Endoscopic transsphenoidal treatment in recurrent and residual pituitary adenomas--first experience.

AIM OF THE STUDY: The aim of the study has been the assessment of the endoscopic method in the surgical management of recurrent and residual pituitary adenomas, as concerns treatment efficiency, substantial complications, and its possible advantages for the operating surgeon and patient. MATERIAL AND METHODS: In Department of Neurosurgery, Silesian University School of Medicine in Katowice, between October 2001 and June 2004, 125 patients underwent endoscopic surgery due to pituitary adenoma. The analysis comprised 20 patients, who were operated on due to recurrent adenomas or residual tumour not completely removed during the first surgical procedure. The group of patients was composed of 9 women and 11 men. The youngest patient was 32 years of age, the oldest 79. The average age was 53.9 years. The analysed group had 14 non-functioning adenomas, 4 GH-secreting adenomas, 1 PRL-secreting adenoma and 1 ACTH-secreting adenoma. 19 of them were macroadenomas while 1 was a microadenoma. 11 of the 20 adenomas infiltrated the cavernous sinuses. The surgical procedures were performed by a stable team, composed of 2 neurosurgeons, a laryngologist and an anaesthesiologist. The surgery method was based upon the technique developed by Jho and Carrau, with own modifications of the operators. A rigid neuroendoscope having the diameter of 4 mm with 0 degrees and 30 degrees optics by Storz was used. The follow-up period after surgery was between 12 and 42 months, 24.2 months on average. RESULTS: Of the 20 cases, complete recovery was achieved in 40% of patients undergoing secondary surgical procedures. In the group of 11 patients with adenomas not infiltrating the cavernous sinuses, recovery was reported for 8 of them, that is 73%. No fatalities occurred. 7 cases of liquorrhoea occurred during operation, requiring reconstruction and sealing of the sella by means of tissue glue and artificial dura or freeze-dried human dura. In 1 case, despite the application of post-operative lumbar drainage, rhinorrhoea occurred one month after the procedure, which required endoscopic reconstructive treatment. In the same patient, a pneumoencephalocele was observed. The average time of the repeat surgical procedure using endoscopic techniques was shorter by 18 minutes than the repeat procedure using microscopic techniques. CONCLUSIONS: The endoscopic method is a safe, hardly invasive and efficient surgical technique in the treatment of recurrent and residual pituitary adenomas. Advantages which add to its attractiveness are also reduction of the procedure duration, very good visualisation of the operative field, absence of serious complications, less pain experienced after the surgery.

Endoscopic transnasal transsphenoidal treatment of pathology of the sellar region.

From October 2001 to the end of November 2002 in Department of Neurosurgery, Silesian University School of Medicine in Katowice 70 explorations of the sella turcica were executed using the endoscopic method. In 63 cases the operation was done because of pituitary gland adenomas. In one case the diagnosis was craniopharyngioma, in 1 chordoma of the clivus, in one glioma of the optic nerve, in 1 the reason for an operation was an empty sella syndrome and in 3 cases the pathological diagnosis was an amorphous masses. Patients were operated using the 4-mm diameter endoscope with 0- and 30-degree angled lenses, using the method according to Jho and Carrau with our own modifications. In all cases of adenomas the total removal of the tumour was obtained in 71.4 %. Permanent diabetes insipidus occurred in 4.3 % of all operated patients. In our series of patients we did not observe any postoperative CSF leak or rhinological complications. One patient died, corresponding to 1.4 % of all cases. We the recommend transsphenoidal transnasal endoscopic approach for use in the cases of sellar region pathology because of the advantages of the method for surgeon and for comfort of the patient.

Cerebral aneurysms in childhood.

OBJECTS: The aim of this work was to ascertain any clinical and anatomical factors allowing differentiation between aneurysms of childhood and those occurring in adults by comparing both groups. METHODS: Results obtained in a total of 17 children and adolescents aged up to 18 who had been operated on for cerebral aneurysm in our department from 1989 to 1997 (3% of all patients treated for subarachnoid haemorrhage resulting from ruptured cerebral aneurysm in this period) were compared with those in the adult group operated on in our department. In contrast to the situation in adults, there was a male predominance in our population. In children we found only 1 case of middle cerebral aneurysm and 1 case of multiple aneurysms. We also found a high rate of rebleeding in the paediatric group. CONCLUSIONS: We suggest that the very good outcome (100% very good results in patients operated on early) obtained and the high risk of rebleeding in children with cerebral aneurysm allow the recommendation of early surgery in children with ruptured cerebral aneurysms.

[Anorexia as a symptom of cerebral aneurysm in a 14-year-old boy]. / Jadlowstret jako glówny objaw tetniaka mózgu u 14-letniego chlopca.

The authors present a very rare case of a child with anterior communicating artery aneurysm and symptoms of anorexia nervosa. Because of coexistence of subarachnoid haemorrhage and head trauma false diagnosis of temporal and frontal lobe contusion was initially established. Headaches, anorexia and cachexia occurred with aneurysm enlargement. Computed tomography and cerebral angiography allowed to indicate operation. After successful surgery all symptoms disappeared.

[A case of arachnoid cyst in vertebral canal]. / Przypadek torbieli pajeczynówki kanalu kregowego.

A rare case of intradural subarachnoid cyst in the vertebral canal was observed in a female aged 52 years. Operation was followed by marked improvement of the neurological condition. The large defect of the dura required grafting of lyophilized dura. The role of MRI in the diagnosis of this case is stressed.

The prognostic value of some clinical and diagnostic factors in traumatic intracranial haematoma.

In order to carry out the analysis of predictive values of some clinical and diagnostic features, 146 patients of the Neurosurgical Clinic of the Silesian School of Medicine, were examined in 1980-1986. All the patients were in coma when admitted while CT findings showed traumatic intracranial haematomas. The examination included neurological diagnosis and CT examination. The analysis of statistical discrimination let us specify the probability of predicting death or survival of every patient. On the basis of 10 prognostic factors applied, the compatibility of prognosis and the real outcome for patients who survived was 78.2% and for those who died 91.2%.

[Post-traumatic posterior cranial fossa hematomas from material of the Department of Neurosurgery, Silesian Medical Academy in Katowice]. / Pourazowe krwiaki tylnego dolu czaszkowego w materiale Kliniki Neurochirurgii SL. AM w Katowicach.

The location of posttraumatic haematomas in the posterior cranial fossa is rare and the correct diagnosis was difficult before the advent of CT. In the years 1976-1989 in the group of 2450 cases of craniocerebellar injuries treated in the Department of Neurosurgery, Silesian Medical Academy 24 patients had posterior fossa haematomas, but only one of them (out of 550 cases of injuries) was diagnosed without CT. In 20 cases surgical treatment was carried out with good and satisfactory results in 16 cases (80%). The authors stress the importance of early CT and surgical intervention.