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Treatment Strategies ◽

Extent Of Resection ◽

Gross Total Resection ◽

Total Resection ◽

Endoscopic Transsphenoidal Surgery ◽

Group A ◽

Giant Pituitary Adenomas ◽

Group B

OBJECTIVE Given the anatomical complexity and frequently invasive growth of giant pituitary adenomas (GPAs), individually tailored approaches are required. The aim of this study was to assess the treatment strategies and outcomes in a large multicenter series of GPAs in the era of endoscopic transsphenoidal surgery (ETS). METHODS This was a retrospective case-control series of 64 patients with GPAs treated at two tertiary care centers by surgeons with experience in ETS. GPAs were defined by a maximum diameter of ≥ 4 cm and a volume of ≥ 10 cm3 on preoperative isovoxel contrast-enhanced MRI. RESULTS The primary operation was ETS in all cases. Overall gross-total resection rates were 64% in round GPAs, 46% in dumbbell-shaped GPAs, and 8% in multilobular GPAs (p < 0.001). Postoperative outcomes were further stratified into two groups based on extent of resection: group A (gross-total resection or partial resection with intracavernous remnant; 21/64, 33%) and group B (partial resection with intracranial remnant; 43/64, 67%). Growth patterns of GPAs were mostly round (11/14, 79%) in group A and multilobular (33/37, 89%) in group B. In group A, no patients required a second operation, and 2/21 (9%) were treated with adjuvant radiosurgery. In group B, early transcranial reoperation was required in 6/43 (14%) cases due to hemorrhagic transformation of remnants. For the remaining group B patients with remnants, 5/43 (12%) underwent transcranial surgery and 12/43 (28%) underwent delayed second ETS. There were no deaths in this series. Severe complications included stroke (6%), meningitis (6%), hydrocephalus requiring shunting (6%), and loss or distinct worsening of vision (3%). At follow-up (mean 3 years, range 0.5–16 years), stable disease was achieved in 91% of cases. CONCLUSIONS ETS as a primary treatment modality to relieve mass effect in GPAs and extent of resection are dependent on GPA morphology. The pattern of residual pituitary adenoma guides further treatment strategies, including early transcranial reoperation, delayed endoscopic transsphenoidal/transcranial reoperation, and adjuvant radiosurgery.

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Transsphenoidal microsurgical removal of growth hormone-secreting pituitary adenomas

Journal of Neurosurgery ◽

10.3171/jns.1982.56.5.0634 ◽

1982 ◽

Vol 56 (5) ◽

pp. 634-641 ◽

Cited By ~ 77

Author(s):

David S. Baskin ◽

James E. Boggan ◽

Charles B. Wilson

Keyword(s):

Growth Hormone ◽

Pituitary Adenomas ◽

Partial Remission ◽

Transsphenoidal Surgery ◽

Content Type ◽

Group A ◽

Group B ◽

Suprasellar Extension ◽

Fine Print

✓ A series of 137 patients with growth hormone (GH)-secreting pituitary adenomas were treated by transsphenoidal surgery during a 10-year period. Group A comprised patients for whom this surgery was the first therapeutic intervention, and Group B included those who underwent the surgery after previous therapeutic intervention. The results were analyzed considering preoperative and postoperative endocrinological, neurological, ophthalmological, and neuroradiological data. Remission was defined as clinical response and a normal postoperative GH level, and partial remission as clinical response and postoperative reduction of the GH level by more than 50%. Any other result was considered failure. The mean follow-up period was 37.1 months; follow-up review was achieved in all the patients. Among the 102 patients in Group A, remission was achieved in 80 (78%) patients with transsphenoidal surgery alone, and in an additional 16 (16%) after postoperative irradiation (combined response rate, 94%). All failures and patients with partial remission had preoperative GH levels of more than 50 ng/ml and suprasellar extension of the tumor. There were no deaths; 8% of patients had minor surgical morbidity; 5% had new hypopituitarism postoperatively. Of patients subsequently irradiated, 71% developed hypopituitarism. Among the 35 patients in Group B, remission was achieved in 26 (74%), partial remission was obtained in two (6%), and seven (20%) were considered treatment failures. There were no deaths, and the morbidity rate was 14%; 66% of patients had hypopituitarism postoperatively. Of the eight patients who had received prior irradiation only, seven (88%) went into remission. All failures and partial responders had preoperative GH levels greater than 40 ng/ml; 56% had suprasellar extension. These results confirm the efficacy of the transsphenoidal approach for the treatment of GH-secreting pituitary adenomas.

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HYPERTONIC SALINE SOLUTION (HTS3%) AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE (ASAH) DOES NOT AFFECT SODIUM (NA) BALANCE

10.26226/morressier.5ab8f564d462b8029238d5a5 ◽

2018 ◽

Author(s):

Sara Habib

Keyword(s):

Subarachnoid Hemorrhage ◽

Hypertonic Saline ◽

Saline Solution ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Hypertonic Saline Solution

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Re-operation rate after surgical treatment of osteochondral lesions of the talus in paediatric and adolescent patients

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02282-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Daniel Körner ◽

Christoph E. Gonser ◽

Stefan Döbele ◽

Christian Konrads ◽

Fabian Springer ◽

...

Keyword(s):

Surgical Treatment ◽

Bone Grafting ◽

Cartilage Damage ◽

Osteochondral Lesions ◽

Retrograde Drilling ◽

Autologous Bone Grafting ◽

Operation Rate ◽

Group A ◽

Autologous Bone ◽

Group B

Abstract Background The aim of this study is to analyse the re-operation rate after surgical treatment of osteochondral lesions of the talus (OCLTs) in children and adolescents. Methods Between 2009 and 2019, 27 consecutive patients with a solitary OCLT (10 male, 17 female; mean age 16.9 ± 2.2 years; 8 idiopathic vs. 19 traumatic) received primary operative treatment (arthroscopy + bone marrow stimulation [BMS], n = 8; arthroscopy + retrograde drilling, n = 8; autologous chondrocyte implantation [ACI]/autologous bone grafting, n = 9; arthroscopy + BMS + retrograde drilling; n = 1; flake fixation, n = 1). Seventeen OCLTs were located at the medial and ten at the lateral talus. ‘Re-operation’ as the outcome measure was evaluated after a median follow-up of 42 months (range 6–117 months). Patients were further subdivided into groups A (re-operation, n = 7) and B (no re-operation, n = 20). Groups A and B were compared with respect to epidemiological, lesion- and therapy-related variables. Results Seven of 27 patients needed a re-operation (re-operation rate 25.9% after a median interval of 31 months [range 13–61 months]). The following operative techniques were initially used in these seven patients: arthroscopy + BMS n = 2, arthroscopy + retrograde drilling n = 4, ACI + autologous bone grafting n = 1. A comparison of group A with group B revealed different OCLT characteristics between both groups. The intraoperative findings according to the International Cartilage Repair Society (ICRS) classification revealed significantly more advanced cartilage damage in group B than in group A (p = 0.001). Conclusions We detected a re-operation rate of 25.9% after primary surgical OCLT treatment. Patients with re-operation had significantly lower ICRS classification stages compared to patients without re-operation.

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Lidocaine coinfusion alleviates vascular pain induced by hypertonic saline infusion: a randomized, placebo-controlled trial

BMC Anesthesiology ◽

10.1186/s12871-021-01329-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhiping Song ◽

Shibiao Chen ◽

Yang Zhang ◽

Xiaoyun Shi ◽

Na Zhao ◽

...

Keyword(s):

Hypertonic Saline ◽

Saline Solution ◽

Time Slot ◽

Controlled Trial ◽

Saline Infusion ◽

Clinical Trial Registry ◽

Hypertonic Saline Solution ◽

Vas Scores ◽

Vascular Pain ◽

Hypertonic Saline Infusion

Abstract Background Hypertonic saline solution has been frequently utilized in clinical practice. However, due to the nonphysiological osmolality, hypertonic saline infusion usually induces local vascular pain. We conducted this study to evaluate the effect of lidocaine coinfusion for alleviating vascular pain induced by hypertonic saline. Methods One hundred and six patients undergoing hypertonic saline volume preloading prior to spinal anesthesia were randomly allocated to two groups of 53 each. Group L received a 1 mg/kg lidocaine bolus followed by infusion of 2 mg/kg/h through the same IV line during hypertonic saline infusion; Group C received a bolus and infusion of normal saline of equivalent volume. Visual analogue scale (VAS) scores of vascular pain were recorded every 4 min. Results The vascular pain severity in Group L was significantly lower than that in Group C for each time slot (P < 0.05). The overall incidence of vascular pain during hypertonic saline infusion in Group L was 48.0%, which was significantly lower than the incidence (79.6%) in Group C (P < 0.05). Conclusion Lidocaine coinfusion could effectively alleviate vascular pain induced by hypertonic saline infusion. Trial registration Chinese Clinical Trial Registry, number: ChiCTR1900023753. Registered on 10 June 2019.

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