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 transsphenoidal treatment of empty sella turcica syndrome using a silastic coil.

An empty sella turcica is due to the presence of an arachnoid diverticulum with its fluid content in the sella turcica, exerting pressure on the pituitary gland. In most cases this condition has an asymptomatic course, and is discovered by accident. Some patients, however, develop empty sella turcica syndrome with headaches, mild dishormonose, dysopsia and, rarely, spontaneous rhinorrhoea. Surgical treatment of empty sella turcica consists of filling the sella, through the transsphenoid route, with tissues collected from the patient or with artificial material. The aim of this report is to present our own experience of endoscopic extradural sella elevation using a silicone spiral, in 4 patients with primary empty sella turcica syndrome. The main indication for surgery was progressing dysopsia. The microinvasive endoscopic transsphenoidal method has been used, based upon the Jho technique with our own modifications. For the elevation of the sella, we used a coiled section of a Pudenz valve intraventricular silicone drain, adjusting its size to the dimensions of the operated sella. Both the implantation of the helix, and the postoperative course were uncomplicated for all surgically treated patients. The follow-up of several months confirmed improvement of the dysopsia in all surgically treated patients. MR examinations confirmed the correct location of the silicone spiral placed in the sella. It seems that the good results achieved are due to a correct indication for surgical treatment. The follow-up period ranges from 12 to 30 months and, so far, the clinical improvement is stable and satisfying both for the patients who underwent treatment and for the neurosurgeons.

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.

[Neurovascular compression within posterior cranial cavity]. / Konflikt naczyniowo-nerwowy w obrebie tylnej jamy czaszki.

30 years ago Janetta proposed neurovascular compression as an etiology factor of trigeminal neuralgia. Neuroanatomical, neurophysiological studies and observations during neurosurgical operations seems to confirm Janetta's suggestions. The conception of neurovascular compression was accepted also as an etiology factor in hemifacial spasm. There are more diseases of unknown etiology described in literature in which neurovascular compression as an etiological factor is suspected. The results of initial treatment of these diseases performed by neurovascular decompression were presented. We are described the methods of contemporary diagnostics of neurovascular compression syndrome. The difficulties with correct diagnostics were underlined. MRI and neurophysiological examinations were pointed out as the most useful in an evaluation of neurovascular compression syndromes.

[Neurovascular compression as a reason for neurogenic hypertension]. / Konflikt naczyniowo-nerwowy jako przyczyna powstania nadcisnienia neurogennego.

30 years ago Janetta proposed neurovascular compression as an etiological factor of trigeminal neuralgia. Neuroanatomical, neurophysiological studies and observations during neurosurgical operations seem to confirm Janetta's suggestion. The conception of neurovascular compression is accepted also as an etiological factor in hemifacial spasm. In literature a neurovascular compression is suspected as an etiological factor in many diseases of unknown etiology. The results of neurovascular decompression performed as initial treatment of these diseases were presented. The methods of contemporary diagnostics of neurovascular compression syndromes and difficulties with correct diagnosis were described. MRI and neurophysiological examinations were pointed out as the most useful in the evaluation of neurovascular compression syndromes.

[Selected problems of neurofibromatosis with presentation of a case of multiple intracranial and intramedullary tumors]. / Przypadek nerwiakowlókniakowatosci typu II z mnogimi guzami wewnatrzczaszkowymi i sródrdzeniowymi.

A case of neurofibromatosis type II in a 19-year-old man is described with clinical and neuroimaging (MRI) findings. The diagnostic criteria of neurofibromatosis type I (NF1) and type II (NF2) and the optimal management options are still controversial. The authors suggest that this patient fulfills criteria of neurofibromatosis type II as well as partially neurofibromatosis type I. At present, without molecular analysis of DNA, this assumption can not be verified.

Characterization of the Variation Potential in Sunflower.

A major candidate for intercellular signaling in higher plants is the stimulus-induced systemic change in membrane potential known as variation potential (VP). We investigated the mechanism of occurrence and long-distance propagation of VP in sunflower (Helianthus annuus L.) plants. Here we present evidence of the relationship among injury-induced changes in xylem tension, turgor pressure, and electrical potential. Although locally applied wounding did trigger a change in membrane potential, it evoked even faster changes in tissue deformation, apparently resulting from pressure surges rapidly transmitted through the xylem and experienced throughout the plant. Externally applied pressure mimicked flame wounding by triggering an electrical response resembling VP. Our findings suggest that VP in sunflower is not a propagating change in electrical potential and not the consequence of chemicals transmitted via the xylem, affecting ligand-modulated ion channels. Instead, VP appears to result from the surge in pressure in the xylem causing a change in activity of mechanosensitive, stretch-responsive ion channels or pumps in adjacent, living cells. The ensuing ion flux evokes local plasma membrane depolarization, which is monitored extracellularly as VP.