scholarly journals Resection of pituitary macroadenomas via the pseudocapsule along the posterior tumor margin: a cohort study and technical note

2018 ◽  
Vol 128 (2) ◽  
pp. 422-428 ◽  
Author(s):  
Davis G. Taylor ◽  
John A. Jane ◽  
Edward H. Oldfield
Keyword(s):  
Cohort Study ◽  
Cavernous Sinus ◽  
Residual Tumor ◽  
Maximum Diameter ◽  
Preoperative Imaging ◽  
Cavernous Sinus Invasion ◽  
Normal Gland ◽  
Group A ◽  
Group B ◽  
Pituitary Macroadenomas

OBJECTIVEExtracapsular resection of pituitary microadenomas improves remission rates, but the application of pseudocapsular techniques for macroadenomas has not been well described. In larger tumors, the extremely thin, compressed normal gland or its complete absence along the tumor’s anterior surface limits the application of the traditional pseudocapsular technique that can be used for microadenomas. However, in the authors’ experience, the interface between the pseudocapsule at the posterior margin of the adenoma and the compressed normal gland behind it is universally present, providing a surgical dissection plane. In mid-2010, the authors began using a new surgical technique to identify and use this interface for the resection of larger macroadenomas, a technique that can be used with the microscope or the endoscope.METHODSThe authors performed a cohort study using prospectively collected preoperative imaging reports and operative details and retrospectively reviewed postoperative images and clinical follow-up of patients with a pituitary macroadenoma 20–40 mm in maximum diameter undergoing microscopic transsphenoidal resection. Since dissection of the tumor capsule only pertains to encapsulated tumor within the sella and not to tumor invading the cavernous sinus, assessment of tumor removal of noninvasive tumors emphasized the entire tumor, while that of invasive tumors emphasized the intrasellar component only. The incidence of residual tumor on postoperative imaging, new-onset endocrinopathy, and recovery of preoperative pituitary deficits was compared between patients who underwent surgery before (Group A) and after (Group B) implementation of the new technique.RESULTSThere were 34 consecutive patients in Group A and 74 consecutive patients in Group B. Tumors in 18 (53%) Group A and 40 (54%) Group B patients had no evidence of cavernous sinus invasion on MRI. Use of the posterior pseudocapsule technique reduced the incidence of intrasellar residual tumor on postoperative MRI for tumors without cavernous sinus invasion (39% [Group A] vs 10%, p < 0.05) and in all tumors regardless of invasion (50% vs 18%, p < 0.005). The incidence of new endocrinopathy was less likely (25% vs 12%, p = 0.098) and the recovery of prior deficits more likely (13% vs 27%, p = 0.199) among patients treated using the pseudocapsule approach, although the differences are not statistically significant.CONCLUSIONSUse of the posterior pseudocapsule dissection plane can enhance the resection of pituitary macroadenomas.

scholarly journals Influence of bone cement distribution on outcomes following percutaneous vertebroplasty: a retrospective matched-cohort study

2021 ◽  
Vol 49 (7) ◽  
pp. 030006052110222
Author(s):  
Ling Mo ◽  
Zixian Wu ◽  
De Liang ◽  
Linqiang Y ◽  
Zhuoyan Cai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Bone Cement ◽  
Percutaneous Vertebroplasty ◽  
Vertebral Compression Fractures ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Cement Distribution ◽  
Group A ◽  
Group B

Objective To evaluate the influence of insufficient bone cement distribution on outcomes following percutaneous vertebroplasty (PVP). Methods This retrospective matched-cohort study included patients 50–90 years of age who had undergone PVP for single level vertebral compression fractures (VCFs) from February 2015 to December 2018. Insufficient (Group A)/sufficient (Group B) distribution of bone cement in the fracture area was assessed from pre- and post-operative computed tomography (CT) images. Assessments were before, 3-days post-procedure, and at the last follow-up visit (≥12 months). Result Of the 270 eligible patients, there were 54 matched pairs. On post-operative day 3 and at the last follow-up visit, significantly greater visual analogue scale (VAS) pain scores and Oswestry Disability Index (ODI) scores were obtained in Group B over Group A, while kyphotic angles (KAs) and vertebral height (VH) loss were significantly larger in Group A compared with Group B. Incidence of asymptomatic cement leakage and re-collapse of cemented vertebrae were also greater in Group A compared with Group B. Conclusions Insufficient cement distribution may relate to less pain relief and result in progressive vertebral collapse and kyphotic deformity post-PVP.

scholarly journals Effectiveness of a Gelatin–Thrombin Matrix Sealant (Floseal®) for Reducing Blood Loss During Microendoscopic Decompression Surgery for Lumbar Spinal Canal Stenosis: A Retrospective Cohort Study

2021 ◽  
pp. 219256822110088
Author(s):  
Kazunori Nomura ◽  
Munehito Yoshida ◽  
Motohiro Okada ◽  
Yosuke Nakamura ◽  
Kenichi Yawatari ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Retrospective Cohort ◽  
Spinal Canal Stenosis ◽  
Lumbar Spinal Canal Stenosis ◽  
Canal Stenosis ◽  
Postoperative Drainage ◽  
Group A ◽  
Group B ◽  
Lumbar Spinal

Study Design: Retrospective cohort study. Objectives: To investigate the effectiveness and safety of a gelatin–thrombin matrix sealant (GTMS) during microendoscopic laminectomy (MEL) for lumbar spinal canal stenosis (LSCS). Methods: This study included 158 LSCS cases on hemostasis-affecting medication who underwent MEL by a single surgeon between September 2016 and August 2020. Patients were divided into 2 groups depending on whether GTMS was used (37 cases, Group A) or not (121 cases, Group B). Perioperative data related to bleeding or postoperative spinal epidural hematoma (PSEH) was investigated. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score for low back pain. Results: The mean intraoperative blood loss per level was greater in Group A (26.0 ± 20.3 g) than in Group B (13.6 ± 9.0 g), whereas the postoperative drainage volume was smaller in Group A (79.1 ± 42.5 g) than in Group B (97.3 ± 55.6 g). No revision surgeries for PSEH were required in Group A, while 2 (1.7%) revisions were required in Group B ( P = .957). The median JOA score improved significantly from the preoperative period to 1-year postoperatively in both Group A and B (total score, 16.0-23.5 and 17.0-25.0 points, respectively). Conclusions: The use of GTMS during MEL for LSCS may be associated with a reduction in postoperative drainage volume. The revision rate for PSEH was not affected significantly by the use of GTMS. Clinical outcomes (represented by the JOA score) were significantly improved after the surgery, regardless of GTMS use during MEL.

scholarly journals Association of different pathologic subtypes of growth hormone producing pituitary adenoma and remission in acromegaly patients: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maryam Dehghani ◽  
Zahra Davoodi ◽  
Farahnaz Bidari ◽  
Amin Momeni Moghaddam ◽  
Davood Khalili ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Cohort Study ◽  
Cavernous Sinus ◽  
Retrospective Cohort Study ◽  
Pituitary Adenomas ◽  
Retrospective Cohort ◽  
Remission Rate ◽  
Cavernous Sinus Invasion ◽  
Dual Staining

Abstract Background Regarding the inconclusive results of previous investigations, this study aimed to determine the association between pathology, as a possible predictor, with remission outcomes, to know the role of pathology in the personalized decision making in acromegaly patients. Methods A retrospective cohort study was performed on the consecutive surgeries for growth hormone (GH) producing pituitary adenomas from February 2015 to January 2021. Seventy-one patients were assessed for granulation patterns and prolactin co-expression as dual staining adenomas. The role of pathology and some other predictors on surgical remission was evaluated using logistic regression models. Results Among 71 included patients, 34 (47.9%) patients had densely granulated (DG), 14 (19.7%) had sparsely granulated (SG), 23 (32.4%) had dual staining pituitary adenomas. The remission rate was about 62.5% in the patients with SG and DG adenomas named single staining and 52.2% in dual staining groups. Postoperative remission was 1.53-folds higher in the single staining adenomas than dual staining-one (non-significant). The remission rate was doubled in DG group compared to two other groups (non-significant). By adjusting different predictors, cavernous sinus invasion and one-day postoperative GH levels decreased remission rate by 91% (95% CI: 0.01–0.67; p = 0.015) and 64% (95% CI: 0.19–0.69; p < 0.001), respectively. Responses to the medications were not significantly different among three groups. Conclusion Various pathological subtypes of pituitary adenomas do not appear to have a predictive role in estimating remission outcomes. Cavernous sinus invasion followed by one-day postoperative GH is the strongest parameter to predict biochemical remission.

scholarly journals Cavernous sinus invasion by pituitary macroadenomas: neuroradiological, clinical and surgical correlation

1998 ◽  
Vol 56 (1) ◽  
pp. 107-110 ◽  
Author(s):  
ARTHUR CUKIERT ◽  
MARIO ANDRIOLI ◽  
JAYME GOLDMAN ◽  
MARCIA NERY ◽  
LUIS SALGADO ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Gold Standard ◽  
Pituitary Tumors ◽  
Medial Wall ◽  
Cavernous Sinus Invasion ◽  
Mri Features ◽  
Pituitary Macroadenomas

The classical imaging gold-standard for this diagnosis is the presence of tumor lateral to the carotid artery. Seventeen patients with pituitary macroadenomas with intraoperative confirmation of cavernous sinus invasion were studied with MRI. Only 8 patients had tumor lateral to the carotid artery; 13 had tumor within the carotid syphon and all lacked the ring enhancement of the medial wall of the cavernous sinus. In 10 patients, widening of the posterior double leaflets of the cavernous sinus could be. All patients were operated by the transesphenoidal route. Only one patient was cured by surgery alone. Only 3 patients disclosing the above mentioned MRI features were identified in a series of 250 patients and did not have cavernous sinus invasion. The present criteria proved to be useful in the pre-operative diagnosis of cavenous sinus invasion and patients' counselling. Pre-operative diagnosis of cavernous sinus invasion of pituitary tumors has a great impact in the management of such patients.

Transcavernous surgery; an effective treatment for pituitary macroadenomas

1995 ◽  
Vol 133 (2) ◽  
pp. 156-165 ◽  
Author(s):  
Akira Matsuno ◽  
Tomio Sasaki ◽  
Nobuhito Saito ◽  
Toshihiro Mochizuki ◽  
Takamitsu Fujimaki ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Cavernous Sinus ◽  
Transsphenoidal Surgery ◽  
Elevated Serum ◽  
Serum Levels ◽  
Pituitary Hormones ◽  
Cavernous Sinus Invasion ◽  
Stimulation Tests ◽  
Sufficient Degree ◽  
Pituitary Macroadenomas

Matsuno A, Sasaki T, Saito N, Mochizuki T, Fujimaki T, Kirino T, Takakura K. Transcavernous surgery; an effective treatment for pituitary macroadenomas. Eur J Endocrinol 1995:133:156–65. ISSN 0804–4643 The endocrinological outcome in four patients with pituitary macroadenomas laterally invading the cavernous sinus, who were treated surgically by the transcranial transcavernous approach, was compared with that in four patients with macroadenomas that had been removed transsphenoidally. The decrease in the elevated serum levels of anterior pituitary hormones after transcavernous surgery ranged from 58.4% to 90.1%, whereas after transsphenoidal surgery it ranged from 0% to 46.1%. The responsiveness of pituitary hormones to stimulation tests was restored and maintained after transcranial transcavernous surgery. Transsphenoidal surgery achieved neither sufficient tumor reduction nor produced a satisfactory endocrinological remission. When cavernous sinus invasion is suspected by magnetic resonance imaging, even if it cannot be confirmed with certainty, transcranial transcavernous surgery is recommended. It is a useful surgical procedure for obtaining a sufficient degree of tumor extirpation and satisfactory endocrinological improvement in patients with macro-adenomas laterally invading the cavernous sinus, particularly somatotroph or corticotroph macro-adenomas. Postoperatively, mild cranial nerve paresis may occur, but this may resolve in 1–4 months. Akira Matsuno, Department of Neurosurgery, Teikyo University Ichihara Hospital, 3426-3 Anegasaki, Ichihara City, Chiba 299-01, Japan

Portable Intraoperative Computed Tomography Scan in Image-Guided Surgery for Brain High-grade Gliomas: Analysis of Technical Feasibility and Impact on Extent of Tumor Resection

2015 ◽  
Vol 12 (1) ◽  
pp. 19-30 ◽  
Author(s):  
Giuseppe MV Barbagallo ◽  
Stefano Palmucci ◽  
Massimiliano Visocchi ◽  
Sabrina Paratore ◽  
Giancarlo Attinà ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Residual Tumor ◽  
High Grade ◽  
Resonance Imaging ◽  
Technical Feasibility ◽  
Intraoperative Computed Tomography ◽  
Guided Surgery ◽  
Image Guided ◽  
Group A ◽  
Group B

Abstract BACKGROUND Intraoperative magnetic resonance imaging is the gold standard among image-guided techniques for glioma surgery. Scant data are available on the role of intraoperative computed tomography (i-CT) in high-grade glioma (HGG) surgery. OBJECTIVE To verify the technical feasibility and usefulness of portable i-CT in image-guided surgical resection of HGGs. METHODS This is a retrospective series control analysis of prospectively collected data. Twenty-five patients (Group A) with HGGs underwent surgery using i-CT and 5-aminolevulinic acid (5-ALA) fluorescence. A second cohort of 25 patients (Group B) underwent 5-ALA fluorescence–guided surgery but without i-CT. We used a portable 8-slice CT scanner and, in both groups, neuronavigation. Extent of tumor resection (ETOR) and pre- and postoperative Karnofsky performance status (KPS) scores were measured; the impact of i-CT on overall survival (OS) and progression-free survival (PFS) was also analyzed. RESULTS In 8 patients (32%) in Group A, i-CT revealed residual tumor, and in 4 of them it helped to also resect pathological tissue detached from the main tumor. EOTR in these 8 patients was 97.3% (96%-98.6%). In Group B, residual tumor was found in 6 patients, whose tumor's mean resection was 98% (93.5-99.7). The Student t test did not show statistically significant differences in EOTR in the 2 groups. The KPS score decreased from 67 to 69 after surgery in Group A and from 74 to 77 in Group B (P = .07 according to the Student t test). Groups A and B did not show statistically significant differences in OS and PFS (P = .61 and .46, respectively, by the log-rank test). CONCLUSION No statistically significant differences in EOTR, KPS, PFS, and OS were observed in the 2 groups. However, i-CT helped to verify EOTR and to update the neuronavigator with real-time images, as well as to identify and resect pathological tissue in multifocal tumors. i-CT is a feasible and effective alternative to intraoperative magnetic resonance imaging. Portable i-CT can provide useful real-time information during brain surgery and can be easily introduced in neurosurgical theaters in daily practice.

scholarly journals Chronic Endometritis and Positive Mycoplasma Cultures: Is There a Correlation?

1995 ◽  
Vol 3 (1) ◽  
pp. 3-6
Author(s):  
Ashwin Chatwani ◽  
Paul Nyirjesy ◽  
Soheil Amin-Hanjani
Keyword(s):  
Cohort Study ◽  
Prospective Cohort ◽  
Ureaplasma Urealyticum ◽  
Mycoplasma Hominis ◽  
Pelvic Infection ◽  
Chronic Endometritis ◽  
Endometrial Cavity ◽  
Group A ◽  
Group B ◽  
The Impact

Objective: This study was undertaken to assess the impact of mycoplasma strains (Mycoplasma hominis or Ureaplasma urealyticum) on the development of chronic endometritis.Methods: Fifty-eight patients with acute pelvic infection were enrolled in this prospective cohort study. Endometrial cultures and biopsies were obtained on admission and 5–7 and 21–28 days after completion of treatment.Results: Of 148 samples, 40 were positive for mycoplasma strains (group A) and 58 were positive for mycoplasma with other pathogens (group B). Twenty-seven samples were positive for other pathogens only (group C). Chronic endometritis was seen in 7 (17.5%), 30 (51.7%), and 10 (37%) in group A, B, and C patients, respectively.Conclusions: The presence of mycoplasma strains in the endometrial cavity was not found to be associated with an increased incidence of chronic endometritis.

scholarly journals The effects of preoperative imaging stability studies on intraoperative correction, postoperative observation, and clinical efficacy of adult lumbar spondylolisthesis treatment

2020 ◽  
Author(s):  
Jie Jiang ◽  
Chong Liu ◽  
Guangping Zhang ◽  
Guoyong Xu ◽  
Tuo Liang ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Pedicle Screws ◽  
Preoperative Imaging ◽  
X Rays ◽  
Stability Studies ◽  
Group A ◽  
Vas Scores ◽  
Group B ◽  
Lumbar Spondylolisthesis ◽  
Postoperative Observation

Abstract Background The aim of this study is to explore the use of preoperative imaging stability studies of adult lumbar spondylolisthesis and it's effects on intraoperative correction, postoperative observation, and clinical efficacy. Methods We retrospectively analyzed a total of 104 patients diagnosed with lumbar spondylolisthesis who underwent Posterior lumbar interbody fusion surgery between 2011 and 2014. The qualified patients were divided into two groups; group A (study/unstable group: 52 cases) and group B (control/stable group: 52 cases). Group A was further divided into group A1 (slip instability: 27 cases) and group A2 (angular instability: 25 cases). The preoperative lumbar sagittal plane translation distances and segmental angle of the preoperative lateral X-rays, hyperflexion X-rays, and hyperextension X-rays were measured and compared with their third-day postoperative lateral X-ray, and slip rate. The occurrences of intraoperative or postoperative complications, one-month postoperative follow-up data, including JOA, and VAS scores were access to evaluate the clinical efficacy of the treatment. Results Satisfactory postoperative radiographic correction was recorded in all groups. Better correction and correction was observed in group A1 patients and group B patients who used puller screws compared to those who used normal screws (P < 0.05). However, patients in group A2 who used normal pedicle screws had similar correction as those who used puller screws. The preoperative VAS scores showed that low back and lower extremity pain were higher in A1 and A2 groups compared to group B. However, they were lower one month postoperative. The preoperative JOA scores for the unstable groups (group A1 and A2) were lower than their stable counterpart but higher during the first month postoperative. Our analysis of postoperative complications also revealed no statistically significant difference between groups A1 and B, and groups A2, and B. Conclusions Preoperative imaging stability for adult lumbar spondylolisthesis does not affect intraoperative correction. The use of puller pedicle screws in patients with unstable or stable segmental slippage could achieve better correction and correction than with normal pedicle screws. The preoperative symptoms of patients with unstable segments were worse than their stable counterparts; however, their postoperative recovery was quicker in the first month postoperative.

Sign in / Sign up

Export Citation Format

Share Document