Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients
Tóm tắt
The authors investigate the complications of transnasal transsphenoidal endoscopic surgery in the treatment of 301 patients with pituitary adenomas. A retrospective analysis of complications in 301 patients submitted to transsphenoidal transnasal endoscopic surgery at the General Hospital of Fortaleza, Brazil between January 1998 and December 2009. The complications were divided in two groups: anatomical (oronasofacial, sphenoid sinus, intrasellar, suprasellar and parasellar) and endocrinological complications (anterior and posterior pituitary dysfunctions). We observed a total of 81 complications (26.9%) in our series. Anatomical complications occurred in 8.97% (27 cases): 8 CSF postoperative leaks (2.6%), 6 cases (1.9%) of delayed nasal bleeding, 5 cases (1.6%) of sphenoidal sinusitis, 3 cases (0.9%) of carotid artery lesion, 2 cases of meningitis (0.6%) and one case (0.3%) of each of the uncommon following complications: intrasella-suprasella hematoma, pontine hematoma and chiasmaplexy. Endocrinological complications occurred in 17.9% (54 cases): additional postoperative anterior lobe insufficiency in 35 cases (11.6%), and postoperative diabetes insipidus in 19 cases (6.3%). In our series, 3 cases of deaths (not directly related to the procedure) were also observed. Endoscopic transsphenoidal surgery represents an effective option for the treatment of patients with pituitary tumor. Complications still occur and must be reduced as much as possible. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Additional improvement can be expected with greater experience and new technical developments.
Tài liệu tham khảo
Cushing H (1914) The Weir Mitchell Lecture. Surgical experience with pituitary disorders. JAMA 63:1515–1525
Hardy J (1969) Transsphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg 16:185–217
Liu JK, Das K, Weiss MH, Lawz ER Jr, Couldwell WT (2001) The history and evolution of transsphenoidal surgery. J Neurosurg 95:1083–1096
Ciric I, Ragin A, Baumgartner C, Pierce D (1997) Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40:225–237
Cooke RS, Jones RA (1994) Experience with the direct transnasal transsphenoidal approach to the pituitary fossa. Br J Neurosurg 8:193–196
Griffith HB, Veerapen R (1987) A direct transnasal approach to the sphenoid sinus. Technical note. J Neurosurg 66:140–142
Sherwen PJ, Patterson WJ, Griesdale DE (1986) Transseptal, transsphenoidal surgery: a subjective and objective analysis of results. J Otolaryngol 15:155–160
Cohen-Gadol AA, Liu JK, Laws ER Jr (2005) Cushing’s first case of transsphenoidal surgery: the launch of the pituitary surgery era. J Neurosurg 103:570–574
Guiot G, Rougerie J, Fourestier M, Fournier A, Comoy C, Vulmiere J (1963) Une nouvelle technique endoscopique: explorations endoscopiques intracrâniennes. Presse Med 72:1225–1231
Jho HD, Carrau RL (1996) Endoscopy assisted transsphenoidal surgery for pituitary adenoma: technical note. Acta Neurochir (Wien) 138:1416–1425
Cappabianca P, Cavallo LM, de Divitiis E (2004) Endoscopic endonasal transsphenoidal surgery. Neurosurgery 55:933–941
Cavallo LM, Cappabianca P, Galzio R, Iaconetta G, de Divitiis E, Tschabitscher M (2005) Endoscopic transnasal approach to the cavernous sinus versus transcranial route: anatomic study. Neurosurgery 56(2 Suppl):379–389
de Divitiis E, Cavallo LM, Esposito F, Stella L, Messina A (2007) Extended endoscopic transsphenoidal approach for tuberculum sellae meningiomas. Neurosurgery 61(5 Suppl):229–238
Dehdashti AR, Gentili F (2007) Current state of the art in the diagnosis and surgical treatment of Cushing disease: early experience with a purely endoscopic endonasal technique. Neurosurg Focus 23(3):E9
Frank G, Pasquini E, Farneti G, Mazzatenta D, Sciarretta V, Grasso V, Faustini Fustini M (2006) The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinology 83:240–248
Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL (2005) Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 19(1):E3
Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL (2005) Expanded posterior clinoids to the foramen magnum. Neurosurg Focus 19(1):E4
Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH et al (2006) A novel reconstructive technique following endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116:1881–1885
Melmed S, Casanueva F, Cavagnini F, Chanson P, Frohman LA, Gaillard R, Ghigo E, Ho K, Jaquet P, Kleinberg D, Lamberts S, Laws E, Lombardi G, Sheppard MC, Thorner M, Vance ML, Wass JA, Giustina A (2005) Consensus statement: medical management of acromegaly. Eur J Endocrinol 153:737–774
Gondim JA, Schops M, de Almeida JP, Albuquerque LAF, Gomes E, Ferraz T, Barroso FAC (2010) Endoscopic endonasal transphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center. Pituitary 13:68–77
Jankowski R, Auque J, Simon C, Marchal JC, Hepner H, Wayoff M (1992) Endoscopic pituitary tumor surgery. Laryngoscope 102:198–202
Jho HD (2001) Endoscopic transsphenoidal surgery. J Neurooncol 54:187–195
Jho HD, Carrau RL (1997) Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87:44–51
Kubo S, Hasegawa H, Inui T, Tominaga S, Yoshine T (2005) Endonasal endoscopic transsphenoidal chiasmapexy with silicone plates for empty sella syndrome. Technical note. Neurol Med Chir (Tokyo) 45:428–432
Helal MZ (1995) Combined micro-endoscopic trans-sphenoid excisions of pituitary macroadenomas. Eur Arch Otorhinolaryngol 252:186–189
Jarrahy R, Berci G, Shahinian H (2000) Assessment of the efficacy of endoscopy in pituitary adenoma resection. Arch Otolaryngol Head Neck Surg 126:1487–1490
Schwartz TH, Frqer JF, Brown S, Tabaee A, Kacker A, Anand VK (2008) Endoscopic cranial base surgery: classification of operative approaches. Neurosurgery 62:991–1005
de Divitiis E, Cappabianca P (2002) Microscopic and endoscopic transsphenoidal surgery. Neurosurgery 51:1527–1529
Cappabianca P, Cavallo LM, Colao A, de Divitiis E (2002) Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 97:293–298
Kabil MS, Eby JB, Shahinian HK (2005) Fully endoscopic endonasal versus transseptal transsphenoidal pituitary surgery. Minim Invasive Neurosurg 48:348–354
Dehdashti AR, Ganna A, Karabatsou K, Gentili F (2008) Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery 62:1006–1015
de Divitiis E, Cappabianca P, Cavallo M (2003) Endoscopic endonasal transsphenoidal approach to the sellar region. In: de Divitiis E, Cappabianca P (eds) Endoscopic endonasal transsphenoidal surgery. Springer, Wien, pp 91–130
Zada G, Kelly DF, Cohan P, Wang C, Swerdloff R (2003) Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions. J Neurosurg 98:350–358
Semple PL, Laws ER Jr (1999) Complications in a contemporary series of patients who underwent transsphenoidal surgery for Cushing’s disease. J Neurosurg 91:175–179
Petry C, Leoes CGS, Lima JFSP, Gerhardt KD, Sant GD, Oliveira MC (2009) Oronasal complications in patients after transsphenoidal hypophyseal surgery. Braz J Otorhinolaryngol 75:345–349
Kennedy DW, Cohn ES, Papel ID et al (1984) Transsphenoidal approach to the sella: the Johns Hopkins experience. Laryngoscope 94:1066–1074
Newmark H III, Kant N, Duerksen R et al (1983) Orbital floor fracture: an unusual complication of trans-septal trans-sphenoidal hypophysectomy. Neurosurgery 12:555–556
Messick JM Jr, Laws ER Jr, Abboud CF (1978) Anesthesia for transsphenoidal surgery of the hypophyseal region. Anesth Analg 57:206–215
Wilson CB, Dempsey LC (1978) Transsphenoidal microsurgical removal of 250 pituitary adenomas. J Neurosurg 48:13–22
Tabaee A, Anand VK, Barrón Y, Hiltzik DH, Brown SM, Kacker A, Mazumdar M, Schwartz TH (2009) Endoscopic pituitary surgery: a systematic review and meta-analysis. J Neurosurg 111:545–554
Pádua FG, Voegels RL (2008) Severe posterior epistaxis–endoscopic surgical anatomy. Laryngoscope 118:156–161
Rotenberg B, Tam S, Ryu WH, Duggal N (2010) Microscopic versus endoscopic pituitary surgery: a systematic review. Laryngoscope 120:1292–1297
Laws ER Jr (1999) Vascular complications of transsphenoidal surgery. Pituitary 2:163–170
Charalampaki P, Ayyad A, Kockro RA, Perneczky A (2009) Surgical complications after endoscopic transsphenoidal pituitary surgery. J Clin Neurosci 16:786–789
Black PM, Zervas NT, Candia GL (1987) Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery 20:920–924
Persky MS, Brunner E, Cooper PR, Cohen NL (1996) Perioperative complications of trans sheptosphenoidal excision for pituitary adenomas. Skull Base Surg 6:231–235
Santos RP, Zymberg ST, Abucham JZ, Gregório LC, Weckx LLM (2007) Endoscopic transnasal approach to sellar tumors. Braz J Otorhinolaryngol 73:463–475
Atkinson JL, Nippoldt TB, Koeller KK (2008) Reoperation for sella haematoma after pituitary surgery. Clin Endocrinol (Oxf) 68:413–415
Zona G, Testa V, Sbaffi PF, Spaziante R (2002) Transsphenoidal treatment of empty sella by means of a silastic coil: technical note. Neurosurgery 51:1299–1303
Raymond J, Hardy J, Czepko R, Roy D (1997) Arterial injuries in transsphenoidal surgery for pituitary adenoma: the role of angiography and endovascular treatment. Am J Neuroradiol 18:655–665
Benoit BG, Wortzman G (1973) Traumatic cerebral aneurysms. Clinical features and natural history. J Neurol Neurosurg Psychiatry 36:127–138
Pretre R, Kursteiner K, Reverdin A, Faidutti B (1995) Blunt carotid artery injury: devastating consequences of undetected pseudoaneurysm. J Trauma 39:1012–1014
Black PM, Zervas NT, Candia GL (1987) Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery 20:920924
Neal JG, Patel SJ, Kulbersh JS, Osguthorpe JD, Schlosser RJ (2007) Comparison of techniques for transsphenoidal pituitary surgery. Am J Rhinol 21:203–206