Endonasal transsphenoidal sellar tumor resection in treating non-functioning pituitary adenomas with hyperprolactinemia: An analysis of efficacy / 第二军医大学学报

Objective To explore the therapeutic effect of endonasal transsphenoidal sellar tumor resection surgery for the treatment of non-functioning pituitary adenoma patients with hyperprolactinemia. Methods A total of 80 non-functioning pituitary adenoma patients with serum prolactin level ＞25 ng/mL and ＜200 ng/mL, who underwent endonasal transsphenoidal sellar tumor resection surgery in the Department of Neurosurgery of our hospital from Jan. 1, 2015 to Dec. 31, 2019, were retrospectively included. The clinical characteristics, surgical methods, postoperative complications, and the relief of postoperative hyperprolactinemia and clinical symptoms were analyzed. The predictive factors of postoperative hyperprolactinemia remission were analyzed using logistic regression. Results Out of the 80 patients, 21 were males and 59 were females. The preoperative prolactin level was 51.11 (25.20-136.52) ng/mL, and the tumor volume was 3.99 (0.23-37.11) cm3. Headache was the most common initial symptom (37.5%, 30/80). There was significant difference in the initial symptoms between the male and female patients (P＝0.031), and the female patients were more likely to present with hypogonadotropic hypogonadism compared with the male patients (28.8%［17/59］vs 9.5%［2/21］). The male patients were significantly more likely to have two or more hormonal axis dysfunctions (47.6%［10/21］vs 15.3%［9/59］, P＝0.025). All the 80 patients received the resection surgery and 88.8% (71/80) of them achieved gross or near total resection. Sixty-five (81.2%) patients had remission of hyperprolactinemia within 3 months after surgery, and the prolactin level was 13.44 (1.74-24.19) ng/mL 3 months after surgery; 15 patients had no remission, and the corresponding prolactin level was 32.69 (25.20-115.23) ng/mL. The prolactin levels before and 1 d after surgery were significantly lower in the remission group than those in the non-remission group (preoperative: 45.47 ［25.20-136.52］ng/mL vs 64.82［33.17-130.88］ng/mL, P＝0.003; postoperative day 1: 13.12［0.60-36.35］ng/mL vs 40.06 ［26.25-118.01］ng/mL, P＜0.01). There were no significant differences in gender, age, tumor volume, surgical methods or extent of tumor resection between the two groups (all P＞0.05). Multivariate logistic regression analysis showed that prolactin level ≤25 ng/mL on postoperative day 1 was an independent predictor of remission of hyperprolactinemia (odds ratio 13.500, 95% confidence interval 3.623-50.298, P＜0.01). The visual defect and headache improvement rates were 87.9% (29/33) and 93.9% (31/33), respectively. Among the 17 female patients with menstrual disorders before surgery, 14 (82.4%) returned to normal menstrual cycles. Conclusion Endonasal transsphenoidal sellar tumor resection surgery is a reliable treatment option for non-functioning pituitary adenoma patients with hyperprolactinemia.

Acessos endoscópicos para lesões hipofisárias / Endoscopic approach of the pituitary lesions

Ao longo dos anos, a cirurgia minimamente invasiva avançou com a contribuição importante dos neurocirurgiões sobre a melhor opção para a abordagem terapêutica de tumores da região selar, partindo-se de uma cirurgia extremamente prejudicial, com alta morbidade e mortalidade, até a evolução de técnicas mais modernas, as quais dispõem de materiais mais adequados, que permitem ressecções completas com menor agressão às estruturas neurovasculares. Para praticá-las, é necessário um grupo de trabalho que envolva diferentes especialidades, como endocrinologia, oftalmologia, otorrinolaringologia, neurocirurgia e radioterapia, a fim de oferecer aos pacientes as melhores opções, garantindo atendimento individualizado, resolutivo e pouco agressivo. Há necessidade de um planejamento pré-operatório cuidadoso, com o uso de exames complementares avançados como ressonância magnética, tomografia computadorizada dos seios da face, dosagem sérica dos hormônios hipofisários e campimetria visual. Ainda, durante o procedimento cirúrgico, pode-se dispor de neuronavegação, tornando a cirurgia mais segura, especialmente nas reoperações. Por essas vantagens, a cirurgia transesfenoidal por microscopia convencional e por endoscopia é o procedimento atual de escolha para tratar tumores selares e fornecer adequada descompressão de estruturas neurais, com recuperação favorável mais rápida no pós-operatório em comparação com a abordagem transcraniana convencional.

Over the years, minimally invasive surgery has advanced with the important contribution of neurosurgeons for the best option for the therapeutic approach of sellar tumors. Starting from an extremely harmful surgery with high morbidity and mortality until the evolution of techniques modern, which have the most suitable materials, which allow complete resections with less aggression to the neurovascular structures. To do them, is necessary a working group involving different specialities, such as endocrinology, ophthalmology, otolaryngology, neurosurgery and radiotherapy in order to offer patients the best options, ensuring individualized care, resolute and less aggressive. It?s necessary a careful preoperative planning, using advanced exams such as MRI, CT scan of the sinuses, serum levels of pituitary hormones and visual perimetry. Still, the surgical procedure can be increased with the neuronavigation, making surgery more safer, especially in reoperations. Thus, because of these advantages, transphenoidal surgery for conventional microscopy and for endoscopy is the current procedure of choice for treating parasellar tumors, and provide adequate decompression of the neural structures with a favorable and faster recovery after surgery compared to the approach transcranial conventional.

Clinical Results of Endoscopic Endonasal Transsphenoidal Hypophysectomy during an Acceleration Phase of Learning Curve / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to compare endoscopic endonasal transsphenoidal hypophysectomy (EETSA) with microscopic transseptal transsphenoidal hypophysectomy (MTTSA) in terms of clinical results during an acceleration of learning curve. SUBJECTS AND METHOD: A retrospective chart review was performed of the first 14 cases of EETSA and previous 14 cases of MTTSA. Resection results, endocrinologic outcomes, complication rates, operating time, and duration of hospital stay were investigated. A non-parametric analysis was performed to determine the significance of differences between groups. RESULTS: EETSA was performed, achieving gross total removal, based on postoperative MRI, for 12 of the 14 patients (86%) and hormonal remission for 4 of the 5 patients (80%); on the other hand, MTTSA was performed, achieving gross total removal for 9 of the 14 patients (64%) and hormonal remission for 1 of the 5 patients (20%). We found better resection results in patients who underwent EETSA than in those who did MTTSA with respect to tumors extending into suprasellar area (p<0.05). Visual improvement was achieved in all the cases with visual defect (n=5) after EETSA, whereas 4 of 6 cases (66%) were improved after MTTSA. Significant differences in complication rates, operating time and hospital stay could not be determined. All cases with CSF leakage in EETSA were successfully managed by using the nasoseptal flap. CONCLUSION: EETSA provided better resection results than MTTSA did, especially in cases extending into the suprasellar area, showing good hormonal cure and visual improvement rates. Two approaches were comparable with respect to complications during the learning curve.

Endonasal Endoscopic Transsphenoidal Pituitary Surgery for Pituitary Adenoma: A retrospective Analysis Of Surgical Outcome

The purpose of this retrospective joint rhino-neurosurgical study from January 1998 until September 2009 is to document the demographic data, clinical presentations, radiological findings, approaches and incidence of residual tumour. Forty-seven patients with pituitary adenoma underwent trans-sphenoidal hypophysectomy of which 25 patients with complete medical and radiological data were included in the study. The medical and radiological data were analyzed. There were 12 males and 13 females with age ranging from 17 to 76 years old (mean 49.2). Fourteen of the patients were Chinese, eight Malays and three Indians. Twelve of the patients had functioning tumour of which five each presented with acromegaly and Cushing disease respectively and two with amenorrhoea. The rest of 13 patients had non functioning tumour presenting with visual disturbances. Sixteen of the patients had pituitary macroadenomas and the rest 9 microadenomas. Eighteen patients had undergone transcollumellar trans-sphenoidal hypophysectomy and the rest 7 patients had undergone transnasal transsphenoidal hypophysectomy. About 68.8% of pituitary macroadenomas had residual tumour, compared to only 22.2% of patient with pituitary microadenomas. Radiologically, about 45.5% of residual macroadenoma had suprasellar extension and the majority had spread to suprasellar cistern and carvenous sinus (54.5%). About 16.6% of patients had undergone post operative radiotherapy. In conclusion, this study showed that patient with pituitary macroadenomas had higher incidence of residual tumour compared to pituitary microadenomas

Oronasal complications in patients after transsphenoidal hypophyseal surgery / Complicações oronasais em pacientes pós-abordagem hipofisária via transesfenoidal

Transsphenoidal surgery is the most commonly used surgical procedure to handle the hypophyseal region, sometimes associated with oronasal complications. MATERIAL AND METHODS/AIM: To evaluate prospectively (specific questionnaire, clinical evaluation) undiagnosed chronic oronasal complications in patients submitted to conventional transsphenoidal adenomectomy surgery, operated at different neurosurgery services more than 6 months ago. RESULTS: 49 patients were evaluated, 37/45 presented macroadenoma. 28,5 percent were submitted to more than one intervention, 2/5 transsphenoidally. Transsphenoidal approach 92.8 percent through sublabial route. No patient had spontaneous complaint. With the specific questionnaire 63.2 percent presented complaints. One patient presented an oronasal fistula, 1 stenosis of the nasal valve area with external nasal deformity. Rhinoscopy detected alterations in 77.5 percent, nasal endoscopy in 87.7 percent. Septal perforation was present in 10/12 patients with scabs and 2 with purulent secretion. All 4 patients submitted to 2 transsphenoidal approaches presented septal perforation and nasal synechiae. In the endonasal, synechiae (2), alteration in medium meatus (1) and stenosis of the nasal valve area (1) were observed. Only two patients presented normal evaluation. CONCLUSION: A high incidence of nasal complications after conventional transsphenoidal surgery observed through examination and not reported spontaneously point to the need of otorhinolaryngological investigation complemented by nasal endoscopy in patients submitted to procedures through this route.

A cirurgia transesfenoidal é o procedimento cirúrgico mais utilizado para abordagem da região hipofisária, sendo por vezes associada a complicações oronasais. MATERIAL E MÉTODOS/OBJETIVO: Estudo prospectivo, através de questionário específico e avaliação clínica complicações oronasais crônicas não-diagnosticadas, em pacientes submetidos à cirurgia transesfenoidal convencional em diferentes serviços de neurocirurgia há mais de 6 meses. RESULTADOS: 49 pacientes, 37/45 com macroadenoma. 14/49 submetidos a mais de uma intervenção, em 2/5 por via transesfenoidal. Abordagem transesfenoidal 92,8 por cento via sublabial. Nenhum apresentava queixa espontânea. Com o questionário específico, 63,2 por cento apresentaram queixas. Um apresentava fístula oronasal, outro, estenose da área de válvula nasal com deformidade nasal externa. A rinoscopia detectou alterações em 77,5 por cento e a endoscopia nasal em 87,7 por cento. Perfuração septal presente em 10/12 pacientes com crostas e 2 com secreção purulenta. Todos 4 pacientes submetidos a 2 abordagens transesfenoidais apresentaram perfuração do septo e sinéquias nasais. Nos casos com abordagem endonasal observaram-se sinéquias2, alteração em meato médio1 e estenose em área de válvula nasal1. Apenas 2 pacientes apresentaram avaliação normal. CONCLUSÃO: Alta incidência de complicações nasais após abordagem transesfenoidal convencional, observadas (exame) e não referidas espontaneamente indicam a necessidad de investigação otorrinolaringológica complementada com endoscopia nasal sistemática nestes pacientes.

Clinical Analysis of Endoscopic Transnasal Transsphenoidal Hypophysectomy of Pituitary Tumor / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various surgical approach has been used for the removal of pituitary tumor. Recently, endoscopic transnasal transsphenoidal approach has been technically upgraded and the morbidity associated with surgical treatment of the pituitary tumor has been decreased. The objectives of our study was to describe surgical techniques and materials used in sellar repair after endoscopic transnasal transsphenoidal approach. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 18 patients who had received endoscopic transnasal transsphenoidal pituitary surgery between November 2002 and January 2004. We evaluated effectiveness of this technique by analyzing surgical techniques, symptom improvement and complications after surgery. RESULTS: In most of the case, tumor was found to be macroadenoma and 8 of the cases had suprasellar extension. Tumor was totally removed in 13 cases and partially removed in 5 cases. In all cases we used endoscopic unilateral transnasal transsphenoidal approach with anterior sphenoidotomy. CONCLUSION: We may consider that this approach is more safe and effective and a better treatment method for pituitary tumor surgery than the transcranial approach.

Postoperative Nasal Symptoms after Transseptal Transsphenoidal Hypophysectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTS: Transseptal transsphenoidal hypophysectomy with nasal columellar flap is now a widely used method with acceptable morbidity, However, a considerable number of patients complain of nasal symptoms after the operation and postoperative complications are continuously reported. The authors analyzed the different types of postoperative symptoms and their incidences. OBJECTS AND METHODS: We interviewed 105 patients (39 male and 66 female) via telephone who have been followed up for more than 1 year. Interviews were proceeded by questionnaires. RESULTS: Among the postoperative symptoms, the most frequent symptom was nasal obstruction (19.0%), followed by hyposmia (17.1%), nasal crust (15.2%), rhinorrhea/headache (12.4%), and upper lip numbness (10.5%). CONCLUSION: On the basis of these clinical experiences, it would be necessary, before undergoing transeptal transsphenoid hypophysectomy, to let patients know and prepare themselves of possible postoperative nasal spnptoms.

Changes In The Distribution of Oxytocin and Vasopressin-Immunoreactive Neurons In the Hypothalamic Area of Normal and Hypophysectomized Rats / 체질인류학회지

The localization and number of oxytocin- and vasopressin-immunoreactive neurons (OXY-IR & VP-IR) and their fibers in the hypothalamic areas (supraoptic nucleus, paraventricular nucleus, lateral hypothalamic area and median eminence) of the hypophysectomized rat were compared with normal rats at 6 months of survival after surgery at the light microscopic level. The number of VP-IR neurons was markedly decreased in the supraoptic nucleus (SON) and paraventricular nucleus (PVN) in the hypophysectomized rats as compared to normal rats. Moreover, The number of VP-IR fibers was decresed in the SON, PVN, lateral hypothalamic area (LHA) and median eminence in the hypophysectomized rats. The number of OXY-IR neurons and thier fibers were also decreased in the SON and PVN in the hypophysectomized rats. The present results demonstrate that hypophysectomy induces a significant decrease in the number of OXY- and VPIR neurons and fibers within hypothalamic areas (SON, PVN, and LHA at 6 months of post-hypophysectomy) are decreased.

Effects of Exogenous IGF-I on Endogenous IGF-I Production, Function and Hyperplasia/Hypertrophy of Kidney during Compensatory Renal Growth in Hypophysectomized Rats / 대한비뇨기과학회지

PURPOSE: Compensatory renal hypertrophy(CRH) after loss of considerable renal volume is essential process for recovery and maintenance of renal function, but on the other hand CRH induces glomerulosclerosis, eventually renal failure. Recently, the considerable studies reveal that insulin-like growth factor-I(IGF-I) is an important molecule relating to renal hypertrophy. This study investigates the possibility of IGF-I as a therapeutic agent, it should be proved whether external IGF-I affects renal function and glomerulosclerosis or does not affect in devoid state of growth hormone(GH) effect. MATERIALS AND METHODS: 100?150g Sprague-Dawley male rats were hypophysectomized by transpharyngeal approach and hypophysectomy were confirmed by daily monitoring of body weight for 3weeks. The left kidney were removed in the rats of UNX group(uninephrectomy) and UNX+IGF-I group(IGF-I treated after uninephrectomy), and sham operation were done in the other rats of control group and IGF-I group(IGF-I treated). Recombinant IGF-I were administered via Alzet osmotic minipump for 5 days in rats of IGF-I group and UNX+IGF-I group. At the 5th day after uninephrectomy, the glomerular filtration rate(GFR) and the effective renal plasma flow(ERPF) were investigated by measuring recovery of 99mTc-DTPA and 125I-hippurate, and then the rats were sacrificed and the kidneys were removed. The wet kidney weights were measured in removed kidneys, renal IGF-I concentrations were measured by RIA, and cellular proliferation were evaluated by flow-cytometry. RESULTS: 1. The wet kidney weight per body weight significantly increased after uninephrectomy, and had not been affected by IGF-I treatment regardless of uninephrectomy. 2. Renal IGF-I tended to increase after uninephrecromy, and significantly increased with IGF-I treatment in both IGF-I and UNX+IGF-I. The level of renal IGF-I of UNX+IGF-I group was significantly higher than that of IGF-I group. 3. Total GFR tended to decreased after uninephrectomy and were significantly increased by IGF-I treatment regardless of uninephrectomy. 4. The GFR per g wet kidney weight significantly increased after uninephrectomy, and were significantly increased by IGF-I treatment regardless of uninephrectomy. 5. Total ERPF were not significantly changed after uninephrectomy and significantly increased by IGF-I treatment in sham operation group but did not changed by IGF-I treatment in uninephrectomy group. 6. The ERPF per g wet weight significantly increased after uninephrectomy, and significantly increased by IGF-I treatment in sham operation group but did not changed by IGF-I treatment in uninephrectomy group. 7. The mean % of S1 phase cells were 33.6% in UNX+IGF-I group, 23.5% in IGF-I group, 19.96% in UNX group, and 10.4% in control group. The mean % of G2+M phase cells were 2.5% in UNX+IGF-I group, 1.95% in IGF-I group, 1.73% in UNX group, and 1.2% in control group. CONCLUSIONS: GH non-dependent IGF-I participate in CRH, and only IGF-I without GH increases renal function. IGF-I treatment during CRH might increase GFR by changing glomerular efferent arteriol of filtration fraction.

Effects of hypothalamic supraoptic ADH neurons at different times after hypophysectomy in Wistar rats / 中国病理生理杂志

AIM:To observe the effects of supraoptic ADH neurons and central diabetes insipidus(CDI)in Wistar rats at different times after hypophysectomy.METHODS:Hypophysectomy was undergone by stereotaxic instrument.Water intake,urine output and urine specific gravity(SG)were observed each day.The survival rate of supraoptic ADH neurons was determined by immunofluorescence after hypophysectomy at different times.RESULTS:The rats manifested triphasic CDI after hypophysectomy.The average water intake in experiment group was 73.9 mL vs 30.9 mL in control group(P0.05),but the cellular body hypertrophy appeared.The survival rate at 10th day was 72%(P0.05),but they were all less than the 10th day(P

Effect of Hypophysectomy on Monoamine-synthesizing Enzyme Activities in Rat Brain and Adrenal Gland / 대한정신약물학회지

In an attempt to investigate the regional specificity of effect of pituitary hormones on the activities of tyrosine hydroxylase(TH) and tryptophan hydroxylase(TPH), which are the rate-limiting enzymes in catecholamine and serotonin biosyntheses, respectively, the authors measured enzyme activities after hormonal deprivation, using the hypophysectomized animal model. The results are summarized as follows. First, whereas body weights of sham-operated group were increased gradually over time, those of hypophysectomized group were little changed. Second, the change of TH activity between sham-operated and hypophysectomized groups was not observed in each region of brain. Third, the change of TPH activity between two groups also was not observed in dorsal raphe nucleus and hypothalamus. It appears from the above findings that neural stimuli may be much more significant in the maintenance of normal level of TH and TPH in the brain than hormonal stimuli, and endocrine hormones might not directly affect monoaminergic neurotransmission in the absence of stress.

Growth Hormone Non-dependent Insulin-like Growth Factor-I of Kidney / 대한비뇨기과학회지

Recent studies have revealed that IGF- I produced in kidney are of two fractions; GH dependent and GH nondependent IGF-I. The role of GH nondependent IGF-I is interesting in renal hypertrophy and glomerulosclerosis because GH is clearly related with hypertrophy accompanying glomerulosclerosis is not seen in GH deficient animal. The relationship of the high protein diet and the IGF- I production under the deprivation of GH was studied. In hypophysectomized Sprague-Dawley rat, the level of serum IGF-I was measured using radioimmunoassay, and renal IGF- I production evaluated by immunohistochemistry during both normal and high protein diet. Serum IGF-I of rats on high protein diet was significantly higher than that fed normal protein diet. After unilateral nephrectomy, the level of serum IGF-I was significantly increased in both normal and high protein diet groups. Henle's loop, distal convoluted tubule and collecting duct were weakly stained with normal protein diet. With high protein diet, the staining intensities increased at these portion , and distal part of proximal convoluted tubule and straight tubule were weakly stained. After unilateral nephrectomy, distal convoluted tubule and collecting duct were densely stained with normal protein diet. With high protein diet, the staining intensities increased in distal part of proximal convoluted tubule and Henle's loop. Regardless of the types of protein diet, the specific difference between unilateral nephrectomized rats and sham- operated rats was immunoreactivity of the distal convoluted tubule.. In conclusion, it is suggested that GH non-dependent IGF-I is mainly produced in distal convoluted tubule during compensatory renal hypertrophy, and protein diet mainly affect IGF- I production of distal part of proximal convoluted tubule and Henle's loop.

The model of hypophysis shut off with dexamethasone in rats / 中国药理学通报

AIM To develop a simple reasonable and provable model of hypophysis shut off in rats with dexamethasone. METHODS Dexamethasone 6 mg?kg -1 was injected subcutaneously into two groups of rats at 3:00～3:30 pm on the preceding day. This dose was repeated at 9:00～9:30 am next day. The control group was treated with saline in the same way. One hour later, one of the dexamethasone treated groups was ig with Z47 200 mg?kg -1 , the other dexamethasone treated group and the control group was ig with 0 5% CMC. Then all the groups were ip with 0 086 mol?L -1 HAc in order to generate stress reaction. The reduction of the content of Vit C in adrenal gland was taken as the index of secretion of ACTH. RESULTS The content of Vit C in NS CMC HAc was obviously lower than in Dex CMC HAc group. There were statistically significant differences ( P

Applied Anqtomy of the Transoronaso-Sphenoidal Hypophysectomy / 第三军医大学学报

In order to provide the applied anatomical data for the transoronaso - sphenoidal hypophysectomy,30 adullt skull specimens were studied.The ollowing item were observed and measured by naked eyes and an operative microscope (10x).They arc: the type,size,septa,and orificas of the sphenoid sinuses; the position,shape and bony thickness of the neural and vascular prominences on the lateral wall of the sinuses; the thickness of sphenoid sinus wall.The significance of the results in transoronaso -sphenoidal hypophysectomy was discussed.

Stereotaxic Radiofrequency Hypophysectomy for Disseminated Breast and Prostate Cancer: Transseptal Transsphenoidal Approach

The authors performed three consecutive cases of stereotaxic radiofrequency hypophy-sectomies for patients with disseminated cancer from breast or prostate at Severance Hospital, Yonsei University. The procedures were essentially the same, in large part, as the technique first introduced by Zervas. The authors modified the-original technique to reduce the known risks of cerebrospinal fluid rhinorrhea and meningitis. Surgical details and clinical cases are presented.