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Resection of pituitary adenoma via an endonasal unilateral-septal transsphenoidal approach
S242
Tumours of the CNS - Craniopharyngiomas and Pituitary Tumours
IP-5-618I unilateral-septal Resection of pituitary adenoma via an endonasal transsphenoldal approach Weiguo Zhao, lianxi Zhang , Jiankang Shen. Dept of Neurosurgery, Rui-Jin Hospitalof ShanghaiSecond Medical University, Shanghai200025, China, PR We report our successful experience of surgery for pituitary adenoma via an endonasal unilateral-septal transsphenoidal approach (EUSTA). 30 clinically and CT or MRI diagnosed pituitary adenoma patients, among whom 17 male and 13 female, age ranging from 15-72, average 45 year-Old, were included in this group. The adenomas were subclassified as nonfunctioning 11cases, PRL 5 cases, ACTH 6 cases and GH8 cases according to their clinical manifestations and endocrinological change. There were 7 microadeomas and 6 giant adenomas in this group with the maximal size of 3.6 em in diameter. The operation was conducted by an incision along the caudal edge of the septal cartilage of the right nostril and an incomplete cross section of the columella if necessary. Intraoperative X-ray monitor was used to define precisely the sellar floor and to check the degree of tumor removal making reference to the size and extent of the tumor on the sagittal MRI image. All operations went smoothly, taking less than 2 hours in average , and no need for blood transfusion. Patients symptoms were improved and no major complications were seen expect for transient CSF rhinorrhea and diabetes insipidus one case respectively. The cure and improvement rate for functional adenoma was 84% (16/19). On the basis of more than four-hundred cases of pituitary adenoma surgery experience with sublabial transsphenoidal approach in our dept, we tried a modified one of EUSTA since 1994. It is proved that this approach is applicable well to Chinese people with small nostril even for those with cushing's disease. Compared with sublabial approach, it can shorten operative distance by about 1 em, reduce operative damage , avoid gingival numbness and atrophy and result in a cosmetica lly acceptab le scar at the base of the nasal collumella. We also think it essential to have an X-ray monitor installed during operation to avoid misjudgement and to guide the extent of resection. In short, we recommend EUSTA as an alternative for transsphenoidal surgery especially for advanced age and high risk patients.
IP-5-619j Transnasal trans-sphenoidal extramucosal surgery through one nostril approach: 320 consecutive cases G. Ouaknine , N. Razon, Y. liberchuk, Y. Vashchiav, S. Rochkind. TelAviv
SouraskyMedicalCenter, Israel We present 320 consecutive cases of sellar region pathology operated in the last six years using a transnasal transephenoidal extramucosal technique through one nostril approach . They were 181 males and 139 females, aged from 15to 81 years old (mean age 49). We used the Guyot-Hardy positioning in the first 150 cases, with the surgeon lateral to the right side of the patient. The approach was almost always through the right nostril whether the septum was deviated or not. The Cushing-Falbush positioningwas used in the 170 following cases, with the surgeon silting at the patient's head. In most cases we used a modified Richardson speculum and in few cases the Hardy or Landolt speculum. We never performed a cutting at the base of the nostril to permit a larger access or dissection of the nasal mucosa. We always push aside the septum together with the mucosa at the septal insertion on the sphenoid . The 320 cases included 285 pituitary adenomas (132 nonsecreting, 72 acromegaly, 53 prolactinoma , 28 Cushing , 2 TSH); other pathologies: 35 cases (craniopharyngioma- 9. carcinoma- 7, meningioma- 6, hypophysectomy for breast carcinoma- 5. Rathke's pouch- 3, Chordoma- 3. paraganglioma- 1, arachnoidocele- 1). They were also 3 reinterventions : 2 for CSF fistula and 1 for profuse nasal bleeding . They were few complications, including diabetes insipidus: transitory- 16 or permanent- 4, CSF fistula: transient- 8 or permanent and necessitating reintervention- 2, meningiemus- 3, severe hyponatremia- 2, transient sphenoidal sinusitis- 4, smell less transitory- 12 and complete- 3, severe post operative bleeding- 1 and 1 death case (rupture of intracavernous carotid artery). In conclusion, we think that the t-nostril, extrarnucosal approach is simpler. Thicker and safer than the classical sublabial and/or submucosal approach .
IP·5-620 I Transsphenoidal approach for pituitary adenomas M. Zafer Berkman , $irzat Bek $afak, Uluer-Celal iplik9ioglu. Department of
Neurosurgery, SSK Okmeydam Hospital, istanbul, Turkey Introduction: First transsphenoidal approach for hypophyseal adenomas, comprising 10-15% of all brain tumors , was performed by Schloffer on an acromegalic patient in 1907. In time transsphenoidal approach has become the most widely used type of surgical treatment for hypophyseal tumors in almost all neurosurgery clinics.
Thursda y, /0 July /997
Methods: In this study findings of t 10 operated hypophyseal tumor cases that were diagnosed in between years 1990-1996 clinically, radiologically and by hormonal tests were evaluated retrospectively. Results: 76 of the cases were females , and 34 males, 92 of the total number of cases were between 20-50 years of age, The period from the start of complaints to admission ranged between 1 month to 7 years, most frequent preventing symptoms were headache, galactorrhea and dismenorrhea in decreasing order. A most frequently encountered sign was visual field defect. According to Wilson Grading System; 48 of the cases were Grade 2, 34 Grade 3, 23 Grade 4, 41 of the cases were Stage A. 35, Stage B, 22 Stage C. Histopathological evaluation revealed, chromophobe adenoma in 40 cases, cosinophylic adenoma in 37 cases and mixed type adenoma in 41 cases. Surgical treatments resulted in hormonal cure in 88 of the cases while clinical cure was observed in 97 cases. As post operative complicat ions we observed transient 01 in 5 cases, permanent 01 in 1 case, transient rhinorrhea in 3 cases and transient visual defect in 1 case. Discussion and conclusions: As we have observed in this study, transsphenoidal approach must be the first choice in the treatment of hypophyseal adenomas for its practical and easy application , and reasonable morbidity and mortality rates.
I P-5-621 I Microsurgical transsphenoidal removal of huge
pituitary pituitary adenomas (>3 em in diameter) in 101 cases
Zuyuan Ren, Changbao Su, Renzhi Wang, Vi Yang. Dept. of Neurosurgery,
PekingUnionMedicalCollegeHospital, Beijing 100730, PR China Introduction: Huge pituitary adenomas account for about 1/6 of all pituitary adenomas . The management is still problematic . There are only a few reports on the transsphenoidal approach of these tumors. The purpose of this study is to identify whether transsphenoidal approach can increase the effects provided by resection of the huge pituitary adenoma, and improve the visual and the endocrine function, and reduce the complications. Materials and Method: A Series of 101 patients with huge pituitary adenomas were treated by transsphenoidal microsurgical removal of tumors, from Jan. 1989 to Oct. 1996. There were 56 males, 45 females, age ranged from 20-74 yrs. The diagnosis depended on the main clinical manifestations, visual function tests, endocrine tests and sella polylomography. But CT and/or MRI scanning were most important. All tumors were over 3 em (range from 3-7 em) in maximum diameter and suprasellar extension had caused compression to the third ventricle. Results: 85 cases (85.15%) were treated with total removal of tumors, 16 cases (15.86%) with subtotal removal because of the hardness of the tumors . The capsule of prolapsed adenomas could be seen into the field within sella completely in 80 cases, incompletely in 21 cases. 94.2% (116/123 eyes) of patients with diminished preoperative visual acuity and 77.2% (101/130 eyes) of patients with preoperative visual field defects had postoperative improvement. In most of patients the endocrine function showed was also postoperative improvement . Transient diabetes insipidus in 83 cases and CSF leakage in 1 case, that was disappeared in a few days. 1 cases of meningitis was cured in 3 weeks, 1 patient died of an heart attack on the 12th day after operation . Conclusions: These data indicate that the feasibility for indication of the transsphenoidal removal of huge pituitary adenoma was obvious and the surgical results were good, safe with complications and little mortality. The authors emphasise that the transsphenoidal approach could be the first choice for removal of huge pituitary adenoma with mainly suprasellar extension .
IP-5-622/
Surgical experience with giant and invasive pituitary tumors
J.C. Lynch, R. Andrade, C. Pereira. Departmentof Neurological Surgery,
Servidores do EstadoHospitalRio de Janeiro, Brazil Introduction: Giant and invasives pituitary adenomas are very difficult to cure with surgery alone and several approach to deal with this lesions has been developed. Methods: Between 1986 to 1996, 52 patients with giant and invasive pituitary adenomas we operated on in our Institution. We consider giant pituitary adenomas to be those adenomas that, besides suprasellar extension, Show extension to the frontal or temporal lobe or posterior fossa, usually with cavemous sinus invasion. In rnost of the cases we utilized a modified pterional approach with midline extension of the craniotomy and in last 14 patients we associated an unilateral orbitotomy. Results: The mortality of these group was 5,7% and in most patients (70%) the lesions were radically removed. We institute radiotherapy only in those cases of recurrences. Conclusion: Utilising skull base approach and microsurgical techniques , the
Tumours of the CNS - Craniopharyngiomas and Pituitary Tumours
IP-5-618I unilateral-septal Resection of pituitary adenoma via an endonasal transsphenoldal approach Weiguo Zhao, lianxi Zhang , Jiankang Shen. Dept of Neurosurgery, Rui-Jin Hospitalof ShanghaiSecond Medical University, Shanghai200025, China, PR We report our successful experience of surgery for pituitary adenoma via an endonasal unilateral-septal transsphenoidal approach (EUSTA). 30 clinically and CT or MRI diagnosed pituitary adenoma patients, among whom 17 male and 13 female, age ranging from 15-72, average 45 year-Old, were included in this group. The adenomas were subclassified as nonfunctioning 11cases, PRL 5 cases, ACTH 6 cases and GH8 cases according to their clinical manifestations and endocrinological change. There were 7 microadeomas and 6 giant adenomas in this group with the maximal size of 3.6 em in diameter. The operation was conducted by an incision along the caudal edge of the septal cartilage of the right nostril and an incomplete cross section of the columella if necessary. Intraoperative X-ray monitor was used to define precisely the sellar floor and to check the degree of tumor removal making reference to the size and extent of the tumor on the sagittal MRI image. All operations went smoothly, taking less than 2 hours in average , and no need for blood transfusion. Patients symptoms were improved and no major complications were seen expect for transient CSF rhinorrhea and diabetes insipidus one case respectively. The cure and improvement rate for functional adenoma was 84% (16/19). On the basis of more than four-hundred cases of pituitary adenoma surgery experience with sublabial transsphenoidal approach in our dept, we tried a modified one of EUSTA since 1994. It is proved that this approach is applicable well to Chinese people with small nostril even for those with cushing's disease. Compared with sublabial approach, it can shorten operative distance by about 1 em, reduce operative damage , avoid gingival numbness and atrophy and result in a cosmetica lly acceptab le scar at the base of the nasal collumella. We also think it essential to have an X-ray monitor installed during operation to avoid misjudgement and to guide the extent of resection. In short, we recommend EUSTA as an alternative for transsphenoidal surgery especially for advanced age and high risk patients.
IP-5-619j Transnasal trans-sphenoidal extramucosal surgery through one nostril approach: 320 consecutive cases G. Ouaknine , N. Razon, Y. liberchuk, Y. Vashchiav, S. Rochkind. TelAviv
SouraskyMedicalCenter, Israel We present 320 consecutive cases of sellar region pathology operated in the last six years using a transnasal transephenoidal extramucosal technique through one nostril approach . They were 181 males and 139 females, aged from 15to 81 years old (mean age 49). We used the Guyot-Hardy positioning in the first 150 cases, with the surgeon lateral to the right side of the patient. The approach was almost always through the right nostril whether the septum was deviated or not. The Cushing-Falbush positioningwas used in the 170 following cases, with the surgeon silting at the patient's head. In most cases we used a modified Richardson speculum and in few cases the Hardy or Landolt speculum. We never performed a cutting at the base of the nostril to permit a larger access or dissection of the nasal mucosa. We always push aside the septum together with the mucosa at the septal insertion on the sphenoid . The 320 cases included 285 pituitary adenomas (132 nonsecreting, 72 acromegaly, 53 prolactinoma , 28 Cushing , 2 TSH); other pathologies: 35 cases (craniopharyngioma- 9. carcinoma- 7, meningioma- 6, hypophysectomy for breast carcinoma- 5. Rathke's pouch- 3, Chordoma- 3. paraganglioma- 1, arachnoidocele- 1). They were also 3 reinterventions : 2 for CSF fistula and 1 for profuse nasal bleeding . They were few complications, including diabetes insipidus: transitory- 16 or permanent- 4, CSF fistula: transient- 8 or permanent and necessitating reintervention- 2, meningiemus- 3, severe hyponatremia- 2, transient sphenoidal sinusitis- 4, smell less transitory- 12 and complete- 3, severe post operative bleeding- 1 and 1 death case (rupture of intracavernous carotid artery). In conclusion, we think that the t-nostril, extrarnucosal approach is simpler. Thicker and safer than the classical sublabial and/or submucosal approach .
IP·5-620 I Transsphenoidal approach for pituitary adenomas M. Zafer Berkman , $irzat Bek $afak, Uluer-Celal iplik9ioglu. Department of
Neurosurgery, SSK Okmeydam Hospital, istanbul, Turkey Introduction: First transsphenoidal approach for hypophyseal adenomas, comprising 10-15% of all brain tumors , was performed by Schloffer on an acromegalic patient in 1907. In time transsphenoidal approach has become the most widely used type of surgical treatment for hypophyseal tumors in almost all neurosurgery clinics.
Thursda y, /0 July /997
Methods: In this study findings of t 10 operated hypophyseal tumor cases that were diagnosed in between years 1990-1996 clinically, radiologically and by hormonal tests were evaluated retrospectively. Results: 76 of the cases were females , and 34 males, 92 of the total number of cases were between 20-50 years of age, The period from the start of complaints to admission ranged between 1 month to 7 years, most frequent preventing symptoms were headache, galactorrhea and dismenorrhea in decreasing order. A most frequently encountered sign was visual field defect. According to Wilson Grading System; 48 of the cases were Grade 2, 34 Grade 3, 23 Grade 4, 41 of the cases were Stage A. 35, Stage B, 22 Stage C. Histopathological evaluation revealed, chromophobe adenoma in 40 cases, cosinophylic adenoma in 37 cases and mixed type adenoma in 41 cases. Surgical treatments resulted in hormonal cure in 88 of the cases while clinical cure was observed in 97 cases. As post operative complicat ions we observed transient 01 in 5 cases, permanent 01 in 1 case, transient rhinorrhea in 3 cases and transient visual defect in 1 case. Discussion and conclusions: As we have observed in this study, transsphenoidal approach must be the first choice in the treatment of hypophyseal adenomas for its practical and easy application , and reasonable morbidity and mortality rates.
I P-5-621 I Microsurgical transsphenoidal removal of huge
pituitary pituitary adenomas (>3 em in diameter) in 101 cases
Zuyuan Ren, Changbao Su, Renzhi Wang, Vi Yang. Dept. of Neurosurgery,
PekingUnionMedicalCollegeHospital, Beijing 100730, PR China Introduction: Huge pituitary adenomas account for about 1/6 of all pituitary adenomas . The management is still problematic . There are only a few reports on the transsphenoidal approach of these tumors. The purpose of this study is to identify whether transsphenoidal approach can increase the effects provided by resection of the huge pituitary adenoma, and improve the visual and the endocrine function, and reduce the complications. Materials and Method: A Series of 101 patients with huge pituitary adenomas were treated by transsphenoidal microsurgical removal of tumors, from Jan. 1989 to Oct. 1996. There were 56 males, 45 females, age ranged from 20-74 yrs. The diagnosis depended on the main clinical manifestations, visual function tests, endocrine tests and sella polylomography. But CT and/or MRI scanning were most important. All tumors were over 3 em (range from 3-7 em) in maximum diameter and suprasellar extension had caused compression to the third ventricle. Results: 85 cases (85.15%) were treated with total removal of tumors, 16 cases (15.86%) with subtotal removal because of the hardness of the tumors . The capsule of prolapsed adenomas could be seen into the field within sella completely in 80 cases, incompletely in 21 cases. 94.2% (116/123 eyes) of patients with diminished preoperative visual acuity and 77.2% (101/130 eyes) of patients with preoperative visual field defects had postoperative improvement. In most of patients the endocrine function showed was also postoperative improvement . Transient diabetes insipidus in 83 cases and CSF leakage in 1 case, that was disappeared in a few days. 1 cases of meningitis was cured in 3 weeks, 1 patient died of an heart attack on the 12th day after operation . Conclusions: These data indicate that the feasibility for indication of the transsphenoidal removal of huge pituitary adenoma was obvious and the surgical results were good, safe with complications and little mortality. The authors emphasise that the transsphenoidal approach could be the first choice for removal of huge pituitary adenoma with mainly suprasellar extension .
IP-5-622/
Surgical experience with giant and invasive pituitary tumors
J.C. Lynch, R. Andrade, C. Pereira. Departmentof Neurological Surgery,
Servidores do EstadoHospitalRio de Janeiro, Brazil Introduction: Giant and invasives pituitary adenomas are very difficult to cure with surgery alone and several approach to deal with this lesions has been developed. Methods: Between 1986 to 1996, 52 patients with giant and invasive pituitary adenomas we operated on in our Institution. We consider giant pituitary adenomas to be those adenomas that, besides suprasellar extension, Show extension to the frontal or temporal lobe or posterior fossa, usually with cavemous sinus invasion. In rnost of the cases we utilized a modified pterional approach with midline extension of the craniotomy and in last 14 patients we associated an unilateral orbitotomy. Results: The mortality of these group was 5,7% and in most patients (70%) the lesions were radically removed. We institute radiotherapy only in those cases of recurrences. Conclusion: Utilising skull base approach and microsurgical techniques , the