Transnasal endoscopic surgery of sphenoid meningocele associated with pituitary adenoma. A case report

Abstract BACKGROUND AND IMPORTANCE A pituitary adenoma patient who underwent surgery in our department was diagnosed with COVID-19 and 14 medical staff were confirmed infected later. This case has been cited several times but without accuracy or entirety, we feel obligated to report it and share our thoughts on the epidemic among medical staff and performing endonasal endoscopic surgery during COVID-19 pandemic. CLINICAL PRESENTATION The patient developed a fever 3 d post endonasal endoscopic surgery during which cerebrospinal leak occurred, and was confirmed with SARS-CoV-2 infection later. Several medical staff outside the operating room were diagnosed with COVID-19, while the ones who participated in the surgery were not. CONCLUSION The deceptive nature of COVID-19 results from its most frequent onset symptom, fever, a cliché in neurosurgery, which makes it hard for surgeons to differentiate. The COVID-19 epidemic among medical staff in our department was deemed as postoperative rather than intraoperative transmission, and attributed to not applying sufficient personal airway protection. Proper personal protective equipment and social distancing between medical staff contributed to limiting epidemic since the initial outbreak. Emergency endonasal endoscopic surgeries are feasible since COVID-19 is still supposed to be containable when the surgeries are performed in negative pressure operating rooms with personal protective equipment and the patients are kept under quarantine postoperatively. However, we do not encourage elective surgeries during this pandemic, which might put patients in conditions vulnerable to COVID-19.

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Complications caused by excessive hemostatic tamponade in the removed tumor area in transnasal endoscopic surgery of pituitary adenoma

Russian journal of neurosurgery ◽

10.17650/1683-3295-2020-22-1-21-30 ◽

2020 ◽

Vol 22 (1) ◽

pp. 21-30

Author(s):

D. N. Andreev ◽

M. A. Kutin ◽

P. L. Kalinin ◽

A. N. Shkarubo ◽

B. A. Kadashev ◽

...

Keyword(s):

Pituitary Adenoma ◽

Medical Research ◽

Endoscopic Surgery ◽

Neurological Disorders ◽

World Literature ◽

Mass Effect ◽

Neurological Status ◽

National Medical ◽

Transnasal Endoscopic Surgery ◽

Tumor Area

The phenomena of the mass effect of hemostatic material in the removed tumor area without the presence of a hematoma that causes or worsens the patient’s neurological status after surgery are difficult to diagnose and, with untimely help, causes irreversible neurological disorders. In world literature, we have found isolated sources describing similar complications. In the article, we present 7 clinical cases recorded from 2005 to 2019 in N. N. Burdenko National Medical Research Center of Neurosurgery and own experience in solving these difficult problems.

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Transnasal endoscopic surgery for vascular tumors of the nasal cavity. Case report

Pharmateca ◽

10.18565/pharmateca.2020.14.122-125 ◽

2020 ◽

Vol 14_2020 ◽

pp. 122-125

Author(s):

M.A. Edzhe Edzhe ◽

A.Yu. Ovchinnikov Ovchinnikov ◽

A.A. Kalandari Kalandari ◽

Keyword(s):

Case Report ◽

Nasal Cavity ◽

Endoscopic Surgery ◽

Vascular Tumors ◽

Transnasal Endoscopic Surgery

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Isolated sphenoethmoid recess poiyps

The Journal of Laryngology & Otology ◽

10.1017/s0022215100141386 ◽

1998 ◽

Vol 112 (7) ◽

pp. 660-663 ◽

Cited By ~ 16

Author(s):

Dharambir S. Sethi ◽

David P. C. Lau ◽

Lincoln W. J. Chee ◽

Vincent Chong

Keyword(s):

Computed Tomography ◽

Pituitary Adenoma ◽

Magnetic Resonance ◽

Mr Imaging ◽

Endoscopic Surgery ◽

Inflammatory Disease ◽

Sphenoid Sinus ◽

The Other ◽

Ectopic Pituitary Adenoma ◽

Transnasal Endoscopic Surgery

AbstractIsolated sphenoethmoid recess (SER) polyps are rare. They usually arise from the sphenoid sinus. We report six patients with SER polyps as the only abnormal clinical finding at initial presentation. All cases were investigated with outpatient biopsy and computed tomography (CT) or magnetic resonance (MR) imaging. Pre-operative histology revealed three cases of inflammatory disease, two cases with inverted papilloma, and one case of an ectopic pituitary adenoma arising from the sphenoid sinus. One of the inflammatory polyps arose directly from the mucosa around the sphenoid ostium. The other five cases involved the sphenoid sinus. Except for the ectopic pituitary adenoma all the polyps were managed by transnasal endoscopic surgery. We emphasize that isolated SER polyps may signify existing sphenoid pathology and a pre-operative biopsy is valuable for planning surgery.

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Multimaterial and multicolor 3D-printed model in training of transnasal endoscopic surgery for pituitary adenoma

Neurosurgical FOCUS ◽

10.3171/2019.6.focus19294 ◽

2019 ◽

Vol 47 (6) ◽

pp. E21

Author(s):

Jia-Ping Zheng ◽

Chu-Zhong Li ◽

Guo-Qiang Chen

Keyword(s):

Pituitary Adenoma ◽

Surgical Training ◽

Endoscopic Surgery ◽

Preoperative Planning ◽

Anatomical Structures ◽

Vidian Nerve ◽

Anatomical Teaching ◽

Neuroimaging Data ◽

3D Printed ◽

Transnasal Endoscopic Surgery

OBJECTIVEThe aim of the present study was to investigate the practical value of a multimaterial and multicolor 3D-printed model in anatomical teaching, surgical training, and preoperative planning of transnasal endoscopic surgery for pituitary adenoma.METHODSMultimodality neuroimaging data were obtained in a 42-year-old healthy male volunteer and a 40-year-old female patient with an invasive nonfunctional pituitary adenoma. Three 3D-printed models were produced: a monomaterial and monocolor model, a monomaterial and multicolor model, and a multimaterial and multicolor model. The effects on anatomical teaching and surgical training for exposing the vidian nerve were assessed by 12 residents, and the training effect was validated on cadavers. The practical values for preoperative planning were evaluated by 6 experienced neurosurgeons. All evaluations were based on 5-point Likert questionnaires.RESULTSThe multimaterial and multicolor model was superior to the monomaterial models in surgical training for exposing the vidian nerve (Fisher test; p < 0.05). In addition, the multimaterial and multicolor model was superior to the monomaterial models in anatomical teaching and preoperative planning (Friedman test; p < 0.05).CONCLUSIONSMultimaterial and multicolor 3D printing technology makes it convenient and efficient to produce a practical model for simulating individualized and complex anatomical structures in the sellar region. Furthermore, the multimaterial model can provide a more realistic manipulative experience for surgical training and facilitate the preoperative planning.

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Primary Pituitary Malignant Lymphoma Was Difficult to Differentiate from Nonfunctioning Pituitary Adenoma: A Case Report

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0036-1592447 ◽

2016 ◽

Vol 77 (S 02) ◽

Author(s):

Yuta Murakami ◽

Shinya Jinguji ◽

Yugo Kishida ◽

Taku Sato ◽

Tadashi Watanabe ◽

...

Keyword(s):

Case Report ◽

Pituitary Adenoma ◽

Malignant Lymphoma ◽

Nonfunctioning Pituitary Adenoma

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Transient Prealbumin- Associated Hyperthyroxinemia in TSH-Producing Pituitary Adenoma

Nuklearmedizin ◽

10.1055/s-0038-1629511 ◽

1990 ◽

Vol 29 (01) ◽

pp. 40-43 ◽

Cited By ~ 3

Author(s):

W. Langsteger ◽

P. Költringer ◽

P. Wakonig ◽

B. Eber ◽

M. Mokry ◽

...

Keyword(s):

Computed Tomography ◽

Case Report ◽

Pituitary Adenoma ◽

Thyroid Hormones ◽

Protein Binding ◽

Alpha Subunit ◽

Normal Range ◽

Thyroxine Binding Globulin ◽

Free Thyroid Hormones ◽

Transmission Computed Tomography

This case report describes a 38-year-old male who was hospitalized for further clarification of clinically mild hyperthyroidism. His increased total hormone levels, the elevated free thyroid hormones and the elevated basal TSH with blunted response to TRH strongly suggested a pituitary adenoma with inappropriate TSH incretion. Transmission computed tomography showed an intrasellar expansion, 16 mm in diameter. The neoplastic TSH production was confirmed by an elevated alpha-subunit and a raised molar alpha-sub/ATSH ratio. However, T4 distribution on prealbumin (PA, TTR), albumin (A) and thyroxine binding globulin (TBG) showed a clearly increased binding to PA (39%), indicating additional prealbumin-associated hyperthyroxinemia. The absolute values of PA, A and TBG were within the normal range. After removal of the TSH-producing adenoma, basal TSH, the free thyroid hormones and T4 binding to prealbumin returned to normal. Therefore, the prealbumin-associated hyperthyroxinemia had to be interpreted as a transitory phenomenon related to secondary hyperthyroidism (T4 shift from thyroxine binding globulin to prealbumin) rather than a genetically conditioned anomaly of protein binding.

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