Cirugía en tumores de la región selar: informe de una serie de 15 casos / Surgery for tumors of the sellar region: report a series of 15 cases

Introducción: La región selar es considerada por algunos autores como el tercer sitio en orden de aparición de lesiones tumorales en la cavidad craneal. Método: Se realizó un estudio descriptivo de 15 pacientes que fueron intervenidos quirúrgicamente en el Hospital “Roberto Rodríguez”, de la ciudad de Morón, provincia de Ciego de Ávila, Cuba, en el período comprendido entre enero de 1996 y diciembre del 2008, con el diagnóstico de tumor selar, con crecimiento supraselar dependiente o no de la silla turca, el diagnóstico fue obtenido con la tomografía axial computarizada (TAC) simple y contrastada de cráneo y silla turca, así como por imágenes de resonancia magnética nuclear (RMN). Resultados: Las principales manifestaciones clínicas al momento de la cirugía fueron la cefalea, presente en todos los casos y los trastornos visuales en 10 (66,67 por ciento), en todos se pudo demostrar crecimiento supraselar excéntrico. En seis pacientes (40 por ciento), se realizaron abordajes combinados, transcraneal-transesfenoidal o viceversa, en tiempos quirúrgicos diferentes, en otros seis (40 por ciento) solo transesfenoidal y en tres (20 por ciento) solo transcraneal. Las complicaciones fueron tres casos (20 por ciento) con anosmia, luego de un corredor bifrontal, una crisis convulsiva tónicoclónica generalizada en el post operatorio inmediato (6,67 por ciento), un sangrado transoperatorio con infarto cerebral secundario a vasospasmo cerebral (6,67 por ciento). Los resultados fueron excelentes en 10 (66,66 por ciento), en tres casos (20 por ciento) buenos, en uno (6,67 por ciento), regular y una paciente falleció (6,67 por ciento).

Introduction: The sellar region is considered the third site of brain tumors. Methods: A retrospective descriptive study was carried out in 15 patients operated on of sellar region tumor by transeptal transsphenoidal microsurgery and transcranialapproaches. Results: 10 giants pituitary adenoma by transesphenoidal or transcranial approaches, 2 craneopharyngiomas by transsphenoidal approach, 2 meningiomas and 1 dermoid tumor by transcranial approach. Complete resection was obtained in 73,33% of cases. The most frecuent complication was anosmia related with transcranial approaches. Results were excellent in 10 patients and with a mortality of 6,67%.

Endocrinological Results of the Transsphenoidal Microsurgery for Cushing's Disease

OBJECTIVE: We analyzed the clinical and endocrinological results of the transsphenoidal microsurgery for ACTH secreting pituitary adenomas. MATERIALS AND METHODS: From October 1995 to August 2000, 18 patients underwent transsphenoidal microsurgery for Cushing's disease. We analyzed the surgical results of 17 patients, one patient who was previously operated from other hospital was excluded. Age of the patients were 18 to 61 years old(mean 37.7), male to female ratio was 1: 3.3, and follow-up period was 3 to 50 months(mean 20.3). The selection of candidates for transsphenoidal exploration was based on endocrinologic criteria. Magnetic resonance imaging was the preferred radiologic test. Selective inferior petrosal sinus sampling of adrenocorticotropic hormone futher refined the diagnosis when endocrinologic and radiologic procedures were not definitive. RESULTS: Results of the preoperative endocrinological test were: level of serum ACTH 29.4 to 225ng/dL(mean 93.88ng/dL); serum cortisol 11.9 to 47.5ng/dL(mean 27.49ng/dL); 24-hour urine free cortisol 235 to 1019ng/day(mean 571.0ng/day). Inferior petrosal sinus sampling for ACTH was performed in 11 patients and all were confirmed by Cushing's disease and we could predict the laterality of the tumor in 9 of 11 patients. We performed transsphenoidal selective adenomectomy in 5 patients, adenomectomy and subtotal hypophysectomy in 2 patients, adenomectomy and partial hypophysectomy in 9 patients, and in the remaining one patient, hemihypophysectomy followed by total hypophysectomy due to remission failure. Fifteen of 17 patients(88.2%) showed endocrinological remission. Glucocorticoid replacement therapy was performed in all the patients who showed remission for 1 to 24 months(mean 5.9 months), and 6 patients received steroid over 6 months. CONCLUSION: We conclude that the direct demonstration of a tumor in the pituitary gland by MRI is the most important and definitive diagnostic tool and the location of a mass should be confirmed with increased level of ACTH by the inferior petrosal sinus sampling. Transsphenoidal microsurgery is effective treatment modality for Cushing's disease and the immediate postoperative evaluation of the surgical resection of the tumor is very important. The patients should show hypocortisolism, decreased, subnormal serum ACTH and cortisol levels and 24-hours urine free cortisol. We performed 18 transsphenoidal microsurgery for Cushing's disease in 17 patients and 15 patients(88.2%) showed endocrinological remission.

The Results of Transsphenoidal Microsurgery for Pituitary Microadenama in Cushing's Disease / 대한내과학회지

BACKGROUND: Cushing's disease is a hypercortisolic state attributable to hypersecretion of ACTH at pituitary gland Most of these diseases are due to pituitary microadenoma. Selective removal of adenoma by transsphenoidal microsurgery is the treatment of choice for Cushing's disease. We evaluated 25 cases to analyze results of transsphenoidal microsurgery and to identify prognostic factors that may predict successful outcome. METHODS: From 1989 to 1995, 25 patients were diagnosed as having Cushing's disease in Seoul National University Hospital. They were underwent pituitary microsurgery and confirmed to have pituitary microadenoma radiologically and pathologically. About these patients. retrospective evaluation was done. RESULTS: The patients consist of 21 females and 4 males and the age was ranged from 23 to 49 years. 19 patients (76%) were judged as immediate remission. The preoperative clinical, hormonal, and radiological characteristics of the remission and failure groups were similiar The patients who were immediate remission were followed from 3 months to 72 months. 3 patients had recurrences(15.8%) at 4, 8, 49 months after operation. The pre and postoperative clinical, hormonal, and radiological characteristics of the long-term remission and recurrence groups were similiar. We could not find any predictable factors of surgical outcome. CONCLUSION: The first line trearment of Cushing's disease is transsphenoidal microsurgery. However considering relative late and high rate of recurrence of Cushing's disease following curative surgery, careful longterm follow up is mandatory.

Clinical Analysis of Pituitary Tumors Treated with Transsphenoidal Approach

A retrospective study of 33 cases of pituitary region tumors which were confirmed by transsphenoidal microsurgery during last three years and eight months. After surgery, there were no direct surgical mortality. Some surgical complications such as diabetes insipitus and meningitis were occurred but which were temporary and easily controllable events. Medical therapy was done pre-& post operatively and also radiation therapy was given postoperatively in some cases as the adjuvant therapy. This review reconfirms that the transsphenoidal approach if safer and more effective procedure than craniotomy for most pituitary tumors.

A Clinical Analysis of Diagnosis and Surgical Treatment in Pituitary Adenoma

The authors present a clinical analysis of 96 patients with pituitary adenoma who underwent surgical treatment. These patients were analyzed in terms of preoperative clinical manifestations, size and extension of tumor, therapeutic modalities and changes of neurological and hormonal symptoms. There were marked improvements of neurological and hormonal sympotms, especially of vision and diabetes insipidus, immediately after operation. Transsphenoidal approach was a safe and effective operative method to achieve rapid decompression. Radiation therapy played a important role as a adjuvant therapeutic method to eradicate postoperative residual tumors.