Analysis of Nursing Cooperation in Microscopic Pituitary Tumor Resection via Transsphenoidal Approach

To analyze the clinical effect of nursing cooperation in transsphenoidal approach microscopic hypophysectomy. From January 2017 to January 2020, 80 patients who underwent transsphenoidal microscopic hypophysectomy in our hospital were selected to participate in the analysis and study. They were divided into two groups according to the randomized allocation, namely the observation group and the control group. Among them, 40 patients in the observation group and 40 patients in the control group were given routine nursing care for the patients in the control group, and comprehensive nursing intervention was adopted for the patients in the observation group, and the overall nursing effect of the two groups of patients was compared. After taking different nursing methods, the condition of patients in both groups was effectively controlled, and the effective rate of patients in the observation group with comprehensive nursing intervention was significantly better than that of patients in the control group with conventional nursing methods, and the difference had certain statistical significance (P < 0.05); The satisfaction degree of patients in the study group was significantly better than that of patients in the control group, and the difference was statistically significant (P < 0.05). The degree of negative emotions of patients in the study group was significantly better than that of patients in the control group after receiving comprehensive nursing intervention, and the difference was statistically significant (P < 0.05), and the difference in the incidence of adverse events between the two groups was not statistically significant (P > 0.05); The scores of each index of SF-36 questionnaire of patients in both groups were higher than those before nursing, and the scores of each index of patients in observation group were higher than those of patients in control group, and the difference was statistically significant (P > 0.05). With adequate preoperative preparation and mastery of the use of mechanical equipment, comprehensive nursing intervention can effectively improve the treatment effect of patients, make patients more satisfied with the nursing work, and can soothe patients’ negative psychological mood, eliminate panic, improve patients' life confidence, enhance intraoperative cooperation, and ensure that the operation can be completed smoothly.

Evaluation of Pure Endoscopic Endonasal Approach in Management of Giant Pituitary Adenoma

Background Giant pituitary adenoma represents one of the challenging tumor for neurosurgeons. Many microsurgical approaches in the past were used for its management. Recently and with evolution of the endoscopic equipment and instruments, extended endoscopic transsphenoidal approach become one of the preferable approaches for its surgical excision. Methods We prospectively document the clinical , surgical and follow up data for all patients presented with giant pituitary adenoma to Ain-Shams university hospital and Weill Cornell Medical College, Presbyterian hospital and were surgically treated with extended transsphenoidal approach from 2015 till 2019. Results Our group study formed of 44 patients with mean age 53.03 (range 14.7-82.4) and a male predominance (59%). The main presentation was visual problems in 75% followed by partial hypopituitarism in 31.81% while headache was in 13.64%. Only 4 patients had functioning adenoma (3 prolactinoma and 1 acromegaly). Average tumor volume was 26.95 ± 17.25 cm3, while the mean maximum tumor diameter was 4.73 cm (range 4.0-8.0 cm). Radiographic invasion was found in 97.73% to suprasellar cistern, 61.36% to the cavernous sinus and in 34% to the sphenoid sinus. GTR was achieved in 45.45% with Knosp score is the only significant predictor factor for resection rate (p = 0.04). Visual improvement achieved in 75.76%. 50% (2 patient) of the patients with functioning adenoma were cured. Complications included CSF leak in 3 patients, permanent DI in 4 patients and postoperative hematoma in 2 patients. Recurrence and progression rates without upfront radiation therapy were 5.00 % and 31.81% respectively after mean follow up period 57.90 months. Conclusions Extended endoscopic approaches for achieving maximum resection with minimal morbidity for giant pituitary adenoma are very effective. Lateral tumor extension with cavernous sinus invasion represents the limiting point in achieving gross total resection. Upfront radiation therapy for patients with residual adenoma can be avoided but regular follow up should be warranted.

The Dose of Somatostatin Analogues During Pre-Surgical Treatment is a Key Factor to Achieve Surgical Remission in Acromegaly

Purpose: To determine whether pre-surgical treatment using long-acting somatostatin analogues (SSAs) may improve surgical outcomes in acromegaly. Methods: Retrospective study of 48 patients with acromegaly operated by endoscopic transsphenoidal approach and for first time. Surgical remission was evaluated based on the 2010 criteria. Results: Most patients, 83.3% (n=40), harboured macroadenomas and 31.3% (n=15) invasive pitu-itary adenomas. Fourteen patients were treated with lanreotide LAR and 6 with octreotide LAR, median monthly doses of 97.5 [range 60-120] and 20 [range 20-30] mg, respectively, for at least 3 months preoperatively. Presurgical variables were comparable between pre-treated and un-treatred patients (P&gt;0.05). Surgical remission was more frequent in those pre-treated with monthly doses &ge;90 mg of lanre-otide or &ge;30 mg of octreotide than in untreated or pre-treated with lower doses (OR=4.64, P=0.025). However, no differences were found between pre-treated and untreated patients when lower doses were included or between those treated for longer than 6 months compared to those untreated or pre-treated for shorter than 6 months. Similarly, no differences were found either in terms of surgical or endocrine complications (OR=0.65, P=0.570)), independently of the doses and the duration of SSA treatment (P&gt;0.05). Conclusions: The dose of SSAs is a key factor during pre-surgical treatment, since the beneficial effects in surgical remission were observed with monthly doses equal or higher than 90 mg of lanreotide and 30 mg of octreotide, but not with lower doses.

Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma

Objective We illustrate a cavernous sinus chondrosarcoma treated with an endoscopic endonasal transethmoidal-transsphenoidal approach. Design Case report of a 15-year-old girl with diplopia and esotropia due to complete abducens palsy. Preoperative images showed a right cavernous sinus lesion with multiple enhanced septa and intralesional calcified spots (Fig. 1). Considering tumor location and the lateral dislocation of the carotid artery, an endoscopic endonasal approach was performed to relieve symptoms and to optimize the target geometry for adjuvant conformal radiotherapy. Setting The study was conducted at University of Insubria, Department of Neurosurgery, Varese, Italy. Participants Skull base team was participated in the study. Main Outcome Measures A transethmoidal-transsphenoidal approach was performed by using a four-hand technique. We used a route lateral to medial turbinate to access ethmoid and the sphenoid sinus. During the sphenoid phase, we exposed the medial wall of the cavernous sinus (Fig. 2) and the lesion was then removed using curette. Skull base reconstruction was performed with fibrin glue and nasoseptal flap. Results No complications occurred after surgery, and the patient experienced a complete recovery of symptoms. A postoperative magnetic resonance imaging showed a small residual tumor inside the cavernous sinus (Fig. 1). After percutaneous proton-bean therapy, patient experienced only temporary low-grade toxicity with local control within 2 years after treatment completion. Conclusion Endoscopic endonasal extended approach is a safe and well-tolerated procedure that is indicated in selected cases (intracavernous tumors, soft tumors not infiltrating the vessels and/or the nerves). A tailored approach according to tumor extension is crucial for the best access to the compartments involved.The link to the video can be found at: https://youtu.be/TsqXjqpuOws.