Tags

Type your tag names separated by a space and hit enter

Surgical management of selected pituitary macroadenomas using extended endoscopic endonasal transsphenoidal approach: early experience.
Neurol India 2013 Mar-Apr; 61(2):122-30NI

Abstract

BACKGROUND AND OBJECTIVES

The endoscopic transsphenoidal approach is commonly used surgical approach for pituitary adenomas. However, adenomas with dumbbell configuration, pure suprasellar location, and fibrous consistency are difficult to remove by this approach. Recently, the extended endoscopic endonasal approach (EEEA) has been utilized to excise this subgroup of pituitary adenomas successfully.

MATERIALS AND METHODS

Between January 2009 and December 2011, 13 patients with pituitary macroadenomas were treated with EEEA. The tumor subgroups included: Dumbbell tumor configuration (4), pure suprasellar tumor location (2), and large suprasellar tumors with subfrontal extension (2). Five patients had fibrous/recurrent tumors and required addition of transtubercular-transplanum extension to the standard endoscopic endonasal exposure for radical resection.

RESULTS

The tumor removal was gross total in 8 (61.5%) patients, subtotal in 4 (30.7%), and partial in 1 (7.7%) patient. Clinical improvement was observed in almost all patients, immediate relief in headaches in 88% and normalization of vision in 90% of patients with pre-operative visual disturbances. Three patients with secreting adenomas, two with growth hormone-secreting adenomas and one with prolactin-secreting adenoma, had normalization of hormonal status. Three patients developed temporary diabetes insipidus two patients suffered transient ischemic attacks and one patient with a recurrent giant pituitary adenoma experienced a serious injury to the perforating artery. Four patients (30.7%) developed post-operative cerebrospinal rhinorrhea and two patients required surgical repair.

CONCLUSIONS

Our early experience suggests that the EEEA offers a potentially viable treatment option in certain pituitary tumors which are difficult to remove by the standard endoscopic approaches. However, longer follow-up and larger series are needed to establish the efficacy of this approach.

Authors+Show Affiliations

Department of Neurosurgery, Dr. Balabhai Nanavati Hospital and Saifee Hospital, Mumbai, Maharashtra, India. sankhlasuresh@gmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23644310

Citation

Sankhla, Suresh K., et al. "Surgical Management of Selected Pituitary Macroadenomas Using Extended Endoscopic Endonasal Transsphenoidal Approach: Early Experience." Neurology India, vol. 61, no. 2, 2013, pp. 122-30.
Sankhla SK, Jayashankar N, Khan GM. Surgical management of selected pituitary macroadenomas using extended endoscopic endonasal transsphenoidal approach: early experience. Neurol India. 2013;61(2):122-30.
Sankhla, S. K., Jayashankar, N., & Khan, G. M. (2013). Surgical management of selected pituitary macroadenomas using extended endoscopic endonasal transsphenoidal approach: early experience. Neurology India, 61(2), pp. 122-30. doi:10.4103/0028-3886.111114.
Sankhla SK, Jayashankar N, Khan GM. Surgical Management of Selected Pituitary Macroadenomas Using Extended Endoscopic Endonasal Transsphenoidal Approach: Early Experience. Neurol India. 2013;61(2):122-30. PubMed PMID: 23644310.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical management of selected pituitary macroadenomas using extended endoscopic endonasal transsphenoidal approach: early experience. AU - Sankhla,Suresh K, AU - Jayashankar,Narayan, AU - Khan,Ghulam M, PY - 2013/5/7/entrez PY - 2013/5/7/pubmed PY - 2013/6/28/medline SP - 122 EP - 30 JF - Neurology India JO - Neurol India VL - 61 IS - 2 N2 - BACKGROUND AND OBJECTIVES: The endoscopic transsphenoidal approach is commonly used surgical approach for pituitary adenomas. However, adenomas with dumbbell configuration, pure suprasellar location, and fibrous consistency are difficult to remove by this approach. Recently, the extended endoscopic endonasal approach (EEEA) has been utilized to excise this subgroup of pituitary adenomas successfully. MATERIALS AND METHODS: Between January 2009 and December 2011, 13 patients with pituitary macroadenomas were treated with EEEA. The tumor subgroups included: Dumbbell tumor configuration (4), pure suprasellar tumor location (2), and large suprasellar tumors with subfrontal extension (2). Five patients had fibrous/recurrent tumors and required addition of transtubercular-transplanum extension to the standard endoscopic endonasal exposure for radical resection. RESULTS: The tumor removal was gross total in 8 (61.5%) patients, subtotal in 4 (30.7%), and partial in 1 (7.7%) patient. Clinical improvement was observed in almost all patients, immediate relief in headaches in 88% and normalization of vision in 90% of patients with pre-operative visual disturbances. Three patients with secreting adenomas, two with growth hormone-secreting adenomas and one with prolactin-secreting adenoma, had normalization of hormonal status. Three patients developed temporary diabetes insipidus two patients suffered transient ischemic attacks and one patient with a recurrent giant pituitary adenoma experienced a serious injury to the perforating artery. Four patients (30.7%) developed post-operative cerebrospinal rhinorrhea and two patients required surgical repair. CONCLUSIONS: Our early experience suggests that the EEEA offers a potentially viable treatment option in certain pituitary tumors which are difficult to remove by the standard endoscopic approaches. However, longer follow-up and larger series are needed to establish the efficacy of this approach. SN - 0028-3886 UR - https://www.unboundmedicine.com/medline/citation/23644310/Surgical_management_of_selected_pituitary_macroadenomas_using_extended_endoscopic_endonasal_transsphenoidal_approach:_early_experience_ L2 - http://www.neurologyindia.com/article.asp?issn=0028-3886;year=2013;volume=61;issue=2;spage=122;epage=130;aulast=Sankhla DB - PRIME DP - Unbound Medicine ER -