[Transsphenoidal approach to prolactinomas]. / Cirugia transeptoesfenoidal en adenomas hipofisarios productores de prolactina.

INTRODUCTION: Transeptal transsphenoidal surgery for pituitary tumors is a well established surgical technique. In particular the use of medical treatment in patient with prolactinomas has induced the control of hiperprolactinemia and the shrinkage of the tumor in the great majority of the patients, for that reason the treatment of the prolactinomas is controversial. OBJECTIVE: We evaluate the results of transsphenoidal microsurgical treatment of prolactin secreting adenomas at our Unit. METHODS: We made a retrospective analysis of 63 patients operated on via transsphenoidal microsurgical technique for prolactin secreting adenomas between 1996 and 2003. Age, sex, symptoms, tumor size, hormonal levels, complications and postsurgical outcome were considered. RESULTS: There was a female predominance of 86% of the cases and middle aged patients were more commonly seen. 31 patients had tumors more than 10mm in diameter on the CT scan. The most frecuent complication was transient diabetes insipidus (11 cases). Prolactin levels were reduced to non tumoral values in 90.6% of microadenomas (29 cases) and in 67.7% of macroadenomas (21 cases). Headache was the most frecuent complain in our patients with amelioration after surgery in 82% (36 cases). Campimetric visual defects were reduced in 69% (18 cases). CONCLUSIONS: Transsphenoidal adenomectomy is a safe treatment option for patients with prolactin secreting adenomas with surgical indication.

Cirugìa transfenoidal en adenomas hipofisiarios productores de prolactina / Transsphenoidal approach to prolactinomas

Para un gran nùmeros de tumores pituitarios, la cirugpia es el tratamiento de primera lìnea y el abordaje trnasfenoidal microquirurgico, el proceder màs utilizado...(AU)

Transeptal transsphenoidal surgery for pituitary tumors is a well established surgical technique...(AU)

Cirugía transeptoesfenoidal en adenomas hipofisarios productores de prolactina / Transsphenoidal approach to prolactinomas

Introducción. Para un gran número de tumores pituitarios, la cirugía es el tratamiento de primera línea y el abordaje transesfenoidal microquirúrgico el proceder más utilizado. El tratamiento actual de los prolactinomas es bastante controversial, por los buenos resultados alcanzados con los nuevos agonistas dopaminérgicos; no obstante la adenomectomía selectiva se incluye entre las modalidades de tratamiento para aquellos prolactinomas que no respondan a dicho tratamiento dopaminérgico. Objetivo. Evaluar los resultados del tratamiento microquirúrgico por vía transepto esfenoidal de los adenomas productores de prolactina en el Servicio de Neurocirugía del Hospital “Hermanos Ameijeiras”. Material y método. Presentamos un estudio retrospectivo y descriptivo de 63 pacientes intervenidos por vía sublabial transepto esfenoidal microquirúrgica, portadores de este tipo de adenomas, y tratados en nuestro servicio desde 1996 hasta el 2003. Se analizan edad, sexo, cuadro clínico, tamaño de las lesiones, niveles hormonales, complicaciones y evolución postoperatoria. Resultados. Se encontró un franco predominio del sexo femenino, 86% (54 pacientes). Se operaron 31 pacientes con macroadenomas y 32 con microadenomas. La complicación más común en el postoperatorio fue la diabetes insípida transitoria (11 enfermos), siendo de poca trascendencia. Se logró reducir las cifras iniciales de prolactina a valores no tumorales en el 90.6% de lo microadenomas (29 casos) y en el 67.7% de los macroadenomas (21 casos). Los síntomas más frecuentes que aquejaban a nuestros pacientes mejoraron, sobre todo la cefalea en el 82% (36 casos) y los trastornos visuales en el 69% (18 casos). Conclusiones. Se concluye que la adenomectomía transeptoesfenoidales un proceder seguro y eficaz como opción de tratamiento para pacientes con adenomas secretores de prolactina que tengan indicación quirúrgica

Introduction. Transeptal transsphenoidal surgery for pituitary tumors is a well-established surgical technique. In particular the use of medical treatment inpatient with prolactinomas has induced the control of hiperprolactinemia and the shrinkage of the tumor in the great majority of the patients, for that reason the treatment of the prolactinomas is controversial. Objective. We evaluate the results of trassphenoidal microsurgical treatment of prolactin secreting adenomas at our Unit. Methods. We made a retrospective analysis of 63 patients operated on via transsphenoidal microsurgical technique for prolactin secreting adenomas between1996 and 2003. Age, sex, symptoms, tumor size, hormonallevels, complications and postsurgical outcome were considered. Results. There was a female predominance of 86%of the cases and middle aged patients were more commonly seen 31 patients had tumors more than 10mmin diameter on the CT scan. The most frecuent complicationwas transient diabetes insipidus (11 cases).Prolactin levels were reduced to non tumoral values in 90.6% of microadenomas (29 cases) and in 67.7% of macroadenomas (21 cases). Headache was the most frecuentcomplain in our patients with amelioration after surgery in 82% (36 cases). Campimetric visual defects were reduced in 69% (18 cases).Conclusions. Transsphenoidal adenomectomy is a safe treatment option for patients with prolactin secreting adenomas with surgical indication

[Transnasal-transsphenoidal endoscopic surgery of the sellar region]. / Cirugía transnasal transesfenoidal endoscópica en afecciones de región selar.

UNLABELLED: Transnasal transsphenoidal endoscopic approach to the sella turcica has recently become an option to the pituitary surgery which could predominate in a near future. OBJECTIVES: To evaluate through the analysis of our results whether it is possible to perform in our Hospital the endoscopic transnasal transsphenoidal approach to the sella with results at least as good as those we obtain with the microscopic sublabial transseptal transsphenoidal approach. MATERIAL AND METHODS: As the first stage of a three stage randomized trial, this is a prospective study of 10 patients operated on, using transnasal transsphenoidal endoscopic approach between august 2002 and August 2003 at the department of neurosurgery of "Hermanos Ameijeiras Hospital". RESULTS: Six patients had pituitary macroadenomas and four had cerebrospinal fluid leak through the sellar floor. In five of six macroadenomas total tumor resection was obtained and in the other one a subtotal resection was performed. Two of four patients with cerebrospinal fluid leak could be cured while the other two patients do not. Complications were present in 30% of cases, but in only 1 (10%) it reached the postoperatory period. CONCLUSIONS: Transnasal transsphenoidal endoscopic approach to the sella can be done save enough in our Hospital to justify the start of the second stage of one randomized trial to determine if the endoscopic technique is better than the usual transsphenoidal approach.

Cirugìa transnasal transesfenoidal endoscòpica en afeciones de regiòn selar / s. t

Transnasal transsphenoidal endoscopic approach to the sella turcica has recently become an option to the pituitary surgery which could predominate in a near future. To evaluate through the analysis of our results whether it is possible to perform in our Hospital the endoscopic transnasal transsphenoidal approach to the sella with results at least as good as those we obtain with the microscopic sublabial transseptal transsphenoidal approach...(AU)

Cirugía transnasal transesfenoidal endoscópica en afecciones de región selar / Transnasal-transsphenoidal endoscopic surgery of the sellar region

Introducción. Para un gran número de tumores pituitarios la cirugía es el tratamiento de primera línea y el abordaje transesfenoidal microquirúrgico el más utilizado. En estos momentos, el mismo se ejecuta tanto por la vía sublabial como por la transnasal. Recientemente, el abordaje transnasal endoscópico ha irrumpido como una opción en desarrollo, que pudiera llegar a predominar en un futuro próximo. Objetivos. Evaluar mediante el análisis de los resultados si es posible realizar en nuestro medio el abordaje transnasal transesfenoidal endoscópico para las lesiones de la región selar con resultados quirúrgicos, al menos, similares a los obtenidos con el método transesfenoidal tradicional. Material y método. Como fase I de un ensayo en 3 etapas se realiza una investigación limitada tipo cohorte, estrictamente controlada y prospectiva de 10 pacientes seleccionados según criterios de inclusión y a los cuales se les practicó el abordaje transnasal endoscópico como método de tratamiento quirúrgico entre Agosto del 2002 y Agosto del 2003 en el servicio de Neurocirugía del Hospital "Hermanos Ameijeiras". Resultados. Se operaron seis casos que tenían macroadenomas hipofisarios, tres productores de GH, uno secretor de PRL y otros dos no productores. A los otros cuatro se les había diagnosticado fístula de LCR a través del piso selar. De los seis macroadenomas, en cinco se logró exéresis total del tumor, mientras que en el otro se obtuvo exéresis subtotal. La rinorrea desapareció en 2 pacientes con fístula de LCR y se mantuvo en los otros 2. De las complicaciones observadas en el 30% de los casos, solo en 1 (10%) transcendieron más allá del transoperatorio. Conclusiones. Los resultados obtenidos en la fase 1 con la utilización del método transnasal endoscópico, hacen que el procedimiento en nuestro medió sea lo suficientemente seguro como para justificar el pase a la fase II del ensayo (aleatorizada y controlada), en busca de información más consistente, en relación al valor real de la técnica a estas alturas del desarrollo de la cirugía hipofisaria

Transnasal transsphenoidal endoscopic approach to the sella turcica has recently become an option to the pituitary surgery which could predominate in a near future. Objectives. To evaluate through the analysis of our results whether it is possible to perform in our Hospital the endoscopic transnasal transsphenoidal approach to the sella with results at least as good as those we obtain with the microscopic sublabial transseptal transsphenoidal approach. Material and methods. As the first stage of a three stage randomized trial, this is a prospective study of 10 patients operated on, using transnasal transsphenoidal endoscopic aproach between august 2002 and August 2003 at the department of neurosurgery of "Hermanos Ameijeiras Hospital". Results. Six patients had pituitary macroadenomas and four had cerebrospinal fluid leak through the sellar floor. In five of six macroadenomas total tumor resection was obtained and in the other one a subtotal resection was performed. Two of four patients with cerebrospinal fluid leak could be cured while the other two patients do not. Complications were present in 30% of cases, but in only 1 (10%) it reached the postoperatory period. Conclusions. Transnasal transsphenoidal endoscopic approach to the sella can be done save enough in our Hospital to justify the start of the second stage of one randomized trial to determine if the endoscopic technique is better than the usual transsphenoidal approach