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Endoscopic Endonasal Management of Rare Sellar Lesions: Clinical and Surgical Experience of 78 Cases and Review of the Literature.
World Neurosurg. 2017 Apr; 100:369-380.WN

Abstract

OBJECTIVE

In the present study we aim to provide further definition of a group of rare sellar diseases treated by the endoscopic endonasal approach.

METHODS

The study was a retrospective analysis of data obtained from a series of 1729 patients who underwent endoscopic endonasal surgery at 2 academic institutions (Università degli Studi di Napoli Federico II, Naples, Italy between January 1997 and December 2013 and the Wexner Medical Center at The Ohio State University between July 2010 and September 2015). Clinical charts, operative notes, and pathology reports were examined.

RESULTS

A total of 346 cases were identified to have nonadenomatous diseases. Applying the Rosner test for outliers assisted in excluding relatively frequent lesions. The final cohort of rare sellar diseases comprised 78 patients. Arachnoid cysts were the most frequently encountered sellar lesion (12 patients, 15%), followed by metastasis (11 cases, 14%), followed by hypophysitis (8 cases, 10%), oncocytoma, and glioma (6 cases, 8% each). The most frequent clinical findings were headache (28%) and visual disorders (80%). A standard endoscopic endonasal approach was performed in 44 patients (56%), and an extended approach was carried out in 34 patients (44%). Tumor removal was gross total in 53% of patients, subtotal in 19%, and partial in 21%. Postoperative endocrinologic and visual deficit evaluation showed improvements in endocrine function in 8 patients (10%) and in visual disorders in 13 (16%). Postoperative complications arose in 28% of cases, mostly represented by diabetes insipidus (10%).

CONCLUSIONS

Endoscopic endonasal approaches offer some specific benefits in the treatment of these patients.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Somma T
Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy. Electronic address: teresa.somma85@gmail.com.
Solari D
Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy.
Beer-Furlan A
Department of Neurosurgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA.
Guida L
Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy.
Otto B
Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA.
Prevedello D
Department of Neurosurgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA.
Cavallo LM
Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy.
Carrau R
Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA.
Cappabianca P
Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy.

MeSH

Adenoma, OxyphilicArachnoid CystsCohort StudiesDisease ManagementFemaleGliomaHumansHypophysitisMaleMiddle AgedNasal CavityNeuroendoscopyRetrospective StudiesSella Turcica

Pub Type(s)

Journal Article
Multicenter Study
Review

Language

eng

PubMed ID

27888088

Citation

Somma, Teresa, et al. "Endoscopic Endonasal Management of Rare Sellar Lesions: Clinical and Surgical Experience of 78 Cases and Review of the Literature." World Neurosurgery, vol. 100, 2017, pp. 369-380.
Somma T, Solari D, Beer-Furlan A, et al. Endoscopic Endonasal Management of Rare Sellar Lesions: Clinical and Surgical Experience of 78 Cases and Review of the Literature. World Neurosurg. 2017;100:369-380.
Somma, T., Solari, D., Beer-Furlan, A., Guida, L., Otto, B., Prevedello, D., Cavallo, L. M., Carrau, R., & Cappabianca, P. (2017). Endoscopic Endonasal Management of Rare Sellar Lesions: Clinical and Surgical Experience of 78 Cases and Review of the Literature. World Neurosurgery, 100, 369-380. https://doi.org/10.1016/j.wneu.2016.11.057
Somma T, et al. Endoscopic Endonasal Management of Rare Sellar Lesions: Clinical and Surgical Experience of 78 Cases and Review of the Literature. World Neurosurg. 2017;100:369-380. PubMed PMID: 27888088.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic Endonasal Management of Rare Sellar Lesions: Clinical and Surgical Experience of 78 Cases and Review of the Literature. AU - Somma,Teresa, AU - Solari,Domenico, AU - Beer-Furlan,Andre, AU - Guida,Lelio, AU - Otto,Bradley, AU - Prevedello,Daniel, AU - Cavallo,Luigi Maria, AU - Carrau,Ricardo, AU - Cappabianca,Paolo, Y1 - 2016/11/22/ PY - 2016/09/24/received PY - 2016/11/10/revised PY - 2016/11/12/accepted PY - 2016/11/27/pubmed PY - 2017/9/22/medline PY - 2016/11/27/entrez KW - Endoscopic endonasal approach KW - Rare tumors KW - Skull base surgery KW - Transsphenoidal sellar region SP - 369 EP - 380 JF - World neurosurgery JO - World Neurosurg VL - 100 N2 - OBJECTIVE: In the present study we aim to provide further definition of a group of rare sellar diseases treated by the endoscopic endonasal approach. METHODS: The study was a retrospective analysis of data obtained from a series of 1729 patients who underwent endoscopic endonasal surgery at 2 academic institutions (Università degli Studi di Napoli Federico II, Naples, Italy between January 1997 and December 2013 and the Wexner Medical Center at The Ohio State University between July 2010 and September 2015). Clinical charts, operative notes, and pathology reports were examined. RESULTS: A total of 346 cases were identified to have nonadenomatous diseases. Applying the Rosner test for outliers assisted in excluding relatively frequent lesions. The final cohort of rare sellar diseases comprised 78 patients. Arachnoid cysts were the most frequently encountered sellar lesion (12 patients, 15%), followed by metastasis (11 cases, 14%), followed by hypophysitis (8 cases, 10%), oncocytoma, and glioma (6 cases, 8% each). The most frequent clinical findings were headache (28%) and visual disorders (80%). A standard endoscopic endonasal approach was performed in 44 patients (56%), and an extended approach was carried out in 34 patients (44%). Tumor removal was gross total in 53% of patients, subtotal in 19%, and partial in 21%. Postoperative endocrinologic and visual deficit evaluation showed improvements in endocrine function in 8 patients (10%) and in visual disorders in 13 (16%). Postoperative complications arose in 28% of cases, mostly represented by diabetes insipidus (10%). CONCLUSIONS: Endoscopic endonasal approaches offer some specific benefits in the treatment of these patients. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/27888088/Endoscopic_Endonasal_Management_of_Rare_Sellar_Lesions:_Clinical_and_Surgical_Experience_of_78_Cases_and_Review_of_the_Literature_ DB - PRIME DP - Unbound Medicine ER -