database for each of the patients, cannot permit a more thorough statistical analysis. Conclusions Extraocular nerve dysfunction after transsphenoidal pituitary surgery essentially concerns CNs III and VI and occurs more frequently when the adenoma invades or extends into the cavernous sinus. This rare complication appears to be more frequent in patients treated by an endoscopic approach. For most of the patients the deficit appears with a delay of at least 12 hours as a result of a swelling process and recovers within the 3 months after surgery. In very few cases
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Simona Mihaela Florea, Thomas Graillon, Thomas Cuny, Regis Gras, Thierry Brue, and Henry Dufour
Richard F. Schmidt, Osamah J. Choudhry, Ramya Takkellapati, Jean Anderson Eloy, William T. Couldwell, and James K. Liu
foundation for much of the practice of modern pituitary surgery. Located in the middle of the skull base, pituitary tumors were considered virtually inaccessible at that time. Schloffer's bold decision to approach the pituitary gland through an extracranial transnasal route via the sphenoid sinus was not only groundbreaking as both a concept and a technical procedure, but it also brought pituitary surgery into mainstream practice and directly contributed to further advancements in its application. The underlying concept of transsphenoidal surgery has withstood the test of
Gautam U. Mehta, Kamran D. Bakhtian, and Edward H. Oldfield
and eliminate any arachnoid herniation, ESS is more likely to present with microadenomas and hormonesecreting tumors. To date, treatment outcomes for pituitary tumors in the setting of primary ESS remain undefined, described only in case reports and small series. 1 , 2 , 4 , 7 , 12 , 15 , 19 , 20 , 26 , 27 Pituitary surgery, which is first-line therapy for adrenocorticotropin (ACTH)- and growth hormone (GH)-secreting tumors, is particularly challenging in the setting of ESS due to diminished pituitary gland volume, as well as the frequent presence of an arachnoid
Paul E. Constanthin, Nathalie Isidor, Sophie De Seigneux, and Shahan Momjian
T ranssphenoidal pituitary surgery (TPS) is a well-established treatment for pituitary gland lesions. This surgery is not without some risks and complications. One of the main postoperative complications of TPS is hyponatremia, which might occur in as many as one-third of patients. 1 – 6 The leading cause of hyponatremia is the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), characterized by an abnormally elevated pituitary release of arginine vasopressin (AVP), leading to an increased retention of water and ultimately resulting in
Shane Shahrestani, Alexander M. Ballatori, Xiao T. Chen, Andy Ton, Ben A. Strickland, Andrew Brunswick, and Gabriel Zada
previously been used to assess frailty’s impact on short-term outcomes of patients undergoing pituitary surgery. Asemota and Gallia conducted a propensity-matched study of frail versus nonfrail patients undergoing transsphenoidal pituitary surgery using the 2000–2014 National Inpatient Sample (NIS), and found that frail patients had significantly higher rates of fluid and electrolyte disorders, intracranial vascular complications, mental status changes, pulmonary insufficiency, acute kidney failure, and other postoperative complications. 18 Our study corroborates
Lea M. Alhilali, Andrew S. Little, Kevin C. J. Yuen, Jae Lee, Timothy K. Ho, Saeed Fakhran, and William L. White
demonstrate that EPO MRI is not only accurate in determining residual tumor but also more accurate than LPO MRI, with superior interreader reliability. Furthermore, we found that LPO MRI detected no additional lesions in the setting of prior EPO MRI. In fact, discrepancies between LPO and EPO MRI were all settled in favor of EPO MRI. This result suggests that EPO MRI rather than LPO MRI should be used as the primary postoperative follow-up study in patients undergoing transsphenoidal pituitary surgery. After the initial EPO MRI, our data support the current recommendations
Lea M. Alhilali, Andrew S. Little, Kevin C. J. Yuen, Jae Lee, Timothy K. Ho, Saeed Fakhran, and William L. White
demonstrate that EPO MRI is not only accurate in determining residual tumor but also more accurate than LPO MRI, with superior interreader reliability. Furthermore, we found that LPO MRI detected no additional lesions in the setting of prior EPO MRI. In fact, discrepancies between LPO and EPO MRI were all settled in favor of EPO MRI. This result suggests that EPO MRI rather than LPO MRI should be used as the primary postoperative follow-up study in patients undergoing transsphenoidal pituitary surgery. After the initial EPO MRI, our data support the current recommendations
Anthony O. Asemota and Gary L. Gallia
In this study, we investigated the significance of frailty as a predictor of outcome in adult patients undergoing transsphenoidal pituitary surgery. Methods Data Source Data were obtained from the 2000–2014 National (Nationwide) Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) managed under the Agency for Healthcare Research and Quality (AHRQ). 19 Study Group Patient records containing a diagnosis of pituitary tumors or disorders were identified using ICD-9-CM codes 194.3, 227.3, 237.0, 239.7, 253.0, 253.8, 253.9, and 255.0. We included
Iyan Younus, Mina M. Gerges, Georgiana A. Dobri, Rohan Ramakrishna, and Theodore H. Schwartz
, it is important to identify common causes and predictors of readmission to improve outcomes. Endonasal endoscopic transsphenoidal surgery (EETS) is an important modality for the treatment of pituitary adenomas. 6 , 7 , 15 , 16 , 24 , 32 , 36 , 37 , 39 This approach has been reported to have favorable outcomes compared with traditional approaches. 10 , 12 , 21 , 22 , 28–30 , 35 However, there are only a handful of reports of 30-day readmission rates after transsphenoidal pituitary surgery, and to the authors’ knowledge, no factors predictive of readmission have
Peter J. Wilson, Sacit B. Omay, Ashutosh Kacker, Vijay K. Anand, and Theodore H. Schwartz
purpose of data presentation using a standard of 1 box plot per data series. Surgical Technique All operations were performed by a surgical team that included an otolaryngologist (V.K.A. or A.K.) and a neurosurgeon (T.H.S.) at the Institute for Minimally Invasive Skull Base and Pituitary Surgery. The details of surgical technique have been described previously. 16 In addition to the routine endoscopic endonasal approach to the sella, a lumbar puncture is routinely performed under general anesthesia but prior to the endonasal approach to facilitate injection of
