Transsphenoidal microsurgical removal of growth hormone-secreting pituitary adenomas

1982 ◽  
Vol 56 (5) ◽  
pp. 634-641 ◽  
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.

Radiosurgery and the prevention of regrowth of incompletely removed nonfunctioning pituitary adenomas

2005 ◽  
Vol 102 ◽  
pp. 71-74 ◽  
Author(s):  
Piero Picozzi ◽  
Marco Losa ◽  
Pietro Mortini ◽  
Micol Angela Valle ◽  
Alberto Franzin ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Gamma Knife Radiosurgery ◽  
Additional Treatment ◽  
Content Type ◽  
Nonfunctioning Pituitary Adenomas ◽  
Surgical Debulking ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. The authors studied the efficacy of gamma knife radiosurgery (GKS) in the prevention of regrowth of nonfunctioning pituitary adenomas (NPA). Methods. One hundred nineteen patients were included in this study and were divided into two groups. All patients had undergone surgery in our department and recurrent or residual adenoma was demonstrated on postoperative MR imaging. Group A consisted of 68 patients who were followed without additional treatment. Group B was composed of 51 patients who received GKS within 1 year after microsurgery. There was no significant demographic difference between the two groups. In Group B the mean margin dose was 16.5 ± 0.3 Gy (range 13–21 Gy). Fifty one and one tenth percent of patients in Group A were recurrence free at 5 years and 89.8% in Group B (p < 0.001). In Group B patients, tumor volume decreased from a baseline value of 2.4 ± 0.2 cm3 to 1.6 ± 0.2 cm3 at last follow up (p < 0.001). Conclusions. The results of this study suggest that GKS is effective in controlling growth of residual NPA for at least 5 years following initial maximal surgical debulking compared with no radiation therapy. Thus, GKS is recommended after microsurgery when visible tumor can be detected on imaging studies.

Radiosurgery and the prevention of regrowth of incompletely removed nonfunctioning pituitary adenomas

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 71-74 ◽  
Author(s):  
Piero Picozzi ◽  
Marco Losa ◽  
Pietro Mortini ◽  
Micol Angela Valle ◽  
Alberto Franzin ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Gamma Knife Radiosurgery ◽  
Additional Treatment ◽  
Content Type ◽  
Nonfunctioning Pituitary Adenomas ◽  
Surgical Debulking ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. The authors studied the efficacy of gamma knife radiosurgery (GKS) in the prevention of regrowth of nonfunctioning pituitary adenomas (NPA). Methods. One hundred nineteen patients were included in this study and were divided into two groups. All patients had undergone surgery in our department and recurrent or residual adenoma was demonstrated on postoperative MR imaging. Group A consisted of 68 patients who were followed without additional treatment. Group B was composed of 51 patients who received GKS within 1 year after microsurgery. There was no significant demographic difference between the two groups. In Group B the mean margin dose was 16.5 ± 0.3 Gy (range 13–21 Gy). Fifty one and one tenth percent of patients in Group A were recurrence free at 5 years and 89.8% in Group B (p < 0.001). In Group B patients, tumor volume decreased from a baseline value of 2.4 ± 0.2 cm3 to 1.6 ± 0.2 cm3 at last follow up (p < 0.001). Conclusions. The results of this study suggest that GKS is effective in controlling growth of residual NPA for at least 5 years following initial maximal surgical debulking compared with no radiation therapy. Thus, GKS is recommended after microsurgery when visible tumor can be detected on imaging studies.

Long-term surgical outcome in 16 patients with thyrotropin pituitary adenoma

2000 ◽  
Vol 93 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Naoko Sanno ◽  
Akira Teramoto ◽  
R. Yoshiyuki Osamura
Keyword(s):  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Primary Hyperthyroidism ◽  
Fine Print

Object. Thyrotropin-secreting pituitary adenomas are rare lesions of the endocrinological system. Although introduction of a hypersensitive radioimmunoassay for thyrotropin enables the recognition of inappropriate secretion of this hormone, the aforementioned lesions remain uncommon and unfamiliar to most neurosurgeons. It has been reported previously that surgical cure of thyrotropin-secreting adenomas is more difficult than in other functional adenomas because of the large size and invasive features of the former. However, the long-term outcome after surgery has not been well documented. The authors report on a surgical series of 16 patients with thyrotropin adenoma and the results of long-term follow up.Methods. Sixteen patients ages 23 to 62 years (12 women and four men) underwent transsphenoidal removal of thyrotropin adenomas between 1983 and 1999. These patients had the syndrome of inappropriate thyrotropin secretion (SITS) with pituitary mass lesions. Four of the patients had undergone previous subtotal thyroidectomy and/or radioiodine thyroid ablation, and 11 had been treated with antithyroid medication. Radiological investigations demonstrated macroadenomas in 14 patients, and 10 of those had cavernous sinus invasion. Surgical findings showed unusually fibrous and firm tumors in 13 (81.2%) of 16 patients. Preoperative octreotide administration was revealed to be effective for serum thyrotropin reduction as well as tumor shrinkage. Transsphenoidal surgery was performed with no morbidity resulting. Surgical remission was achieved in 10 (62.5%) of 16 patients, and total remission was achieved in 14 patients (87.5%) with a combination of additional radiation or medical therapy. In the other two patients, SITS persisted because of tumor rests in the cavernous sinus. Therefore, radiation and/or antithyroid therapy was administered. In the mean follow-up period of 7.5 years (range 11 months–15.8 years), no recurrence of tumor was observed on magnetic resonance images, whereas recurrence of SITS was found in two patients with no tumor regrowth. In addition, coexistent primary hyperthyroidism was found in two other patients despite remission of SITS after surgery.Conclusions. Transsphenoidal surgery can achieve a good long-term outcome in patients with thyrotropin-secreting pituitary adenomas if surgery is performed before these become larger, invasive tumors. In the authors' experience, thyrotropin-secreting adenomas are fibrous and firm, which makes it difficult to achieve surgical remission. In addition, even satisfactory resection of the tumor sometimes results in recurrence of SITS or hyperthyroid symptoms due to coexistent primary hyperthyroidism. It is emphasized that a careful follow-up review is necessary after surgery, especially in patients with a long preoperative history of hyperthyroidism.

Transsphenoidal extracapsular approach to pituitary tumors

1986 ◽  
Vol 64 (1) ◽  
pp. 16-20 ◽  
Author(s):  
Nobuo Hashimoto ◽  
Hajime Handa ◽  
Tatsuhito Yamagami
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Pituitary Tumors ◽  
Hormonal Control ◽  
Arachnoid Membrane ◽  
Content Type ◽  
Tumor Capsule ◽  
Suprasellar Extension ◽  
Fine Print ◽  
Transsphenoidal Resection

✓ Two years' experience with an extracapsular transsphenoidal approach to pituitary adenomas is presented. Some pituitary tumors contain an inordinate amount of connective tissue that often makes transsphenoidal resection difficult. By opening the tumor capsule and adjacent arachnoid membrane, such tumors with suprasellar extension can be safely removed. In some cases of functioning adenoma, resection of the diaphragma sellae and adjacent arachnoid membrane results in hormonal control. Among 62 cases of transsphenoidal surgery for pituitary adenomas, eight cases required this procedure. The surgical procedure is described and the cases are summarized. The indication and limitations of this procedure are discussed.

Comparison of syringopleural and syringosubarachnoid shunting in the treatment of syringomyelia in children

1996 ◽  
Vol 84 (4) ◽  
pp. 624-628 ◽  
Author(s):  
Olivier Vernet ◽  
Jean-Pierre Farmer ◽  
José L. Montes
Keyword(s):  
Spina Bifida ◽  
Chiari Malformation ◽  
Content Type ◽  
Spina Bifida Aperta ◽  
Group A ◽  
Chiari Ii ◽  
Chiari I ◽  
Group B ◽  
Fine Print

✓ Case records from the Montreal Children's Hospital containing the diagnosis of shunted syringomyelia were retrospectively reviewed. From 1984 to 1994, 31 patients had their syrinx treated by either syringopleural (19 cases, Group A) or syringosubarachnoid (13 cases, Group B) shunting. One patient was included in both groups. Associated diagnoses included: in Group A, two cases of Chiari I and 14 of Chiari II malformations, 14 cases of shunted hydrocephalus, 13 cases of spina bifida aperta, and three cases of spina bifida occulta; Group B, four cases of Chiari I and two of Chiari II malformations, four cases of shunted hydrocephalus, two cases of spina bifida aperta, and five cases of spina bifida occulta. Eight Group A and six Group B patients had undergone prior posterior fossa decompression. Motor deficits predominated in both groups and arachnoiditis was a uniform operative finding. Neurological follow-up examinations showed 11 Group A patients improved and eight stabilized, whereas on magnetic resonance imaging, 12 cavities appeared to have collapsed, five were markedly reduced, and one had increased. One patient underwent reoperation for pleural effusions and one for shunt displacement. In Group B, one patient improved, eight stabilized, three worsened neurologically, and one was lost to follow-up review. Radiologically, one cavity appeared to have collapsed, six were significantly reduced, two were unchanged, and three had enlarged. The authors conclude that syringopleural shunting is a valuable option for controlling syringomyelia in patients without Chiari malformation or in patients who have previously undergone a craniovertebral decompression or are otherwise asymptomatic from their Chiari malformation.

Management of prolactinomas associated with very high serum prolactin levels

1988 ◽  
Vol 68 (4) ◽  
pp. 554-558 ◽  
Author(s):  
Daniel L. Barrow ◽  
Junichi Mizuno ◽  
George T. Tindall
Keyword(s):  
Pituitary Adenomas ◽  
High Serum ◽  
Serum Prolactin ◽  
Treatment Control ◽  
Content Type ◽  
Preoperative Serum ◽  
Group A ◽  
Group B ◽  
Very High ◽  
Fine Print

✓ The authors have reviewed the results of transsphenoidal microsurgical management in 69 patients with prolactin-secreting pituitary adenomas who had preoperative serum prolactin levels over 200 ng/ml. The patients were divided into three groups based on their preoperative serum prolactin levels: over 200 to 500 ng/ml (Group A); over 500 to 1000 ng/ml (Group B); and over 1000 ng/ml (Group C). The percentage of successful treatment (“control rate”) was 68%, 30%, and 14%, respectively, in these three groups of patients. Based on these results, the authors offer guidelines for the management of patients with prolactin-secreting pituitary adenomas associated with exceptionally high serum prolactin levels. The surgical control rate of 68% in Group A seems to justify surgery for these patients, while primary medical care with bromocriptine is recommended for most patients with serum prolactin levels over 500 ng/ml.

Gamma knife radiosurgery for primary management for trigeminal neuralgia

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 159-161 ◽  
Author(s):  
Ronald Brisman
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Content Type ◽  
Group A ◽  
Group B ◽  
Primary Management ◽  
Fine Print

Object. The purpose of this study was to assess the efficacy of gamma knife radiosurgery (GKS) as the primary rather than secondary management for trigeminal neuralgia. Methods. Eighty-two patients underwent GKS as their first neurosurgical intervention (Group A), and 90 patients underwent GKS following a different procedure (Group B). All GKS patients were treated with a maximum dose of 75 Gy. The single 4-mm isocenter was placed close to the junction of the trigeminal nerve and the brainstem. Six-month follow up was available for 126 patients and 12-month follow up for 84 patients. Excellent (no pain and no medicine) or good (at least 50% reduction in pain and less medicine) relief was more likely to occur in Group A than in Group B patients 6 and 12 months following GKS for trigeminal neuralgia (p = 0.058). Excellent or good results were also more likely in patients with trigeminal neuralgia without multiple sclerosis (MS) (p = 0.042). The number and type of procedures performed prior to GKS, the interval between the last procedure and GKS, and the interval from first symptom to GKS (within Groups A and B) did not affect 6-month outcome. The interval between first symptom and GKS was shorter in Group A patients without MS (87 months) than in Group B (148 months; p < 0.004). There were no significant differences between Group A and B patients with regard to sex, age, or laterality. Conclusions. Patients with trigeminal neuralgia who are treated with GKS as primary management have better pain relief than those treated with GKS as secondary management. Patients are more likely to have pain relief if they do not have MS.

Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: a 12- to 70-month follow-up evaluation

1997 ◽  
Vol 87 (6) ◽  
pp. 876-880 ◽  
Author(s):  
Michael Sanders ◽  
Wouter W. A. Zuurmond
Keyword(s):  
Cluster Headache ◽  
Pharmacological Therapy ◽  
Complete Relief ◽  
Sphenopalatine Ganglion ◽  
Content Type ◽  
Group A ◽  
Group B ◽  
Fine Print ◽  
Made In

✓ This study was conducted to evaluate the efficacy, based on 12- to 70-month follow-up data, of radiofrequency (RF) lesions of the sphenopalatine ganglion made in patients suffering from cluster headache. Sixty-six patients suffering from either episodic (Group A, 56 patients) or chronic (Group B, 10 patients) cluster headache who were not responsive to pharmacological management were treated by RF lesioning in the sphenopalatine ganglion. Complete relief of pain was achieved in 34 (60.7%) of 56 patients in Group A and in three (30%) of 10 patients in Group B. No relief was found in eight patients (14.3%) in Group A and in four (40%) in Group B. The mean time of follow up was 29.1 ± 10.6 months in Group A and 24 ± 9.7 months in Group B, ranging from 12 to 70 months. With regard to side effects and complications, temporary postoperative epistaxis was observed in eight patients and a cheek hematoma in 11 patients; a partial RF lesion of the maxillary nerve was inadvertently made in four patients. Nine patients complained of hypesthesia of the palate, which disappeared in all cases within 3 months. The authors conclude that RF lesioning in the sphenopalatine ganglion via the infrazygomatic approach may be performed in patients suffering from cluster headache that does not respond to pharmacological therapy.

A new denervation procedure for idiopathic cervical dystonia

2002 ◽  
Vol 97 (2) ◽  
pp. 201-206 ◽  
Author(s):  
Takaomi Taira ◽  
Tomonori Kobayashi ◽  
Kenji Takahashi ◽  
Tomokatsu Hori
Keyword(s):  
Blood Loss ◽  
Cervical Dystonia ◽  
Symptomatic Improvement ◽  
Sensory Loss ◽  
Intraoperative Blood Loss ◽  
Content Type ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. The Bertrand selective peripheral denervation for cervical dystonia (CD) has been well described, and its effectiveness and safety are established. It is, however, always accompanied by postoperative sensory loss in the C-2 region. Intraoperative bleeding from epidural venous plexuses may also be problematic. The authors developed a new denervation procedure with which to avoid such complications and compared the surgery-related results with those of the traditional Bertrand operation. Methods. The new procedure consists of intradural rhizotomy of the anterior C-1 and C-2 nerve roots, extradural peripheral ramisectomy from C-3 to C-6, and selective section of peripheral branches of the accessory nerve to the sternocleidomastoid muscle. This procedure was performed in 30 patients (Group A). The results of this procedure were compared with those obtained in a matched group of 31 patients in the authors' series who underwent Bertrand denervation (Group B). Changes of CD rating score at 6-month follow up did not differ between the two groups. In one patient in Group A a C-2 sensory deficit was found, whereas C-2 sensory deficits were demonstrated in all the patients in Group B. No patients in Group A and four patients in Group B experienced occipital neuralgia. The operative time was significantly shorter in Group A. The mean intraoperative blood loss was 115 ± 30 ml (± standard deviation) in Group A and 233 ± 65 ml in Group B (p < 0.005). Conclusions. Although symptomatic improvement is the same after the Bertrand operation, the authors' new procedure for CD was associated with a lower incidence of complications and significant decrease of intraoperative blood loss.

Beta—tricalcium phosphate as a substitute for autograft in interbody fusion cages in the canine lumbar spine

2002 ◽  
Vol 97 (3) ◽  
pp. 350-354 ◽  
Author(s):  
Takashiro Ohyama ◽  
Yoshichika Kubo ◽  
Hiroo Iwata ◽  
Waro Taki
Keyword(s):  
Lumbar Spine ◽  
Tricalcium Phosphate ◽  
Interbody Fusion ◽  
Donor Site ◽  
Posterolateral Approach ◽  
Content Type ◽  
Spine Model ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. An interbody fusion cage has been introduced for cervical anterior interbody fusion. Autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies. Thus, donor site—related complications can still occur. In this study a synthetic ceramic, β—tricalcium phosphate (TCP), was examined as a substitute for autograft bone in a canine lumbar spine model. Methods. In 12 dogs L-1 to L-4 vertebrae were exposed via a posterolateral approach, and discectomy and placement of interbody fusion cages were performed at two intervertebral disc spaces. One cage was filled with autograft (Group A) and the other with TCP (Group B). The lumbar spine was excised at 16 weeks postsurgery, and biomechanical, microradiographic, and histological examinations were performed. Both the microradiographic and histological examinations revealed that fusion occurred in five (41.7%) of 12 operations performed in Group A and in six (50%) of 12 operations performed in Group B. The mean percentage of trabecular bone area in the cages was 54.6% in Group A and 53.8% in Group B. There were no significant intergroup differences in functional unit stiffness. Conclusions. Good histological and biomechanical results were obtained for TCP-filled interbody fusion cages. The results were comparable with those obtained using autograft-filled cages, suggesting that there is no need to harvest iliac bone or to use allo- or xenografts to increase the interlocking strength between the cage and vertebral bone to achieve anterior cervical interbody fusion.

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