Complications resulting from transsphenoidal surgery can be traced to a number of causes, including improper indications, a variety of intercurrent medical conditions, anesthesia, the anatomy surrounding the approach and pituitary, the endocrine systems involved, and, clearly, the surgical technique. During transsphenoidal pituitary surgery, the common forms of hemostasis are modified because of the nature of the surgical field. Study design a 14 year retrospective analysis was carried out on 23 children 16 boys. Transsphenoidal surgery tss is performed in removal of the majority of pituitary tumors, although transcranial surgery may be needed in the case of a large pituitary. A smooth emergence from general anesthesia is important after this type. Perioperative management of endoscopic transsphenoidal. Transsphenoidal surgery is considered a safe procedure but it does carry the risks of various postoperative complications. Transsphenoidal surgery is performed to remove tumors from the pituitary gland, sellar region, and sphenoid sinus of the skull. Postoperative complications is an important marker of healthcare quality. Endoscopic transsphenoidal pituitary surgical technique vula.
Transsphenoidal surgery is used to remove tumors of the pituitary gland. Managing the patient with transsphenoidal pituitary tumor resection wen yuan abstract patients who undergo transsphenoidal pituitary tumor resection require a multidisciplinary team approach, consisting of a neurosurgeon, an endocrinologist, and nurses. Occasionally, though quite rare, a patient may develop a sinus infection after pituitary surgery. Pre and postoperative management of pituitary tumors remains an important part of the treatment of patients with pituitary tumors. The pituitary gland is attached to the brain and sits behind the bridge of the nose.
See transsphenoidal surgery for pituitary adenomas and other sellar masses and primary therapy of cushings disease. Transsphenoidal means that the surgery is done through the sphenoid sinus, a hollow space in the. In our series, various groups showed different postoperative complications in which csf leak was the commonest followed by di, ponv and hematoma at operation site. Postoperative diabetes insipidus is common after pituitary surgery and is typically selflimited. Discussion complications of transsphenoidal surgery. Endoscopic pituitary surgery, transsphenoidal cincinnati.
Endoscopic transsphenoidal pituitary surgery request pdf. A smooth emergence from general anesthesia is important after this type of surgery to limit the risk of complications, such as a cerebrospinal. Thorough knowledge of the anesthetic implications of various surgical approaches, transsphenoidal, transethmoidal or transcranial is essential for the anesthesiologist. Transsphenoidal surgery for pituitary tumors is done to remove a tumor on the pituitary gland. Advances in the understanding of the biology of pituitary tumours, close cooperation between endocrinologists, surgeons and oncologists, and huge advances in. Post pituitary surgery fact sheet this information has been provided for patients who have recently had pituitary surgery and to inform patients of what they could expect postoperatively. Endoscopic endonasal transsphenoidal surgery american. This section also offers explanations regarding diagnosis, treatment, therapy and surgery. The transseptal transsphenoidal approach allows the surgeon to reach lesions located in the middle of the skull base and is widely accepted as the procedure of choice for the surgical treatment of pituitary adenomas with a primary sellar extension. Robert solomon im living a normal life for the first time. Josephs hospital and medical center, phoenix, arizona.
Transsphenoidal surgery for pituitary tumours archives of. Growth hormonesecreting pituitary tumors are the most common cause of acromegaly, which is associated with serious complications, including cardiomyopathy and heart failure. These will help minimize sinus headaches and help mucus and blood drain away as you heal after surgery. Endoscopic pituitary surgery johns hopkins medicine. Pdf anesthesia for transsphenoidal pituitary surgery. Successful transsphenoidal surgery needs expert nursing care for early identification and prompt treatment of pituitary dysfunction and. The obtained results indicate that an endoscopic approach seems to be more advantageous than a microscopic approach for protecting olfactory system and function.
This is the first study to seek the difference between the endoscopic and microscopic transsphenoidal approaches on the olfactory system during pituitary surgery. Some patients will require treatment with desmopressin and it is important to avoid overshoot iatrogenic syndrome of inappropriate antidiuretic hormone siadh and hyponatremia in these patients. How well the surgery works depends on the type of tumor, its exact location, its size, and whether it has spread into nearby structures. A multidisciplinary approach is important in managing patients with pituitary disease. More of these operations have been performed at ucsf than any other site in the united states. More extensive previous experience with transsphenoidal surgery was associated with a greater likelihood of having witnessed each specific complication. Complications associated with microscopic and endoscopic. Transsphenoidal surgery, although not strictly a craniotomy, involves manipulation of ventilation to raise the paco 2 and icp, which forces the pituitary into a more easily visualized position. The mean operative mortality rate for all three groups was 0. Patients who undergo transsphenoidal pituitary tumor resection require a multidisciplinary team approach, consisting of a neurosurgeon, an endocrinologist, and nurses.
Cappabianca has been a leader in this regard and has developed a set of instrumentation specific to this procedure. Transsphenoidal surgery is a type of surgery in which an endoscope andor surgical instruments are inserted into part of the brain by going through the nose and the sphenoid bone a butterflyshaped bone forming the anterior inferior portion of the brain case into the sphenoidal sinus cavity. If you have other questions, please write them down so we can answer them for you. Binostril versus mononostril approaches in endoscopic. The outcome of endoscopic endonasal transsphenoidal surgery in 10 patients with pituitary adenomas was compared with that of traditional transnasal transsphenoidal approach tta in 20 subjects. Endoscopic endonasal transsphenoidal approach to pituitary. In 2000, the direct endonasal approach for transsphenoidal surgery was developed at ucsf making this surgery even less invasive and greatly reducing surgical complications. Call your neuroendocrinologistlocal endocrinologist.
Since the first report of successful endonasal endoscopic resection of pituitary adenomas by jankowski et al 1 in 1992, endoscopic endonasal surgery has. Anaesthesia and pituitary disease bja education oxford. Endoscopic pituitary and skull base surgery anatomy and surgery of the endoscopic endonasal. Initially operations were performed often without any input from endocrinology colleagues, and without preoperative imaging, operative magnification and illumination. Complications following primary and revision transsphenoidal. Propofol requirement in patients with growth hormone. The transseptal transsphenoidal approach to pituitary tumors. Surgery for pituitary tumors american cancer society.
Proposing a strategy for sellar reconstruction in endoscopic transsphenoidal transsellar approachfor pituitary adenoma. Surgical technique, results, and complications of transsphenoidal surgery are discussed separately. Pituitary diseases have anaesthetic implications, such as a challenging airway, obstructive sleep apnoea, and associated endocrine disease. The endoscopic transsphenoidal approach has become widely adopted for the resection of pituitary tumors. Arrange to have someone drive you home after surgery. Among the 10 individuals subjected to pure endoscopy. The endoscopic endonasal transsphenoidal approach to pituitary tumors is a safe and minimally invasive procedure, which can be employed safely in any of our centers in nepal, equipped with endoscopic sinus surgery and endoscopically trained ent and neurosurgeons. Managing the patient with transsphenoidal pituitary tumor. All these children and adolescents with pituitary adenomas were managed with microscopic transsphenoidal surgery. A lmost a century ago in 1907, the transnasal transsphenoidal approach to lesions of the sella turcica was first intro. This method can be designated as pure pituitary endoscopy and not only as a complement to the microscopic intervention the term pure being applied to a surgical procedure in which the endoscope is the only optical device being used. Anesthesia for transsphenoidal pituitary surgery anestesinorr. The main treatment for many pituitary tumors is surgery. For a transsphenoidal approach, no significant differences in surgical outcomes, mortality during the perioperative period or complications were observed between patients younger than 14 years old.
Transsphenoidal surgery almost always results in a decrease in adenoma size figure 18. Fatal complication after transsphenoidal surgery of pituitary. Post operative instructions after transsphenoidal surgery this information is intended to answer questions you may have after your tss pituitary surgery. Complications of transsphenoidal surgery latest news and. Endoscopic pituitary and skull base surgery karl storz. Fatal complication after transsphenoidal surgery of pituitary adenoma. The narrow approach hampers the use of standard bipolar cautery. This section answers frequently asked questions regarding transsphenoidal surgery for pituitary adenomas. The major complication rate following both primary and revision transsphenoidal pituitary surgery was calculated.
Transsphenoidal surgery an overview sciencedirect topics. National hospital for neurology and neurosurgery pituitary. It is responsible for regulating most of your bodys hormones, the chemical messengers that travel through your blood. Transsphenoidal surgery for pituitary tumours archives. What to expect after transsphenoidal pituitary surgery. Majority of pituitary surgery is now performed via the transsphenoidal approach as it has fewer incidence of complications.
Pituitary tumor resection is one of the common neurosurgical procedures performed. Sublabial transsphenoidal approach and resection of pituitary tumors suboccipital craniectomy for microvascular decompression of the trigeminal nerve or facial nerve or cerebellopointine angle tumor splitting the sylvian fissure, drilling of the anterior clinoid process and ophthalmic aneurysm clipping. Rapidly deteriorating neurologic status after closed head injury often leads to emergency intubation, neuroradiologic studies, and emergent craniotomy. The endoscopic technique has been gaining in popularity in recent years. Seventy to eighty percent of patients who have abnormal visual fields due to a gonadotroph adenoma in one series experienced improvement following transsphenoidal surgery. Objectives transsphenoidal surgery tss is the preferred method for the excision of pituitary microadenomas in adults. The purpose of this study was to establish the value of early postoperative mr imaging in differentiating residual tumor from postoperative surgical changes in the sella after transsphenoidal resection of pituitary adenomas. Transnasal transsphenoidal approach to pituitary iowa. Pituitary adenomas are benign slowgrowing tumours that arise within the pituitary gland. Transsphenoidal surgery tss is performed in removal of the majority of pituitary tumors, although transcranial surgery may be needed in the case of a large pituitary tumor with no or a minor. To examine the osmotic regulation of vasopressin secretion in normonatremic patients, water loads were administered 7 days after surgery. Endoscopic endonasal transsphenoidal surgery neurosurgery.
Sublabial transsphenoidal approach and resection of. Transsphenoidal surgery and pituitary irradiation, section on transsphenoidal surgery. All operations and procedures have risks and we will talk to you about the risks of transsphenoidal hypophysectomy. The main treatment for most pituitary tumor patients is a minimally invasive operation called transsphenoidal surgery. Immediate postoperative complications in transsphenoidal. Microscopic transsphenoidal surgery for pituitary adenomas in. Managing the patient with transsphenoidal pituitary tumor resection. Olfactory functions after transsphenoidal pituitary. Study design a 14 year retrospective analysis was carried out on 23 children 16 boys and seven girls, all less than 18 years of age, who had undergone tss at our centre. Endoscopic pituitary surgery transsphenoidal overview. Patients with functioning adenomas frequently present with symptoms of. I have been told i need surgery for a pituitary adenoma. Memorial sloan kettering surgeons are particularly experienced in using this technique, also called transnasal endoscopy, to remove pituitary.
Transsphenoidal pituitary surgery is the standard surgical treatment for most pituitary tumors 1. Pdf anesthesia for transsphenoidal pituitary surgery researchgate. The history and development of the transsphenoidal approach to the sella is discussed, as are the contemporary techniques of microscopic and endoscopic pituitary surgery. Complication avoidance and management techniques will be of great value to neurosurgeons, otolaryngologists, endocrinologists, radiation oncologists, and residents and fellows in these specialties. Computerassisted navigation and intraoperative mri has further improved surgical outcomes. Your pituitary gland is a small, beanshaped structure that lies at the base bottom of your brain behind your eyes. Pituitary adenoma, surgical technique, transsphenoidal surgery neurosurgery 51. The care of these patients involves a detailed knowledge of pituitary hormonal imbalances and the effects. Case example transphenoidal approach to pituitary tumorreturn to. Pedicled nasoseptal flap hadadbassagasteguy flap protocolclick on videos below to active.
Transsphenoidal surgery for pituitary tumors precare. Bivariate analyses were performed to investigate the relationship of patient characteristics with complication occurrence, and a multivariate model was constructed to determine risk factors associated with these complications. The endoscopic endonasal transsphenoidal approach to the sella is performed via. When performed at experienced pituitary centers, transsphenoidal surgery for pas may be performed with a high degree of safety. Frequently asked questions about transsphenoidal surgery for. Propofol is known to be better than inhalation agents for. Ct of the sella turcica after transsphenoidal resection of. Your blood sodium level may be too lowhyponatremia. The impact of resident and fellow participation in.
This study was carried out to establish the long term efficacy and safety of tss in children. Ninetytwo patients who underwent transsphenoidal pituitary surgery were studied. May 23, 2004 the primary objectives of this report were, first, to determine the number and incidence of complications of transsphenoidal surgery performed by a crosssection of neurosurgeons in the united states and, second, to ascertain the influence of the surgeons experience with the procedure on the occurrence of these complications. The pituitary gland is located at the bottom of your brain and above the inside of your nose. Division of neurological surgery, barrow neurological institute, st. To evaluate posterior pituitary damage, a questionnaire was completed immediately after surgery in 61 patients. This is the most common way to remove pituitary tumors.
Pituitary surgery california center for pituitary disorders. This is why we test your blood at regular intervals during the first 2 weeks after surgery. Corticotrophproducing adenomas represent approxi mately 16% of all surgically resected pituitary tumors. Transsphenoidal surgery for pituitary adenomas pituitary adenomas are benign tumors which arise from the pituitary gland and can be successfully treated with transsphenoidal through the sinus surgery.
May 23, 2004 discussion complications related to indications. Transnasal transsphenoidal approach to pituitary transnasal transsphenoidal approach to pituitary see. Transsphenoidal surgery for pituitary tumors memorial. The popular embrace of a multidisciplinary stratagem to disease management has seen the incorporation of otolaryngologists, neurosurgeons, and neuroendocrinologists as integral parts of teams addressing pituitary lesions. The transseptal transsphenoidal approach to pituitary. No differences in complication rates between endoscopic and microscopic surgery were observed. This article examines recent advancements in the preoperative assessment and anesthetic management of patients undergoing transsphenoidal pituitary surgery. Madisons epilepsy cure meet the doctor video series complete. The miracle on fort washington avenue aneurysm surgery is a personal choice, says dr. Pathophysiology of hyponatremia after transsphenoidal. The aim of this study was to analyze the impact of resident and fellow participation on postoperative complications in transsphenoidal pituitary surgery in a multi. Pituitary adenomas are benign slowgrowing tumours that.
The endoscopic endonasal transsphenoidal approach to pituitary tumors is a safe and minimally invasive procedure, which can be employed safely. In this minimally invasive surgery, the surgeon works through the nostrils with a tiny endoscope camera and light to remove tumors with long instruments. Transsphenoidal surgery is a surgical procedure that allows the surgeon to remove tumours, cysts or other abnormalities that can affect the pituitary gland and the area around it. Transsphenoidal surgery continues to be the mainstay of surgical treatment for pituitary tumors, and has good outcomes in experienced hands. Successful transsphenoidal surgery needs expert nursing care for early identification and prompt treatment of pituitary dysfunction and neurosurgical complications. Pdf pituitary tumors are commonly encountered in clinical practice. We also use monopolar or bipolar suction cautery for dural bleeding. Anesthesia for transsphenoidal pituitary surgery uptodate.
Endoscopic surgery is performed through the nose to remove tumors from the pituitary gland and skull base. Tell your surgeon about all medicines you currently take. Apr 01, 2004 this book is a must for any pituitary surgeon, and, to this end, as a critical member of the team, the neuroradiologist will gain great insight into how surgeons and endocrinologists approach this disease, along with the evolving field of minimally invasive surgery as it relates to pituitary surgery. Definition of transsphenoidal surgery nci dictionary of. Backgroundsurgical approaches to the pituitary have undergone significant changes from transcranial, sublabial, direct transnasal microscopic, and now endoscopic. Frequently asked questions about transsphenoidal surgery. Contemporary indications for transsphenoidal pituitary surgery. Risk factors for complications included prior surgical treatment and pa invasion. Endoscopic transsphenoidal pituitary adenoma resection. Recent findings endoscopic guidance has improved tumor visualization while minimizing the risk of nasal and dental complications and septal perforation.1001 1469 550 629 1257 879 1183 1095 825 1296 268 732 1059 30 1411 147 364 498 492 688 1034 305 169 184 829 605 549 1294 788 1152 909 580 239 1367 745 367 838 696 1137 437 1399 920 715