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Transsphenoidal hypophysectomy

N Vastenhout, S J van Rijn, F M Riemers, M A Tryfonidou, B P Meij, L C Penning
Pituitary-dependent hypercortisolism (PDH) is a common endocrinopathy in dogs, but the promotors and initiators of the tumourigenesis of corticotroph pituitary adenomas remain unknown. Based on human data, we investigated mRNA expression of pituitary tumour transforming gene 1 (PTTG1) with quantitative RT-PCR in canine corticotroph pituitary adenomas. PTTG1 was overexpressed in adenomas approximately 3-fold. A strong association was observed between PTTG1 expression and disease-free interval; dogs with high PTTG1 expression had a significantly (4 times; P=0...
October 2018: Veterinary Journal
Margaret A Miller, Tina Jo Owen, David S Bruyette, J Catharine Scott-Moncrieff, José A Ramos-Vara, Hsin-Yi Weng, Annie V Chen, Linda G Martin, Deidre M DuSold
Hypophysectomy specimens from 16 dogs with pituitary adenoma were evaluated with periodic acid-Schiff (PAS), reticulin, and immunohistochemistry for adrenocorticotrophic hormone (ACTH), melanocyte stimulating hormone (MSH), growth hormone (GH), and Ki-67. The reticulin network was obliterated in all adenomas. One adenoma expressed ACTH and GH. Eight corticotroph adenomas were basophilic to chromophobic, and PAS- and ACTH-positive. Seven melanotroph adenomas were distinguished from corticotroph adenomas by expression of MSH...
November 2018: Veterinary Pathology
Tina J Owen, Annie V Chen, Stephen Frey, Linda G Martin, Tobin Kalebaugh
OBJECTIVE: To determine the accuracy of locating the pituitary fossa with the Brainsight neuronavigation system by determining the mean target error of the rostral (tuberculum sellae) and caudal (dorsum sellae) margins of the pituitary fossa. STUDY DESIGN: Experimental cadaveric study. ANIMALS: Ten canine cadavers. METHODS: Computed tomography (CT) and MRI were performed on each cadaver with fiducials in place. Images were saved to the neuronavigation computer and used to plan the drilling approach...
July 2018: Veterinary Surgery: VS
Lara A Boland, Vanessa R Barrs
Practical relevance: Hyperadrenocorticism (HAC) is a relatively uncommon endocrinopathy of older cats, with a mean age at diagnosis of 10 years. In addition to pituitary-dependent and adrenal-dependent hypercortisolism, clinical signs of HAC can result from adrenal sex steroid-producing tumours. Clinical challenges: While HAC in cats has many similarities to canine HAC, there are key differences in presentation, diagnosis and response to therapy. Most, but not all, cats with HAC have concurrent diabetes mellitus, which is often insulin resistant...
September 2017: Journal of Feline Medicine and Surgery
Chukwudi O Chiaghana, Julia M Bauerfeind, Cheri A Sulek, J Christopher Goldstein, Caleb A Awoniyi
BACKGROUND: Acromegaly is a rare syndrome in which there is unregulated hypersecretion of growth hormone. The anesthetic management of patients with this disorder is particularly challenging due to pre-existing cardiovascular and respiratory dysfunction, as well as recognized difficulties with airway management. Because of the insidious progression of the disease and the presence of nonspecific signs and symptoms, diagnosis is often made late when characteristic acromegalic features become apparent...
June 24, 2017: Journal of Medical Case Reports
Curtis Hanba, Peter F Svider, Jeffrey T Jacob, Murali Guthikonda, James K Liu, Jean Anderson Eloy, Adam J Folbe
OBJECTIVES/HYPOTHESIS: To explore the relationship between lower airway disease and postoperative cerebrospinal fluid (CSF) rhinorrhea among patients undergoing pituitary surgery STUDY DESIGN: Retrospective review. METHODS: A retrospective review of the Healthcare Cost and Utilization Project's 2013 National Inpatient Sample was conducted to characterize the hospital stay and surgical outcomes of patients undergoing pituitary surgery. Patients with lower airway disease (including chronic obstructive pulmonary disease and asthma) were compared to a disease-free population identifying demographics and complications over-represented in the lower airway group...
July 2017: Laryngoscope
Emily P Sieg, Hayk Stepanyan, Russell Payne, Tao Ouyang, Brad E Zacharia
Pituitary macroadenomas are the most common suprasellar lesions in adults and are typically managed surgically through transsphenoidal resection when symptomatic. Due to their close proximity to the optic chiasm, pituitary macroadenomas often present with signs of bitemporal hemianopsia. Alternatively, these tumors can cause mass effect, thus presenting with signs of elevated intracranial pressure or can present with signs and symptoms of endocrine dysfunction. Here, we discuss a 55-year-old male diagnosed with a non-functioning pituitary macroadenoma (NFPA) based on cranial imaging, ophthalmologic exam, and endocrine evaluation...
October 20, 2016: Curēus
Hasmet Yazici, Sedat Doğan, Mehmet Akif Sönmez, Olcay Eser
INTRODUCTION: Pituitary surgery involving different techniques is often applied to the excision of benign adenomas. Operative interventions involved various approaches and techniques. Endoscopic transsphenoidal approach is the less traumatic route to the sella turcica, avoiding brain retraction, and also permitting good visualization, with lower rates of morbidity and mortality. Although mortality of pituitary surgery decreased by advances in surgical techniques morbidities such as synechiae formation, anosmia, bleeding, nasal septal perforations, drying, and incrustation due to traumatization of the nasal structures such as septum, nasal mucosa, and middle concha are the current problems in pituitary surgery...
October 2016: Journal of Craniofacial Surgery
Russell R Lonser, Gautam U Mehta, Bogdan A Kindzelski, Abhik Ray-Chaudhury, Alexander O Vortmeyer, Robert Dickerman, Edward H Oldfield
BACKGROUND: Carney complex (CNC) is a familial neoplasia syndrome that is associated with pituitary-associated hypersecretion of growth hormone (GH) (acromegaly). The underlying cause of pituitary GH hypersecretion and its management have been incompletely defined. OBJECTIVE: To provide biological insight into CNC-associated pituitary pathology and improve management, we analyzed findings in CNC patients who underwent transsphenoidal surgery. METHODS: Consecutive CNC patients at the National Institutes of Health with acromegaly and imaging evidence of a pituitary adenoma(s) who underwent transsphenoidal resection of tumor(s) were included...
May 1, 2017: Neurosurgery
Sara Del Magno, Guy C M Grinwis, George Voorhout, Björn P Meij
Selective removal of the pituitary adenoma has not been advocated in dogs with pituitary-dependent hypercortisolism because the pituitary adenoma is usually not visualized on routine computed tomography (CT). Dynamic pituitary CT scanning is aimed at the detection of the pituitary flush and, indirectly, at the presence and position of the adenoma. The first aim of this retrospective study was to compare findings of a multiple slice dynamic scanning protocol with those of a single slice dynamic protocol using a single slice CT scanner...
August 2016: Research in Veterinary Science
S J van Rijn, S Galac, M A Tryfonidou, J W Hesselink, L C Penning, H S Kooistra, B P Meij
BACKGROUND: Transsphenoidal hypophysectomy is one of the treatment strategies in the comprehensive management of dogs with pituitary-dependent hypercortisolism (PDH). OBJECTIVES: To describe the influence of pituitary size at time of pituitary gland surgery on long-term outcome. ANIMALS: Three-hundred-and-six dogs with PDH. METHODS: Survival and disease-free fractions were analyzed and related to pituitary size; dogs with and without recurrence were compared...
July 2016: Journal of Veterinary Internal Medicine
Kaveh Karimnejad, Justin Michael Sweeney, Jastin Levi Antisdel
Cerebral vasospasm following transsphenoidal hypophysectomy is an exceedingly rare but serious complication with high morbidity and mortality. The initial signs and symptoms of cerebral vasospasm following transsphenoidal hypophysectomy are changes in mental status, motor deficits, and speech difficulties. Symptomatic vasospasm is difficult to reverse despite treatment and often only resolves with time. Furthermore, most transsphenoidal hypophysectomy patients have been discharged before the onset of vasospasm, so when they do present it is often in a fulminant form and recalcitrant to available treatments...
June 2016: Journal of Craniofacial Surgery
Matthew D Wiles, Matthew I Sanders, Saurabh Sinha, Showkat Mirza, John C Andrzejowski
In patients undergoing endoscopic transsphenoidal hypophysectomy, the nasal mucosa is often infiltrated with local anesthetic solutions that contain epinephrine to aid hemostasis. This may, however, result in hemodynamic changes, especially hypotension. We characterized the cardiovascular changes using a LiDCOrapid monitor in 13 patients after the infiltration of 4% articaine containing 1:200,000 epinephrine. Nine (69%) had a >20% decrease in mean arterial pressure at a median time of 116 seconds after the infiltration of articaine with epinephrine...
July 2017: Journal of Neurosurgical Anesthesiology
Yoshikazu Ogawa, Kenichi Sato, Yasushi Matsumoto, Teiji Tominaga
BACKGROUND: Giant pituitary adenomas carry higher surgical risks despite recent advances in microsurgical and/or endoscopic surgery, and postoperative acute catastrophic changes without major vessel disturbance are still extremely difficult to predict, may manifest as postoperative pituitary apoplexy, and are associated with poor outcomes. METHODS: Eight males and 4 females aged 31-72 years (mean 50.7 years) with giant pituitary adenomas underwent preoperative investigation of fine angioarchitecture using C-arm cone-beam computed tomography with a flat-panel detector...
January 2016: World Neurosurgery
S Carr, V Twigg, S Mirza
OBJECTIVES: An optimum septoplasty result may require complete detachment of the superior osseocartilaginous junction (OCJ), but this may lead to disruption of the keystone area with loss of nasal support and consequent supratip depression deformity. The aim of this study was to analyse normal keystone anatomy using CT scan images and to estimate the incidence of risk of supratip depression when completely detaching the OCJ. DESIGN: Retrospective study. SETTING: Tertiary referral centre...
August 2016: Clinical Otolaryngology
M A Kutin, A B Kurnosov, P L Kalinin, D V Fomichev, S N Alekseev, A N Shkarubo, O I Sharipov, Yu V Strunina
The structure of surgery of pituitary adenomas has been fundamentally changed over the past decade. The transnasal transsphenoidal approach is currently used to resect more than 95% of adenomas. The wide use of endoscopy has changed the need for perioperative control of intracranial pressure. While controlled intracranial hypertension was previously used during microscopically controlled transnasal surgery to bring the suprasellar capsule and tumor remnants to the field of vision, endoscopically controlled tumor resection implies that controlled intracranial hypotension is required to achieve complete spreading of the suprasellar capsule...
2015: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
Garni Barkhoudarian, Aaron R Cutler, Sam Yost, Bjorn Lobo, Amalia Eisenberg, Daniel F Kelly
OBJECTIVE: With the resection of pituitary lesions, the anterior pituitary gland often obstructs transsphenoidal access to the lesion. In such cases, a gland incision and/or partial gland resection may be required to obtain adequate exposure. We investigate this technique and determine the associated risk of post-operative hypopituitarism. METHODS: All patients who underwent surgical resection of a pituitary adenoma or Rathke cleft cyst (RCC) between July 2007 and January 2013 were analyzed for pre- and post-operative hormone function...
December 2015: Pituitary
S J van Rijn, J M Hanson, D Zierikzee, H S Kooistra, L C Penning, M A Tryfonidou, B P Meij
BACKGROUND: Transsphenoidal hypophysectomy is an effective treatment for dogs with pituitary-dependent hypercortisolism (PDH). However, long-term recurrence of hypercortisolism is a well-recognized problem, indicating the need for reliable prognostic indicators. OBJECTIVES: The aim of this study was to evaluate the prognostic value of perioperative plasma ACTH and cortisol concentrations for identifying recurrence of hypercortisolism after transsphenoidal hypophysectomy...
May 2015: Journal of Veterinary Internal Medicine
Giorgio Frank, Matteo Zoli, Diego Mazzatenta, Ernesto Pasquini, Giovanni Farneti
Among the fathers of transsphenoidal surgery, a relevant role should be reserved for Cesare Cavina (1888-1935). He had the merit to develop and popularize in Italy this approach for pituitary tumors, performing 47 transsphenoidal hypophysectomies out of his personal series of 66 patients between 1927 and 1935. He contributed to this surgery by introducing radiological control of the surgical trajectory to reduce the risk of complications and increase the safety of this approach. We think that both his short lifespan (he died when he was 47 years old) and the language of his papers (Italian and not English) are two important factors that have contributed to forgetting his role in the history of transsphenoidal surgery...
June 2015: Acta Neurochirurgica
Brandon D Liebelt, Meng Huang, David S Baskin
OBJECTIVE: The Medpor porous polyethylene implant provides benefits to perform sellar floor reconstruction when indicated. This material has been used for cranioplasty and reconstruction of skull base defects and facial fractures. We present the most extensive use of this implant for sellar floor reconstruction and document the safety and benefits provided by this unique implant. METHODS: The medical charts for 200 consecutive patients undergoing endonasal transsphenoidal surgery from April 2008 through December 2011 were reviewed...
August 2015: World Neurosurgery
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