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Article in Chinese | WPRIM | ID: wpr-936212


Objective: To investigate the related factors and treatments of delayed cerebrospinal fluid rhinorrhea (CFR) after invasive pituitary adenoma (IPA) surgery. Methods: One hundred and forty-two patients with IPA treated in Tianjin Huanhu Hospital from January 2014 to January 2019 were analyzed retrospectively, including 62 males and 80 females, aging from 38 to 67 years. The clinical data of patients before and after operation were collected. All patients with postoperative CFR underwent endoscopic CFR repair. During the operation, residual or recurrent pituitary adenomas were resected, the dura around the leak was enlarged and the necrotic tissue was removed. For those who still had fluid leakage after repair, the necrotic tissue was cleaned up, the leakage was filled and reinforced under endoscopy. Endoscopic rhinorrhea repair was performed if necessary. The cerebrospinal fluid leak was repaired with multi-layer materials. The related risk factors of delayed CFR after operation were analyzed. SPSS 19.0 software was used for statistical analysis. Results: Among the 142 patients in this group, 64 cases underwent total tumor resection and 78 cases underwent non-total tumor resection. They were followed up for 6 to 72 months. Thirty-one cases had delayed CFR, with an incidence of 21.83%, and occurred between 1 and 5 years postoperatively, with an average of 2.4 years. All 31 patients with delayed CFR underwent endoscopic CFR repair. The nasal endoscopy was rechecked at 2 weeks, 1 month, 3 months and 6 months after operation. Twenty-eight patients were repaired successfully after 1 operation, while 2 patients after 2 operations and 1 patient after 3 operations. These patients were followed up for 6 to 60 months, and no CFR occurred again. Univariate analysis showed that the degree of tumor resection, recurrence, size, texture, postoperative radiotherapy and operator experience were the risk factors of delayed CFR (all P<0.05). Multivariate analysis showed that the degree of tumor resection and recurrence were the highest independent risk factors for postoperative CFR, and tumor size, texture, postoperative radiotherapy and operator experience were the independent risk factors in this study. Conclusions: Delayed CFR after IPA is related to the degree of tumor resection, recurrence, size, texture, postoperative radiotherapy and the operator experience. It is necessary to completely remove the tumor under endoscope, to expand resection of the dura and necrotic tissue around the leak, to repair the defect with multi-layer materials, to follow-up closely and to repair timely after operation.

Adenoma/surgery , Adult , Aged , Cerebrospinal Fluid Leak , Cerebrospinal Fluid Rhinorrhea/surgery , Female , Humans , Male , Middle Aged , Pituitary Neoplasms/surgery , Retrospective Studies
Arq. bras. neurocir ; 40(1): 82-85, 29/06/2021.
Article in English | LILACS | ID: biblio-1362242


Introduction The endoscopic endonasal transsphenoidal approach (EETA) is routinely used to treat sellar and suprasellar tumors. It provides safe and direct access to tumors in these locations, with wide visualization of anatomical landmarks and great surgical results. With the COVID-19 pandemic, despite the high risk of transmission involved, various surgical procedures cannot be postponed due to their emergency. Case Report A 62-year-old female presented in the previous two months with headaches, followed by bilateral severe visual loss. In 2016, she was submitted to subtotal resection of a non-secretorymacroadenoma. Because of the progressive visual deficits, the EETA was used to the resect the pituitary adenoma. Technical Note We developed a low-cost adaptation to the surgical fields, covering the patient's head and superior trunk with a regular surgicalmicroscope bag with a tiny slit to enable the endoscope and surgical instruments to enter the nose, thus protecting the personnel in the operating room from the aerosolization of particles. This makes surgery safer for the surgical team and for the patient. Conclusion In view of the lack of literature on this subject, except for some reports of experiences from some services around the world, we describe the way we have adjusted the EETA in the context of the COVID-19 pandemic.

Humans , Female , Middle Aged , Pituitary Neoplasms/surgery , Adenoma/surgery , Natural Orifice Endoscopic Surgery/methods , COVID-19/transmission , Pituitary Gland/surgery , Adenoma/complications , Adenoma/diagnostic imaging , COVID-19/prevention & control
Arch. endocrinol. metab. (Online) ; 64(5): 614-622, Sept.-Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131135


SUMMARY The usual clinical presentation of non-functioning pituitary adenoma (NFPA) consists of symptoms of mass effect and hypopituitarism. NFPA is a rare condition in young women and an uncommon complication during pregnancy. We present the outcome of three patients with NFPA during pregnancy. Case 1: a 38-year-old woman was referred at 32nd week of spontaneous pregnancy because of diagnosis of a pituitary macroadenoma discovered in the context of progressive visual loss. Hormonal deficiency and hypersecretion were ruled out. Prolactin levels were high as expected. She developed diplopia and severe headache despite the use of dopamine agonists and corticosteroids, so pregnancy was interrupted at 34th week. After an uncomplicated delivery of a healthy newborn, transsphenoidal surgery was performed. The pathology was consistent with a gonadotroph adenoma. She recovered visual field, and remained with normal pituitary function. Postsurgical tumor remnant increased in size during the follow-up. Case 2: a 34-year-old woman was referred due to secondary amenorrhea and galactorrhea. A macroadenoma with suprasellar extension was discovered. Transsphenoidal surgery confirmed a gonadotroph adenoma. Two years after surgery she had a normal pregnancy. Six years after surgery a small tumor recurrence occurred. Case 3: a 23-year-old woman was referred due to a microincidental pituitary adenoma. Laboratory testing was normal. No findings on physical examination. A wait and see approach was decided. Two years after diagnosis, the patient got pregnant without complications. Image remained stable. This article may contribute new cases and provides an extensive review of NFPA during pregnancy.

Humans , Female , Pregnancy , Infant, Newborn , Adult , Young Adult , Adenoma/surgery , Galactorrhea , Hypopituitarism/etiology , Pituitary Neoplasms/surgery , Pituitary Neoplasms/diagnostic imaging , Neoplasm Recurrence, Local
Rev. bras. anestesiol ; 70(2): 165-170, Mar.-Apr. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137151


Abstract The 2020 pandemic caused by the novel coronavirus, COVID-19, had its headquarters in China. It causes Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and presents a broad spectrum of clinical manifestations, ranging from entirely asymptomatic through severe acute respiratory failure and death. Presuming a significant quantity of ventilator-dependent patients, several institutions strategically delayed elective surgeries. Particularly procedures performed involving the nasal mucosa, such as a transsphenoidal approach of the pituitary gland, considering the tremendous level of viral shedding. Nevertheless, critical cases demand expeditious resolution. Those situations are severe pituitary apoplexy, declining consciousness level, or risk of acute visual loss. This case presents a successful urgent perioperative management of a 47 year-old male COVID-19 positive patient who presented to the Emergency Department with a left frontal headache that culminated with diplopia, left eye ptosis, and left visual acuity loss after 5 days. Transsphenoidal hypophysectomy was uneventfully performed, and the patient was discharged from the hospital on postoperative day four. It additionally describes in detail the University of Mississippi Medical Center airway management algorithm for patients infected with the novel coronavirus who need emergent surgical attention.

Resumo A pandemia de 2020 causada pelo novo coronavírus, COVID-19, teve seu epicentro na China. Causa Síndrome Respiratória Aguda Grave pelo Coronavírus 2 (SARS-CoV-2) e apresenta um amplo espectro de manifestações clínicas, que vão desde nenhum sintoma a insuficiência respiratória aguda grave e óbito. Com a expectativa de um número significativo de pacientes dependentes de ventilador, várias instituições estrategicamente adiaram cirurgias eletivas. Esse é o caso principalmente de procedimentos envolvendo a mucosa nasal, como a via transesfenoidal para a hipófise, devido ao nível imenso de disseminação de material viral. Não obstante, casos críticos requerem resolução acelerada. Essas situações são grave apoplexia hipofisária, diminuição do nível de consciência ou risco de perda visual aguda. O presente caso relata o manejo perioperatório bem sucedido de urgência de paciente do sexo masculino de 47 anos de idade com COVID-19 que chegou ao Pronto Socorro com cefaleia frontal à esquerda que culminou com diplopia, ptose do olho esquerdo e perda de acuidade visual à esquerda após 5 dias. A hipofisectomia transesfenoidal ocorreu sem intercorrências e o paciente recebeu alta do hospital no quarto dia do pós-operatório. Adicionalmente, descrevemos em detalhe o algoritmo de manejo de via aérea da University of Mississippi Medical Center para pacientes infectados pelo novo coronavírus e que necessitam de atenção cirúrgica de emergência.

Humans , Male , Pituitary Neoplasms/surgery , Pneumonia, Viral/complications , Coronavirus Infections/complications , Airway Management/methods , Pituitary Neoplasms/diagnosis , Treatment Outcome , Perioperative Care , Pandemics , Betacoronavirus/isolation & purification , SARS-CoV-2 , COVID-19 , Middle Aged
Arq. bras. neurocir ; 37(2): 119-122, 24/07/2018.
Article in English | LILACS | ID: biblio-912242


Pituicytoma is a rare tumor that arises from the glial cells of the neurohypophysis. For a long time, it was believed that pituicytomas only appeared in adults. Currently, at least three cases of this entity occurring in children have been reported in the literature. The aim of the present report is to describe the case of a 5-year-old girl who presented to the emergency department with visual disturbances, and the diagnosis was a recurrent pituicytoma. Therefore, the clinical presentation, the radiological features of the tumor, and the corresponding surgical management are described. Additionally, a brief review of the management of this unusual entity was performed.

O pituicitoma é um tumor raro que surge das células gliais da neurohipófise. Durante muito tempo, acreditou-se que os pituicitomas só aparecessem em adultos. Atualmente, pelo menos três casos desta entidade ocorrendo em crianças foram relatados na literatura. O objetivo do presente artigo é descrever o caso de uma menina de 5 anos que chegou à emergência com distúrbios visuais, e o diagnóstico foi um pituicitoma recorrente. A apresentação clínica, as características radiológicas do tumor, e o correspondente manejo cirúrgico foram, portanto, descritos. Além disso, foi realizada uma breve revisão do tratamento desta entidade incomum.

Humans , Female , Child, Preschool , Pediatrics , Pituitary Neoplasms , Pituitary Neoplasms/pathology , Pituitary Neoplasms/surgery
Rev. argent. endocrinol. metab ; 55(2): 11-20, jun. 2018. graf
Article in Spanish | LILACS | ID: biblio-1041732


RESUMEN Los pacientes con adenomas hipofisarios constituyen una población heterogénea y requieren un enfoque individualizado. El objetivo de nuestro trabajo fue analizar nuestra población con adenomas hipofisarios no funcionantes (ACNF) y evaluar factores pronóstico de crecimiento (como el Ki-67) que ayuden en la toma de decisiones. Se realizó un análisis retrospectivo de 202 pacientes, incluyendo evaluación basal, enfoque terapéutico y evolución tumoral en 2 grupos: pacientes con conducta expectante (n = 69) y pacientes con cirugía (n = 133). La serie tuvo 55% de pacientes mujeres y la edad media al diagnóstico fue de 49 años. Los motivos de consulta más frecuentes fueron incidentaloma hipofisario y alteraciones visuales. Radiológicamente, 83% fueron macroadenomas, 77% invasivos y 55% mostraron compromiso visual. Entre los adenomas invasores, el 53% tenían disfunción hipofisaria, siendo el hipogonadismo el hallazgo más frecuente. El tratamiento inicial fue la cirugía en el 65,8% realizándose por vía transnasal en el 79% de los casos. Las complicaciones más frecuentes fueron diabetes insípida transitoria e hiponatremia, con mayor incidencia de diabetes insípida permanente en la cirugía transcraneal. La inmunohistoquímica mostró gonatropinomas en el 43,4% de los casos y fue negativa en el 37,7%. Doce adenomas tuvieron índice de proliferación Ki-67 ≥3%. Luego de la cirugía 56,8% de los pacientes mejoraron el campo visual, 22,6% recuperó alguna función endocrina y 18,8% agregó un nuevo déficit. En pacientes no operados, se observó crecimiento tumoral en 5,6% de los adenomas Hardy 1-2 y en el 21% de los Hardy 3-4. Entre los adenomas operados, aquellos sin resto tumoral postoperatorio no presentaron recurrencia. De los tumores con remanente postoperatorio (78,6%) no irradiados, el 41,5% mostró recrecimiento lesional al seguimiento. Este porcentaje se eleva a 66,6% en aquellos con Ki-67 ≥3% y disminuye a 12% en los que recibieron radioterapia.

ABSTRACT Patients with pituitary adenomas are a heterogeneous population and require an individualized approach. The aim of our study was to analyze our population of patients with nonfunctioning pituitary adenomas (NFA) and to evaluate prognostic growth factors (such as Ki-67) that help in decision making. A retrospective analysis of 202 patients, including baseline assessment, therapeutic approach and tumor evolution was performed in 2 groups: expectant management (n = 69) and surgery (n = 133). The mean age at diagnosis was 49 years, 55% women. The most frequent reasons for consultation were pituitary incidentaloma and visual impairment. Eighty three percent were macroadenomas, 77% invasive, and 55% with visual impairment. Among the invasive adenomas, 53% had pituitary dysfunction, with hypogonadism being the most frequent finding. The initial treatment was surgery in 65.8%, 79% of them through transnasal approach. The most frequent complications were transient diabetes insipidus and hyponatremia, with a higher incidence of permanent diabetes insipidus in transcranial surgery. The immunohistochemistry showed: 43.4% gonadotropinomas, 37.7% negative. Twelve adenomas had proliferation index Ki-67 ≥3%. After surgery, 56.8% improved the visual fields, 22.6% recovered some endocrine function and 18.8% added a new deficit. In non-operated patients, tumor growth was observed in 5.6% of the Hardy 1-2 adenomas and 21% of the Hardy 3-4 adenomas. Among the operated adenomas, those without postoperative tumor residue did not present recurrence. In tumors with non-irradiated postoperative remnant (78.6%), 41.5% increased. This percentage rises to 66.6% in those with Ki-67 ≥3%, and decreases to 12% in those who received radiotherapy.

Humans , Male , Female , Adult , Middle Aged , Aged , Pituitary Neoplasms/complications , Pituitary Neoplasms/physiopathology , Adenoma/complications , Pituitary Neoplasms/surgery , Prognosis , Adenoma/radiotherapy , Decision Making , Cell Proliferation
Medicina (B.Aires) ; 78(1): 33-36, feb. 2018. ilus
Article in Spanish | LILACS | ID: biblio-894544


El oncocitoma fusocelular es una neoplasia selar primaria no endocrina infrecuente, de curso clínico benigno. Debido a su similitud morfológica con los adenomas hipofisarios, considerar al oncocitoma como diagnóstico diferencial lleva a un abordaje quirúrgico cuidadoso, con el objetivo de evitar el sangrado intraquirúrgico y lograr la resección más completa posible, de la que parecería depender la evolución a largo plazo. Se presenta el caso de un hombre de 60 años que consultó por alteración campimétrica. La evaluación bioquímica evidenció panhipopituitarismo y la resonancia magnética (RM) una lesión selar. Se indicó tratamiento quirúrgico por compromiso visual con diagnóstico presuntivo de macroadenoma hipofisario no funcionante. El diagnóstico anatomopatológico fue compatible con oncocitoma fusocelular. En la RM selar, postquirúrgica (a los 5 meses), se observó remanente tumoral y se decidió realizar radiocirugía, constatándose en las subsiguientes RM disminución tumoral sin evidencia de remanente ni recidiva en 4 años de seguimiento. La comunicación de nuevos casos de esta entidad permitirá aumentar la disponibilidad de evidencia y ayudará a determinar la eficacia de los tratamientos disponibles y el pronóstico.

Spindle cell oncocytoma is an infrequent benign non-endocrine sellar neoplasm. Due to its similar morphology to pituitary adenomas, consideration of this differential diagnosis would conduce to a more careful surgical approach in order to avoid intraoperative bleeding and aiming to a complete resection, on which depends long-term outcomes. We present the case of a 60-year-old male who complained about visual abnormalities, with computerized visual field confirmation. On biochemistry, a panhypopituitarism was detected. The brain magnetic resonance images showed a sellar mass. A non-functioning pituitary macroadenoma was presumptively diagnosed and due to the visual impairment, surgical transesphenoidal treatment was indicated. The histological diagnosis was spindle cell oncocytoma. Five months after surgery, the control image demonstrated a lesion that was considered as remnant tumor, hence radiosurgery was performed. During the follow-up, the tumor reduced its size and four years after initial treatment, the sellar resonance imaging showed disappearance of the residual tumor. Communication of new cases of this rare entity will enlarge the existing evidence and will help to determinate the most effective treatment and prognosis.

Humans , Male , Middle Aged , Pituitary Neoplasms/diagnosis , Adenoma, Oxyphilic/diagnosis , Pituitary Neoplasms/surgery , Immunohistochemistry , Magnetic Resonance Imaging , Follow-Up Studies , Adenoma, Oxyphilic/surgery
Rev. otorrinolaringol. cir. cabeza cuello ; 77(4): 373-379, dic. 2017. tab, ilus
Article in Spanish | LILACS | ID: biblio-902790


RESUMEN Introducción: La elaboración de colgajos ha representado un cambio en reconstrucción de defectos resultantes de exéresis de tumoraciones de base de cráneo. No siempre indispensables, existen circunstancias, planificados o no, donde debemos emplearlos. Preservando los pedículos de la mucosa, damos cobertura a urgencias intraquirúrgicas, como fístula LCR no sospechada, así como reintervenciones. Objetivo: Presentar nuestra experiencia en pacientes, a quienes hemos realizado colgajo tipo rescue flap. Material y método: Se diseña este colgajo, sin comprometer su pedículo. En caso de fístula, sospecha de ésta o herniación del diafragma selar, se extiende, cubriendo el defecto. Resultados: De 34 pacientes intervenidos de patología hipofisaria endoscópicamente, en 18 diseñamos colgajo tipo rescue flap. 12 casos se elaboraron, no utilizándolos. En 4 pacientes con extenso tumores lo empleamos preventivamente. En 1 caso, de reintervención, previamente con colgajo Hadad izquierdo, realizamos colgajo de mucosa contralateral. En otro, diseñamos un rescue flap derecho, al objetivar salida de LCR, sellamos con este colgajo. No evidenciamos fístulas. Discusión: Esta técnica consiste en levantar parcialmente mucosa del potencial colgajo, preservando su pedículo, pudiendo utilizarse en casos de fístula LCR no programada, o reintervenciones. Sin realizar colgajos innecesariamente. Conclusión: La técnica rescue flap favorece un corredor quirúrgico, menos invasivo, manteniendo mucosa para eventuales reintervenciones.

ABSTRACT Introduction: The development of flaps has represented a change in reconstruction of defects resulting from excision of skull base tumors. It not always indispensable, there are circumstances, planned or not, where we must use them. Preserving the pedicles of the mucosa, we cover intraoperative emergencies, such as unsuspected CSF fistula, as well as reinterventions. Aim: We present our experience where we performed rescue flap. Material and method: This flap is designed without compromising its pedicle. In case of fistula, suspicion of this or herniation of the selar diaphragm, it extends, covering the defect. Results: Of 34 patients who underwent endoscopic surgery for pituitary pathology, in 18 we designed a rescue flap. 12 cases were made, not using them. In 4 patients with extensive tumors we used it preventively. In 1 case, of reintervention previously with left Hadad flap, we performed contralateral mucosa flap. In another, we designed a right rescue flap, when we observed LCR output, we seal with this flap. We did not show fistulas. Discussion: This technique consists in partially lifting the mucosa of the potential flap, preserving its pedicle, and may be used in cases of unscheduled CSF fistula, or reinterventions. Without flapping unnecessarily. Conclusions: The Rescue Flap technique favors a less invasive surgical corridor, maintaining mucosa for posible reinterventions.

Humans , Male , Female , Middle Aged , Pituitary Neoplasms/surgery , Surgical Flaps , Adenoma/surgery , Reconstructive Surgical Procedures/methods , Skull Base/surgery , Endoscopy/methods , Cerebrospinal Fluid Leak/prevention & control
Braz. j. otorhinolaryngol. (Impr.) ; 83(3): 349-355, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-889250


Abstract Introduction: The large increase in the number of transnasal endoscopic skull base surgeries is a consequence of greater knowledge of the anatomic region, the development of specific materials and instruments, and especially the use of the nasoseptal flap as a barrier between the sinus tract (contaminated cavity) and the subarachnoid space (sterile area), reducing the high risk of contamination. Objective: To assess the otorhinolaryngologic complications in patients undergoing endoscopic surgery of the skull base, in which a nasoseptal flap was used. Methods: This was a retrospective study that included patients who underwent endoscopic skull base surgery with creation of a nasoseptal flap, assessing for the presence of the following post-surgical complications: cerebrospinal fluid leak, meningitis, mucocele formation, nasal synechia, septal perforation (prior to posterior septectomy), internal nasal valve failure, epistaxis, and olfactory alterations. Results: The study assessed 41 patients undergoing surgery. Of these, 35 had pituitary adenomas (macro- or micro-adenomas; sellar and suprasellar extension), three had meningiomas (two tuberculum sellae and one olfactory groove), two had craniopharyngiomas, and one had an intracranial abscess. The complications were cerebrospinal fluid leak (three patients; 7.3%), meningitis (three patients; 7.3%), nasal fossa synechia (eight patients; 19.5%), internal nasal valve failure (six patients; 14.6%), and complaints of worsening of the sense of smell (16 patients; 39%). The olfactory test showed anosmia or hyposmia in ten patients (24.3%). No patient had mucocele, epistaxis, or septal perforation. Conclusion: The use of the nasoseptal flap has revolutionized endoscopic skull base surgery, making the procedures more effective and with lower morbidity compared to the traditional route. However, although mainly transient nasal morbidities were observed, in some cases, permanent hyposmia and anosmia resulted. An improvement in this technique is therefore necessary to provide a better quality of life for the patient, reducing potential complications.

Resumo Introdução: O grande crescimento no número de cirurgias endoscópicas transnasais para a base do crânio ocorreu a partir de um maior conhecimento anatômico da região; do desenvolvimento de materiais e instrumentais específicos e, principalmente, após o uso do retalho nasosseptal como uma barreira entre o trato sinusal (cavidade contaminada) e o espaço subaracnóideo (área estéril), com redução de grandes riscos de contaminação. Objetivo: Avaliar as complicações otorrinolaringológicas nos pacientes submetidos à cirurgia endoscópica da base do crânio, na qual foi usado o retalho nasoseptal. Método: Estudo retrospectivo, no qual foram avaliados os pacientes submetidos à cirurgia da base do crânio por via endoscópica com retalho nasosseptal, quanto à presença no pós-operatório das seguintes complicações: fístula liquórica, meningite, formação de mucocele, sinéquia nasal, perfuração septal (anterior à septectomia posterior), insuficiência de válvula nasal interna, epistaxe e alteração olfatória. Resultados: Foram avaliados 41 pacientes submetidos à cirurgia. Desses, 35 eram portadores de adenomas hipofisários (macro ou microadenomas; selares e extensão supraselar), três meningiomas (dois de tubérculo selar e um da goteira olfatória), dois craniofaringiomas e um abscesso intracraniano. As complicações observadas foram: fístula liquórica (três pacientes - 7,3%), meningite (três pacientes - 7,3%), sinéquia em fossa nasal (oito pacientes - 19,5%), insuficiência de válvula nasal interna (seis pacientes - 14,6%) e queixa de pioria do olfato (16 pacientes - 39%). O teste olfatório evidenciou anosmia ou hiposmia em 10 pacientes (24,3%). Nenhum paciente apresentou mucocele, epistaxe ou perfuração septal. Conclusão: O uso do retalho nasosseptal proporcionou uma revolução na cirurgia da base do crânio por via endoscópica e tornou os procedimentos mais eficazes e com baixa morbidade, comparado com a via tradicional. Porém, passou a ocasionar morbidades nasais principalmente transitórias, mas em alguns casos permanentes, como hiposmia e anosmia. Assim, torna-se necessário um aperfeiçoamento dessa técnica para proporcionar uma melhoria na qualidade de vida do paciente e diminuir possíveis complicações.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Pituitary Neoplasms/surgery , Brain Abscess/surgery , Craniopharyngioma/surgery , Natural Orifice Endoscopic Surgery/methods , Meningioma/surgery , Nasal Septum/surgery , Postoperative Complications , Surgical Flaps , Retrospective Studies , Treatment Outcome , Skull Base/surgery , Natural Orifice Endoscopic Surgery/adverse effects
Arq. neuropsiquiatr ; 75(5): 301-306, May 2017. tab, graf
Article in English | LILACS | ID: biblio-838906


ABSTRACT Objective The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for growth hormone (GH)-secreting adenomas. Methods A retrospective analysis based on medical records of 23 acromegalic patients submitted to endoscopic transsphenoidal surgery. Biochemical control was defined as basal GH < 1ng/ml, nadir GH < 0.4ng/ml after glucose load and age-adjusted IGF-1 normal at the last follow-up. Results The overall endocrinological remission rate was 39.1%. While all microademonas achieved a cure, just one third of macroadenomas went into remission. Suprasellar extension, cavernous sinus invasion and high GH levels were associated with lower rates of disease control. The most common complication was diabetes insipidus and the most severe was an ischemic stroke. Conclusion The endoscopic transsphenoidal approach is a safe and effective technique to control GH-secreting adenomas. The transcavernous approach may increase the risk of complications. Suprasellar and cavernous sinus extensions may preclude gross total resection of these tumors.

RESUMO Objetivo O objetivo do estudo é analisar os resultados da cirurgia de ressecção endoscópica transesfenoidal para adenomas secretores do hormônio do crescimento (GH). Métodos Revisão retrospectiva baseada em análise de prontuários de 23 pacientes acromegálicos submetidos à cirurgia endoscópica. Remissão foi definida por GH < 1ng/ml, nadir de GH ≤ 0,4ng/ml no teste oral de tolerância a glicose e IGF-1 normal para idade. Resultados A taxa de remissão endocrinológica foi 39,1%. Enquanto todos microadenomas alcançaram controle hormonal, apenas um terço dos macroadenomas obtiveram remissão. Extensão suprasselar, invasão do seio cavernoso e altos níveis de GH foram associados a menores taxas de controle da doença. A complicação mais comum foi diabetes insipidus e a mais grave foi acidente vascular encefálico isquêmico. Conclusão A abordagem endoscópica transesfenoidal é segura e efetiva para controle de adenomas hipofisários secretores de GH. A abordagem ao seio cavernoso pode aumentar a morbidade da cirurgia. Extensões suprasselares e no seio cavernoso podem dificultar a ressecção completa e o controle da doença.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Pituitary Neoplasms/surgery , Acromegaly/surgery , Neuroendoscopy/methods , Growth Hormone-Secreting Pituitary Adenoma/surgery , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Neuroendoscopy/adverse effects
Rev. otorrinolaringol. cir. cabeza cuello ; 77(1): 27-34, mar. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-845643


Introducción: La cirugía endoscópica transesfenoidal en la exéresis de patología hipofisaria ha sido ratificada dentro de la mejores opciones para conseguir abordajes exitosos. Para cerrar la brecha ósea, se puede utilizar el colgajo nasoseptal, el cual lograría un cierre adecuado y seguro, evitando complicaciones como persistencia de fístulas de líquido cefalorraquídeo. Dentro de los probables efectos secundarios de este colgajo se señala la presencia de anosmia o hiposmia. Objetivo: Nuestro objetivo es mostrar los resultados obtenidos empleando la técnica del colgajo nasoseptal y la evaluación del olfato posoperatorio. Material y método: Incluimos 14 pacientes con diagnóstico de adenoma hipofisiario intervenidos en nuestro servicio entre diciembre 2014 a diciembre 2015. Se evaluaron diversos parámetros entre otros, olfatometría pre y posoperatorias. A todos se les realizó la técnica endoscópica transesfenoidal. Efectuando la disección del colgajo con la técnica tipo Hadad. La exéresis tumoral fue realizada por neurocirujano, se cubrió la osteotomía con este colgajo. Resultados: De los 14 pacientes, 13 llegaron al estado olfativo preoperatorio. 1 paciente se mantuvo hipósmico mantenidamente. En nuestro estudio, no hemos encontrado deterioro significativo en la calidad del sentido del olfato. Así como tampoco observamos otras complicaciones. Conclusiones: Esta experiencia aún inicial, estimamos que podría ya esbozar una tendencia de mantención de la función olfativa en este tipo de cirugía.

Introduction: Transsphenoidal endoscopic surgery resection of pituitary pathology has been ratified within the best options for successful approaches. To close the gap bone, you can use the nasoseptal flap, which achieved an adequate and secure closure, preventing complications such as persistent cerebrospinal fluid leaks. Among possible side effects of this flap anosmia-hyposmia noted. Aim: Our goal is to show the results obtained using the technique of nasoseptal flap and postoperative evaluation of smell. Material and method: We included 14 patients with a diagnosis of pituitary adenoma surgery in our department between December 2014 to December 2015. Various parameters were evaluated pre and post operative, specially olfactory function. All underwent transsphenoidal endoscopic technique. Performing dissection flap with the technical type Hadad. The tumor resection was performed by neurosurgeon, osteotomy covered with this flap. Results: Of the 14 patients, 13 reached the olfactory preoperative state. 1 patient remained with hyposmia. In our study, we found no significant deterioration in the quality of the sense of smell. Not other complications were found. Conclusions: This is an initial experience, and we estimate that could outline a trend of maintaining olfactory function in this surgery approach.

Humans , Male , Female , Adult , Middle Aged , Aged , Adenoma/surgery , Endoscopy/methods , Pituitary Neoplasms/surgery , Sphenoid Sinus/surgery , Adenoma/physiopathology , Epidemiology, Descriptive , Nasal Septum/blood supply , Pituitary Neoplasms/physiopathology , Smell/physiology , Surgical Flaps , Treatment Outcome
Arch. argent. pediatr ; 115(1): 43-49, feb. 2017. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-838318


Introducción. los craneofaringiomas son malformaciones histológicamente benignas entre el hipotálamo y la hipófisis que pueden afectar la secreción hormonal clave en la regulación endócrina y modulación de la saciedad. Si bien se trata de una enfermedad relativamente benigna, la combinación de obesidad grave de origen hipotalámico y las comorbilidades asociadas a ella disminuyen la calidad de vida. Objetivo. Evaluar el estado nutricional de pacientes operados de craneofaringioma infantil. Población y métodos. Pacientes menores de 21 años al momento del estudio que requirieron cirugía por craneofaringioma en el Hospital de Pediatría Garrahan y que firmaron el consentimiento informado. Se realizó la evaluación antropométrica, composición corporal con impedanciometría, gasto energético con calorimetría indirecta e ingesta energética. Se determinó la resistencia a la insulina y la dislipidemia. Resultados. Se incluyeron 39 pacientes; 41%, normopeso y 59%, obesos. El 68% de los pacientes presentó distribución grasa central; 40%, resistencia a la insulina; y 32%, dislipidemia. No se encontraron diferencias significativas en la presencia de resistencia a la insulina, dislipidemia, gasto energético en reposo ni en la ingesta entre obesos vs. normopeso. El 77% de los pacientes obesos presentó bajo gasto energético independiente del porcentaje de masa magra (62 ± 2,7% vs. 61,2 ± 1,8% de gasto energético en reposo normal vs. bajo; p 0,8). Conclusiones. El 59% de la población estudiada presentó obesidad. No se encontraron diferencias significativas en complicaciones metabólicas entre pacientes obesos y normopeso. Se observó menor gasto energético independiente del porcentaje de masa magra y similar ingesta energética.

Introduction. Craniopharyngiomas are histologically benign malformations located between the pituitary and hypothalamus that may affect key hormone secretion for endocrine regulation and satiety modulation. Although this is a relatively benign disease, the combination of severe hypothalamic obesity and associated comorbidities results in a reduced quality of life. Objective. To assess the nutritional status of patients after craniopharyngioma surgery. population and Methods. Patients younger than 21 years old at the time of the study who required craniopharyngioma surgery at Hospital de Pediatria Garrahan and who signed an informed consent. Anthropometric characteristics, body composition by impedance analysis, energy expenditure by indirect calorimetry and energy intake were assessed. Insulin resistance and dyslipemia were estimated. Results. A total of 39 patients were included; 41% had a normal weight and 59% were obese. Overall, 68% of patients had a central fat distribution; 40% had insulin resistance; and 32%, dyslipemia. No significant differences were observed in terms of insulin resistance, dyslipemia, energy expenditure at rest, or energy intake between normal weight and obese patients. Among obese patients, 77% had a low energy expenditure, regardless of their percentage of lean body mass (62 ± 2.7% versus 61.2 ± 1.8% of normal versus low energy expenditure at rest; p = 0.8). Conclusions. A total of 59% of the studied population was obese. No significant differences were observedinterms ofmetabolic complications between normal weight and obese patients. A lower energy expenditure was observed, regardless of the lean body mass percentage and a similar energy intake.

Humans , Child, Preschool , Child , Adolescent , Young Adult , Pituitary Neoplasms/surgery , Pituitary Neoplasms/physiopathology , Nutritional Status , Craniopharyngioma/surgery , Craniopharyngioma/physiopathology , Nutrition Assessment , Prospective Studies
Rev. chil. neuro-psiquiatr ; 54(4): 282-290, dic. 2016. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-844467


Purpose: To establish the prognostic value of the retinal nerve fiber layer thickness measured at Optical Coherence Tomography (OCT) as a predictor of visual function posterior to resection of sellar tumors. Material and Methods: Descriptive, retrospective study in patients undergoing microscopic transsphenoidal resection of sellar tumors with preoperative ophthalmologic evaluation (evaluation by specialist, 24-2 Sita Standard visual field (24-2 SS VF) and optic nerve head Stratus OCT) and postoperative (evaluation by specialist and 24-2 SS VF). Minimum follow-up was 3 months. For statistical analysis, Spearman and Pearson's Correlation Coefficient and linear regression was used. Results: A total of 18 patients were included. In the preoperative evaluation, patients had logMAR average Snellen visual acuity (VA) of 0.70 (0.15 logMAR, 0-4.0), an average mean deviation (MD) of -9.25 dB (0.4 to -30.4 dB) and a average retinal nerve fiber layer thickness of 83.7 microns (45.24 to 115.37). Postoperative evaluation of patients showed an Snellenaverage VA of 0.78 (0.1 logMAR, 0-1.3) and MD of 5.58 dB (2.31 -32.39 dB). A positive correlation (r = 0.51) between average retinal nerve fiber layer thickness and postoperative MD, less probably to improved in VF and VA with thicknesses below 80 microns. Conclusion: A nerve fiber layer thickness on optic nerve head Stratus OCT below 80 microns correlated with poorer visual function improvement in patients undergoing transsphenoidal resection surgery of sellar tumors.

Propósito: Establecer el valor pronóstico del grosor peripapilar de la capa de fibras de las células ganglionares (CFCG) cuantificado a la Tomografía de Coherencia Óptica (OCT) como factor pronóstico visual posterior a la resección de tumores selares. Material y Método: Estudio descriptivo, retrospectivo en pacientes sometidos a resección transesfenoidal microscópica de tumores selares con evaluación oftalmológica preoperatoria (evaluación por especialista, campo visual 24 Sita Standard (CV 24-2 SS) y OCT Stratus de papila) y postoperatoria (evaluación por especialista y CV 24-2 SS). El seguimiento mínimo fue de 3 meses. Para el análisis estadístico se utilizó el coeficiente de correlación de Pearson y Spearman, y regresión lineal. Resultados principales: Se incluyó un total de 18 pacientes. En la evaluación prequirúrgica los pacientes presentaron agudeza visual (AV) promedio de 0,70 en Snellen (0,15 en logMAR, rango 0-4 logMAR), una desviación media (DM) promedio de -9,25 dB (0,4 a -30,4 dB) y un grosor de CFCG de 83.7 μm promedio (45,24 a 115,37 μm). En la evaluación postoperatoria los pacientes presentaron AVpromedio de 0,78 Snellen (0,1 logMAR, rango 0-1,3) y una DMpromedio de -5,58 dB (2,31, -32,39 dB). Se encontró una correlación positiva (r2 = 0,51) entre el grosor de CFCG y la DM postoperatoria, con tendencia a la menor mejoría del CV y AV con grosores bajo 80 μm. Conclusión: Una capa de fibras nerviosas bajo 80 μm al OCT Stratus se correlacionó con menor mejoría visual postoperatoria en pacientes sometidos a cirugia transesfenoidal de tumores selares.

Humans , Male , Female , Adult , Middle Aged , Pituitary Neoplasms/surgery , Retinal Ganglion Cells/pathology , Tomography, Optical Coherence , Visual Fields , Pituitary Neoplasms/pathology , Predictive Value of Tests , Preoperative Care , Treatment Outcome , Visual Acuity
Rev. chil. neurocir ; 42(2): 111-117, nov. 2016. ilus, tab
Article in Spanish | LILACS | ID: biblio-869761


Los pituicitomas son tumores infrecuentes de la región selar y supraselar, originados de la neurohipófisis, que suelen ser confundidos con otros tumores al compartir características imaginológicas. Se reporta el caso de una mujer de 36 años de edad, con un pituicitoma en la región selar, que fue diagnosticado como un adenoma hipofisario debido a los hallazgos clínicos e imaginológicos preoperatorios y se realiza una revisión de la literatura.

The Pituicytomas are rare tumors of the sellar and suprasellar region originated of the neurohypophysis and are usually confused with other tumors when sharing imagining features. It is reported a case of a 36 years old woman with pituicytoma in the sellar region that was diagnosed as a pituitary adenoma due to the presurgical clinical and imaging findings and, it is revised the literature.

Humans , Adult , Female , Endoscopy/methods , Galactorrhea , Hyperprolactinemia , Pituitary Gland, Posterior/pathology , Prolactinoma/surgery , Prolactinoma/diagnosis , Magnetic Resonance Imaging/methods , Immunohistochemistry/methods , Pituitary Neoplasms/surgery , Pituitary Neoplasms/diagnosis , Pituitary Neoplasms/epidemiology , Radiosurgery , Sella Turcica/injuries , Tomography, X-Ray Computed/methods
Arq. neuropsiquiatr ; 74(5): 388-395, May 2016. tab, graf
Article in English | LILACS | ID: lil-782027


ABSTRACT Objective In this study, we investigate our institutional experience of patients who underwent endoscopic endonasal transsphenoidal approach for treatment of large and giant pituitary adenomas emphasizing the surgical results and approach-related complications. Method The authors reviewed 28 consecutive patients who underwent surgery between March, 2010 and March, 2014. Results The mean preoperative tumor diameter was 4.6 cm. Gross-total resection was achieved in 14.3%, near-total in 10.7%, subtotal in 39.3%, and partial in 35.7%. Nine patients experienced improvement in visual acuity, while one patient worsened. The most common complications were transient diabetes insipidus (53%), new pituitary deficit (35.7%), endonasal adhesions (21.4%), and cerebrospinal fluid leak (17.8%). Surgical mortality was 7.1%. Conclusions Endoscopic endonasal transsphenoidal surgery is a valuable treatment option for large or giant pituitary adenomas, which results in high rates of surgical decompression of cerebrovascular structures.

RESUMO Objetivo Neste manuscrito investigamos a experiência institucional com o acesso endonasal endoscópico transesfenoidal no tratamento de adenomas hipofisários grandes e gigantes com ênfase às complicações relacionadas ao acesso cirúrgico. Método Foram incluídos neste estudo 28 pacientes consecutivos submetidos à cirurgia entre Março de 2010 e Março de 2014. Resultados O diâmetro médio pré-operatório dos tumores era 4,6 cm. Uma ressecção total foi obtida em 14,3%; quase total, em 10,7%; subtotal, em 39,3% e parcial, em 35,7%. Nove pacientes evoluíram com melhora na acuidade visual, enquanto um paciente apresentou piora da função visual. As complicações mais comuns foram diabetes insipidus transitório (53%), novo défice hipofisário (35,7%), sinéquias endonasais (21,4%) e fistula liquórica (17,8%). A mortalidade cirúrgica foi 7,1%. Conclusões A cirurgia por via endonasal endoscópica transesfenoidal é uma opção terapêutica extremamente útil para adenomas hipofisários grandes e gigantes, a resultar numa significativa descompressão das estruturas cerebrovasculares.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Pituitary Neoplasms/surgery , Adenoma/surgery , Natural Orifice Endoscopic Surgery/adverse effects , Nasal Cavity , Postoperative Complications , Visual Acuity , Retrospective Studies , Treatment Outcome , Adrenal Insufficiency/etiology , Diabetes Insipidus/etiology , Natural Orifice Endoscopic Surgery/methods , Neoplasm Recurrence, Local/etiology
Biomédica (Bogotá) ; 35(4): 471-474, oct.-dic. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-768076


Yokenella regensburgei es un bacilo Gram negativo de la familia Enterobacteriaceae, que puede encontrarse en agua de pozos, alimentos y en el tubo digestivo de insectos y reptiles. Aunque se ha aislado de muestras provenientes de seres humanos, pocas veces se ha reportado como causante de infección y, en tales casos, especialmente en pacientes inmunosuprimidos. Se presenta aquí el primer caso de osteomielitis secundaria a una infección por Y. regensburgei en una paciente inmunocompetente después de un procedimiento quirúrgico.

The gram-negative bacillus Yokenella regensburgei (of the Enterobacteriaceae family) can be found in groundwater and foodstuffs, as well as the digestive tracts of insects and reptiles. Although it has been isolated from humans since its original description, it has rarely been reported as a cause of infection, and then, only in immunosuppressed patients. We report the first case of post-surgical secondary osteomyelitis due to Y. regensburgei in an immunocompetent woman who had undergone a craniotomy.

Aged , Female , Humans , Osteomyelitis/microbiology , Surgical Wound Infection/microbiology , Temporal Bone/microbiology , Craniotomy , Enterobacteriaceae/isolation & purification , Enterobacteriaceae Infections/microbiology , Osteomyelitis/etiology , Osteomyelitis/diagnostic imaging , Pituitary Neoplasms/surgery , Surgical Wound Infection/diagnostic imaging , Temporal Bone/diagnostic imaging , Prolactinoma/surgery , Tomography, X-Ray Computed , Drainage , Immunocompromised Host , Drug Resistance, Multiple, Bacterial , Enterobacteriaceae/drug effects , Enterobacteriaceae Infections/etiology , Enterobacteriaceae Infections/diagnostic imaging , Hypophysectomy , Anti-Bacterial Agents/therapeutic use
Rev. chil. neurocir ; 41(2): 138-140, nov. 2015. ilus
Article in Spanish | LILACS | ID: biblio-869737


Se presenta el caso clínico de una paciente con un cuadro de Meningitis crónica recurrente en que el diagnóstico de absceso selar sólo se logró al operarla con el diagnóstico de Adenoma Hipofisiario. Siendo el absceso hipofisiario una patología de muy baja frecuencia, la presencia de una Meningitis crónica recurrente como forma de presentación es aún más infrecuente. La literatura en general presenta muy pocas series de abscesos hipofisiarios, siendo la mayoría sólo comunicaciones de casos clínicos.

We present the case of a patient with a history of Recurrent Chronic Meningitis, in which the diagnosis of Pituitary abscess was only made after surgery under the diagnosis of Pituitary Adenoma. Given the low frequency of the Pituitary Abscess, the presence of a Recurrent Chronic Meningitis as its presentation is even more infrequent. The common literature presents only a few series of pituitary abscess, which, in most cases, are only case reports.

Humans , Adult , Female , Abscess/diagnosis , Pituitary Gland/pathology , Meningitis , Pituitary Neoplasms/surgery , Staphylococcal Infections , Diagnostic Imaging , Pituitary Diseases/surgery
Arq. neuropsiquiatr ; 73(9): 764-769, Sept. 2015. tab, ilus
Article in English | LILACS | ID: lil-757396


Over the past three decades, surgical series of elderly patients treated for pituitary adenomas have been published, all of which used the microscopic transsphenoidal or transcranial approach. The objective of this study was to retrospectively analyze the surgical results of our first 25 elderly patients with non-functioning pituitary macroadenoma (NFPM) operated by the endoscopic endonasal approach (EEA). Preoperative visual loss was found in 92.8% of the cases, and 70.8% experienced visual improvement following surgery. Preoperative pituitary dysfunction was found in 69.2% of the cases and postoperative pituitary recovery occurred in 22.2% of them. Mean hospital stay was 6.7 days. The results of this study suggest that surgery remains the first line of treatment for NFPM in the elderly. Because age alone is not a barrier for surgery, patients should be selected for surgical treatment based on their symptoms and clinical condition, as defined by comorbidities.

Nas últimas três décadas, foram publicadas casuísticas de pacientes idosos operados por adenomas de hipófise, nas quais foram utilizadas as vias transcraniana ou transesfenoidal microcirúrgicas. O objetivo deste estudo foi analisar retrospectivamente os resultados dos nossos primeiros 25 pacientes idosos com macroadenomas não secretores de hipófise, operados pela via endoscópica endonasal. O déficit visual pré-operatório foi encontrado em 92,8% dos casos e 70,8% apresentaram melhora da visão depois da cirurgia. O hipopituitarismo pré-operatório foi encontrado em 69,2% dos casos e a sua recuperação ocorreu em 22,2% destes casos. A estadia hospitalar média foi de 6,7 dias. Este estudo sugere que a cirurgia permanece como o tratamento de primeira escolha para pacientes idosos com macroadenomas não secretores de hipófise e a idade por si só não é contraindicação para cirurgia.

Aged , Female , Humans , Male , Adenoma/surgery , Endoscopy/methods , Neurosurgical Procedures/methods , Pituitary Neoplasms/surgery , Adenoma/pathology , Adenoma , Endocrine System Diseases , Magnetic Resonance Imaging , Neoplasm Invasiveness/pathology , Neoplasm Invasiveness , Pituitary Neoplasms/pathology , Pituitary Neoplasms , Retrospective Studies
Arq. neuropsiquiatr ; 73(7): 611-615, 07/2015. graf
Article in English | LILACS | ID: lil-752376


Objective The purpose of this study was to describe the endoscopic combined “transseptal/transnasal” approach with a pedicled nasoseptal flap for pituitary adenoma and skull base reconstruction, especially with respect to cerebrospinal fluid (CSF) fistula.Method Ninety-one consecutive patients with pituitary adenomas were retrospectively reviewed. All patients underwent the endoscopic combined “transseptal/transnasal” approach by the single team including the otorhinolaryngologists and neurosurgeons. Postoperative complications related to the flap were analyzed.Results Intra- and postoperative CSF fistulae were observed in 36 (40%) and 4 (4.4%) patients, respectively. Among the 4 patients, lumbar drainage and bed rest healed the CSF fistula in 3 patients and reoperation for revision was necessary in one patient. Other flap-related complications included nasal bleeding in 3 patients (3.3%).Conclusion The endoscopic combined “transseptal/transnasal” approach is most suitable for a two-surgeon technique and a pedicled nasoseptal flap is a reliable technique for preventing postoperative CSF fistula in pituitary surgery.

Objetivo O objetivo deste estudo foi descrever o acesso endoscópico transeptal/transnasal combinado com a criação do flap naso-septal pediculado para reconstrução da base do crânio em cirurgias de resseção de adenoma de hipófise, especialmente nos casos que ocorrem fístula líquido cefalorraquidiano (FLC).Método Noventa e um pacientes consecutivos portadores de adenoma de hipófise foram retrospectivamente revisados. Complicações pós-operatórias relacionadas ao flap foram analisadas.Resultados Fístulas líquido cefalorraquidiano intra e pós-operatórias foram observadas em 36 (40%) e 4 (4,4%) dos pacientes, respectivamente. Entre os 4 pacientes, drenagem lombar e repouso absoluto foram suficientes para o fechamento da fístula e intervenção cirúrgica foi necessária em apenas um paciente. Outra complicação relacionada ao flap foi o sangramento em 3 (3,3%) dos pacientes.Conclusão O acesso endoscópico transeptal/transnasal combinado é melhor aplicado quando realizado por dois cirurgiões e o flap naso-septal é uma técnica eficaz para prevenção de fístula pós-operatória em cirurgias de hipófise.

Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Adenoma/surgery , Cerebrospinal Fluid Leak/prevention & control , Fistula/prevention & control , Natural Orifice Endoscopic Surgery/methods , Pituitary Neoplasms/surgery , Skull Base/surgery , Surgical Flaps/surgery , Cerebrospinal Fluid Leak/etiology , Fistula/etiology , Nasal Cavity/surgery , Nasal Septum/surgery , Natural Orifice Endoscopic Surgery/adverse effects , Postoperative Complications/prevention & control , Reproducibility of Results , Retrospective Studies , Risk Factors , Reconstructive Surgical Procedures/methods , Time Factors , Treatment Outcome