RESUMEN
OBJECTIVE: Symptomatic pituitary apoplexy is a rare but life-threatening condition caused by sudden hemorrhage or infarction of a pituitary adenoma. In the current study, we aim to evaluate the clinical presentation, management, and clinical outcomes in a cohort of patients who were treated for this condition in our center in the last 16 years. METHODS: We performed a retrospective analysis of all patients who underwent endoscopic endonasal surgery for treatment of symptomatic pituitary apoplexy between 2001 and 2016 in our center. RESULTS: A total of 39 patients were included in the study, mean age of 54.9 years (range, 18-70 years) and mean follow-up 5.1 years (range, 0.6-16 years). Most of the patients had nonfunctioning adenomas (32 patients). Headache (89%), visual impairment (79%), and hypopituitarism (86%) were the most common preoperative findings. Surgical treatment led to gross total resection in 31 patients (79.4%). During follow-up, visual fields and oculomotor improvement was observed in 23 (74.1%) and 21 (67.7%) of the patients, respectively. Intractable headache also improved in all patients. Hypopituitarism was present in 77% of patients after surgery. In this series, no cerebrospinal fluid leak, vascular injury, or infection was observed. There was no postoperative mortality. CONCLUSIONS: The endoscopic endonasal transsphenoidal approach is an effective modality to treat pituitary apoplexy with a high rate of success and minimal risk in selected cases. Although reversion of preoperative visual deficits is often observed, hormonal deficits tend to persist, and require long-term hormonal therapy, even after successful endoscopic endonasal surgical resection.
Asunto(s)
Adenoma/cirugía , Cirugía Endoscópica por Orificios Naturales/métodos , Neuroendoscopía/métodos , Apoplejia Hipofisaria/cirugía , Neoplasias Hipofisarias/cirugía , Adenoma/complicaciones , Adolescente , Adulto , Anciano , Pérdida de Líquido Cefalorraquídeo/epidemiología , Femenino , Humanos , Hipopituitarismo/epidemiología , Masculino , Persona de Mediana Edad , Cavidad Nasal , Apoplejia Hipofisaria/etiología , Neoplasias Hipofisarias/complicaciones , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Hueso Esfenoides , Infección de la Herida Quirúrgica/epidemiología , Lesiones del Sistema Vascular/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To present our experience with the surgical management of giant pituitary adenomas in a series of 50 cases operated on by an endoscopic endonasal approach. METHODS: A retrospective data analysis of all patients who underwent transsphenoidal endonasal endoscopic surgery at the General Hospital of Fortaleza, Brazil, between January 1998 and November 2011 was performed. Patients who presented with pituitary adenomas larger than 4 cm were included in the study. Analysis of factors related to the choice of the operative approach, hormonal and visual status, extent of resection, tumor control rates, clinical outcome, and complications were evaluated. RESULTS: Fifty cases (10.41%) matched our inclusion criteria. Nonfunctioning tumors were present in 42 patients (84%); among functioning adenomas, five patients (10%) had growth hormone-secreting adenomas, and three patients (6%) had prolactinomas. Total removal of the tumor occurred in 19 cases (38%), near-total removal in 9 cases (18%), and partial removal in 22 cases (44%). Postoperative cerebrospinal fluid leaks occurred in four cases (8%). Postoperative diabetes insipidus was present in 10% and new anterior pituitary insufficiency affecting one axis or more than one axis was observed in 22% and 14%, respectively. The presence of Knosp score ≥3 was associated with subtotal resection. Patients harboring hormonally active adenomas were submitted to adjuvant medical therapy for long-term clinical control. Vision improved in 38 patients (76%), with only one case of visual deterioration reported. CONCLUSION: Transsphenoidal endoscopic endonasal surgery may provide effective treatment for patients with giant adenomas when performed by a surgical team that specializes in pituitary surgery. In cases in which total resection by the endoscopic approach may be associated with important complications, we advocate the use of partial resections followed by adjuvant drug therapy or radiotherapy. In cases of progressive enlargement of residual lesions, a second endoscopic debulking of the tumor may be considered for control of the disease.
Asunto(s)
Adenoma/cirugía , Cavidad Nasal/cirugía , Procedimientos Neuroquirúrgicos/métodos , Neoplasias Hipofisarias/cirugía , Adenoma/patología , Adolescente , Adulto , Anciano , Terapia Combinada , Endoscopía/métodos , Femenino , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuroimagen/métodos , Hormonas Hipofisarias/sangre , Neoplasias Hipofisarias/patología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/terapia , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/terapia , Estudios Retrospectivos , Base del Cráneo/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
The authors investigate the complications of transnasal transsphenoidal endoscopic surgery in the treatment of 301 patients with pituitary adenomas. A retrospective analysis of complications in 301 patients submitted to transsphenoidal transnasal endoscopic surgery at the General Hospital of Fortaleza, Brazil between January 1998 and December 2009. The complications were divided in two groups: anatomical (oronasofacial, sphenoid sinus, intrasellar, suprasellar and parasellar) and endocrinological complications (anterior and posterior pituitary dysfunctions). We observed a total of 81 complications (26.9%) in our series. Anatomical complications occurred in 8.97% (27 cases): 8 CSF postoperative leaks (2.6%), 6 cases (1.9%) of delayed nasal bleeding, 5 cases (1.6%) of sphenoidal sinusitis, 3 cases (0.9%) of carotid artery lesion, 2 cases of meningitis (0.6%) and one case (0.3%) of each of the uncommon following complications: intrasella-suprasella hematoma, pontine hematoma and chiasmaplexy. Endocrinological complications occurred in 17.9% (54 cases): additional postoperative anterior lobe insufficiency in 35 cases (11.6%), and postoperative diabetes insipidus in 19 cases (6.3%). In our series, 3 cases of deaths (not directly related to the procedure) were also observed. Endoscopic transsphenoidal surgery represents an effective option for the treatment of patients with pituitary tumor. Complications still occur and must be reduced as much as possible. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Additional improvement can be expected with greater experience and new technical developments.
Asunto(s)
Adenoma/cirugía , Endoscopía/métodos , Neoplasias Hipofisarias/cirugía , Complicaciones Posoperatorias/epidemiología , Adenoma/epidemiología , Adolescente , Adulto , Anciano , Niño , Estudios de Cohortes , Endoscopía/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/efectos adversos , Procedimientos Neuroquirúrgicos/métodos , Nariz , Neoplasias Hipofisarias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Hueso Esfenoides/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECT: Acromegaly is a chronic disease related to the excess of growth hormone (GH) and insulin-like growth factorI secretion, usually by pituitary adenomas. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The introduction of endoscopy as an additional tool for surgical treatment of pituitary adenomas and, therefore, acromegaly represents an important advance of pituitary surgery in the recent years. The aim of this retrospective study is to evaluate the results of pure transsphenoidal endoscopic surgery in a series of patients with acromegaly who were operated on by a pituitary specialist surgeon. The authors discuss the advantages, outcome, complications, and factors related to the success of the endoscopic approach in cases of GHsecreting adenomas. METHODS: The authors retrospectively analyzed data from cases involving patients with GH-secreting adenomas who underwent pure transsphenoidal endoscopic surgery at the Department of Neurosurgery of the General Hospital in Fortaleza, Brazil, between 2000 and 2009. Tumors were classified according to size as micro- or macroadenomas, and tumor extension was analyzed based on suprasellar/parasellar extension and sella floor destruction. All patients were followed up for at least 1 year. The criteria of disease control were GH levels < 1 ng/L after oral glucose tolerance test and normal insulin-like growth factorI levels for age and sex. RESULTS: During the study period, 67 patients underwent pure endoscopic transsphenoidal surgery for treatment of acromegaly. Disease control was obtained in 50 cases (74.6%). The rate of treatment success was higher in patients with microadenomas (disease control achieved in 12 [85.7%] of 14 cases) than in those with larger lesions. Suprasellar/parasellar extension and high levels of sella floor erosion were associated with lower rates of disease control (p = 0.01 and p = 0.02, respectively). Complications related to the endoscopic surgery included epistaxis (6.0%), transitory diabetes insipidus (4.5%), and 1 case of seizure (1.5%). CONCLUSIONS: Endoscopic transsphenoidal surgery represents an effective option for treatment of patients with acromegaly. High disease control rates and a small number of complications are some of the most important points related to the technique. Factors related to the success of the endoscopic surgery are lesion size, suprasellar/parasellar extension, and the degree of sella floor erosion. Although presenting important advantages, there is no conclusive evidence that endoscopy is superior to microsurgery in treatment of GH-secreting adenomas.
Asunto(s)
Acromegalia/cirugía , Endoscopía/métodos , Hormona de Crecimiento Humana/metabolismo , Procedimientos Neuroquirúrgicos/métodos , Neoplasias Hipofisarias/cirugía , Acromegalia/sangre , Adenoma/cirugía , Adulto , Anciano , Femenino , Adenoma Hipofisario Secretor de Hormona del Crecimiento/sangre , Adenoma Hipofisario Secretor de Hormona del Crecimiento/cirugía , Hormona de Crecimiento Humana/sangre , Humanos , Factor I del Crecimiento Similar a la Insulina/análisis , Masculino , Persona de Mediana Edad , Neoplasias Hipofisarias/sangre , Inducción de Remisión , Estudios Retrospectivos , Hueso Esfenoides , Resultado del Tratamiento , Carga TumoralRESUMEN
Pituitary tumors are challenging tumors in the sellar region. Surgical approaches to the pituitary have undergone numerous refinements over the last 100 years. The introduction of the endoscope have revolutionized pituitary surgery. The aim of this study is to report the results of a consecutive series of patients undergoing pituitary surgery using a pure endoscopic endonasal approach and to evaluate the efficacy and safety of this procedure. We reviewed the data of 228 consecutive patients who underwent endonasal transsphenoidal adenoma removal over an 10-year period. Pre- and post-operative hormonal status (at least 3 months after surgery) were analyzed and compared with clinical parameters presented by the patients. Tumor removal rate, endocrinological outcomes, and complications were retrospectively assessed in 228 patients with pituitary adenomas who underwent 251 procedures between December 1998 and December 2007. There were 93 nonfunctioning adenomas, 58 growth hormone-secreting, 41 prolactin-secreting, 28 adrenocorticotropin hormone secreting, 7 FSH-LH secreting and 1 thyroid-stimulating hormone-secreting adenomas. Gross total removal was achieved in 79.3% of the cases after a median follow-up of 61.5 months. The remission results for patients with nonfunctioning adenomas was 83% and for functioning adenomas were 76.3% (70.6% for GH hormone-secreting, 85.3% for prolactin hormone-secreting, 71.4% for ACTH hormone-secreting, 85.7% for FSH-LH hormone-secreting and 100% for TSH hormone-secreting), with no recurrence at the time of the last follow-up. Post-operative complications were present in 35 (13.9%) cases. The most frequent complications were temporary and permanent diabetes insipidus (six and two cases, respectively), syndrome of inappropriate antidiuretic hormone secretion (two cases) and CSF leaks (eight cases). There was no death related to the procedure in this series. The endoscopic endonasal approach for resection of pituitary adenomas, provides acceptable results representing a safe alternative procedure to the microscopic approach. This less invasive method, associated with a small number of complications, provides excellent tumor removal rates and represents an important tool for the achievement of good results in the pituitary surgery, mainly for the complete removal of large adenomas.
Asunto(s)
Adenoma/cirugía , Endoscopía/métodos , Neoplasias Hipofisarias/cirugía , Adenoma/clasificación , Adenoma/complicaciones , Endoscopía/efectos adversos , Endoscopía/normas , Humanos , Hormonas Hipofisarias/sangre , Neoplasias Hipofisarias/clasificación , Neoplasias Hipofisarias/complicaciones , Complicaciones Posoperatorias , Estudios RetrospectivosRESUMEN
BACKGROUND: Acromegaly is an excessive GH secretion, which in most cases, is caused by a pituitary GH-secreting adenoma. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The aim of this retrospective study is to evaluate the results of transsphenoidal endoscopic surgery in a group of patients with intrasellar GH adenoma who were operated by a pituitary specialist surgeon. We shall then argue about the economical advantages, for the NHS of a developing country, between surgical and medical treatment. METHODS: We have analyzed data from 33 patients with intrasellar GH tumor who had been referred to the neuroendocrine department of the HGF, Brazil. The patients underwent a transsphenoidal endoscopic adenomectomy for acromegaly between 2000 and 2005. Their ages were between 20 and 67 years (mean, 44 years) at the moment of surgery. No cavernous sinus invasion was present. Follow-up was a median of 2 years (range, 12 months-6 years). RESULTS: All 33 patients had intrasellar adenoma, 84.84% of patients achieved remission by surgery. One patient was operated twice and reached hormonal normalization. Five patients still had the disease and refused a second surgery. A treatment with octreotide was started for these 5 patients and resulted in an adequate control of GH and IGF-1 levels. No patients had radiotherapy. CONCLUSION: Our patients, with intrasellar GH tumor, operated by a pituitary specialist neurosurgeon had remission rates approaching those obtained by most specialized neurosurgical centers worldwide. For equal results, our study shows that the surgical treatment is the best issue for the patient and for the NHS.
Asunto(s)
Adenoma/cirugía , Endoscopía/estadística & datos numéricos , Adenoma Hipofisario Secretor de Hormona del Crecimiento/cirugía , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Silla Turca/cirugía , Hueso Esfenoides/cirugía , Adenoma/patología , Adenoma/fisiopatología , Adulto , Anciano , Antineoplásicos Hormonales/uso terapéutico , Brasil , Análisis Costo-Beneficio , Países en Desarrollo , Endoscopía/economía , Endoscopía/métodos , Femenino , Adenoma Hipofisario Secretor de Hormona del Crecimiento/patología , Adenoma Hipofisario Secretor de Hormona del Crecimiento/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Procedimientos Neuroquirúrgicos/instrumentación , Procedimientos Neuroquirúrgicos/métodos , Octreótido/uso terapéutico , Evaluación de Resultado en la Atención de Salud/métodos , Radiografía , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Silla Turca/diagnóstico por imagen , Silla Turca/patología , Especialización/economía , Especialización/estadística & datos numéricos , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/patología , Insuficiencia del Tratamiento , Resultado del Tratamiento , Adulto JovenRESUMEN
The objective of this study is to analyze the presence of headache in pituitary tumors and their characteristics, the relationship between pituitary tumor size, biological type, local extension and intrasellar pressure (ISP). This is a prospective study, of 64 consecutive patients presenting with primary pituitary masses at Neuroendocrinological Department of General Hospital of Fortaleza from October 2005 to December 2006. We analyzed sex, age, headache (laterality, site, severity, quality, frequency, duration, associated symptoms, time of onset, trigger, alleviating factors and familial history) and tumor characteristics (type, size, quiasmatic compression, cavernous sinus invasion, sella turcica destruction, cystic or solid mass and ISP). We observed a statistic significant factor between pituitary tumor and tumor size, optic compression, sellar destruction, cavernous sinus invasion and ISP. Biochemical-neuroendocrine factors, mainly in prolactinomas, seem to be an important factor in the determination of headache. The presence of headache in pituitary tumor is related to a combination of factors, including ISP, tumor extension, relationship with the sellar structures, patient predisposition, familial history, and functional disturbance within the hypothalamo-pituitary axis.
Asunto(s)
Cefalea/etiología , Cefalea/fisiopatología , Hipófisis/patología , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/diagnóstico , Adulto , Seno Cavernoso/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Silla Turca/patologíaRESUMEN
A 53 year-old woman presented a recurrent bifrontal headache of 2 years duration and bilateral progressive visual disturbance. The clinical and neurological examination showed a bilateral feet adactyly and bitemporal hemianopsia. The brain MRI demonstrated a Rathke's cleft cyst. The patient was operated by a transnasal endoscopic approach. It seems that this unusual association has never been described before.
Asunto(s)
Quistes del Sistema Nervioso Central/complicaciones , Neoplasias Hipofisarias/complicaciones , Sindactilia/complicaciones , Dedos del Pie/anomalías , Quistes del Sistema Nervioso Central/diagnóstico , Quistes del Sistema Nervioso Central/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/cirugíaRESUMEN
A 53 year-old woman presented a recurrent bifrontal headache of 2 years duration and bilateral progressive visual disturbance. The clinical and neurological examination showed a bilateral feet adactyly and bitemporal hemianopsia. The brain MRI demonstrated a Rathke's cleft cyst. The patient was operated by a transnasal endoscopic approach. It seems that this unusual association has never been described before.
Mulher de 53 anos com história recorrente de cefaléia com duração de 2 anos bilateral e progressiva, acompanhada de distúrbios visuais. O exame clinico e neurológico mostrou uma adactilia dos pés e hemianopsia bitemporal. A ressonância nuclear magnética cerebral mostrou um cisto de Rathke. A paciente foi operada por via transnasal endoscópica. Aparentemente esta é a primeira vez que esta associação é descrita na literatura.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Quistes del Sistema Nervioso Central/complicaciones , Neoplasias Hipofisarias/complicaciones , Sindactilia/complicaciones , Dedos del Pie/anomalías , Quistes del Sistema Nervioso Central/diagnóstico , Quistes del Sistema Nervioso Central/cirugía , Imagen por Resonancia Magnética , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/cirugíaRESUMEN
OBJECTIVE: To determine if there was a relationship between intrassellar pressure (ISP) and pituitary tumor volume. METHOD: Between August 2002 and May 2004, 60 patients aged between 13 and 75 years old (39 males), having a pituitary adenoma were submitted to an endoscope transseptal approach. During the surgery and before tumor resection, 2 mm of the sellaÆs floor were removed and a 1.5 mm dural opening made to place a transducer into the pituitary adenoma. The transducer was connected to a pressure monitor. RESULTS: The intrasellar pressure, ranged from 2-51 mmHg and was measured based on the classification of Hardy-Vezina. The most elevated was in the type II macro adenomas with 32.6 mmHg, sharply superior to the value of a normal intracranial pressure. CONCLUSION: These values showed that the macroadenomas confined to the sella, without destruction of the floor and integrity of the diaphragm, type II of Hardy-Vezina, presented a value of ISP much higher than intra-extrasellar macroadenomaÆs.
OBJETIVO: Determinar se existia uma relação entre a pressão intraselar (ISP) e o volume de tumor de hipófise. MÉTODO: Entre agosto de 2002 e maio de 2004, 60 pacientes com idades variando entre 13 e 75 anos (39 homens), portadores de adenoma hipofisários foram operados por via transesfenoidal. Durante o ato cirúrgico e antes da resseção do tumor, uma osteotomia de 2 mm foi realizada no assoalho selar e uma abertura de 1,5 mm na duramater para a introdução de um transdutor dentro do tumor. O transdutor foi conectado a um monitor de pressão e esta foi medida por 2 minutos. RESULTADOS: A pressão intra-selar variou entre 2-51 mmHg e a correlação entre tamanho do tumor e ISP foi baseada na classificação de Hardy-Vezina. A média da ISP mais elevada foi encontrada nos macroadenomas tipo II com 32,6 mmHg, nitidamente superior a pressão intra selar normal. CONCLUSÃO: Estes valores mostram que os macroadenomas confinados a sela sem destruição do assoalho selar e com integridade do diafragma, classificados como tipo II de Hardy-Vezina, apresentam uma ISP muito superior aos outros adenomas.
Asunto(s)
Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adenoma/patología , Presión Intracraneal , Neoplasias Hipofisarias/patología , Silla Turca/fisiopatología , Adenoma/fisiopatología , Adenoma/cirugía , Cuidados Preoperatorios , Neoplasias Hipofisarias/fisiopatología , Neoplasias Hipofisarias/cirugía , Transductores de PresiónRESUMEN
OBJECTIVE: To determine if there was a relationship between intrassellar pressure (ISP) and pituitary tumor volume. METHOD: Between August 2002 and May 2004, 60 patients aged between 13 and 75 years old (39 males), having a pituitary adenoma were submitted to an endoscope transseptal approach. During the surgery and before tumor resection, 2 mm of the sellas floor were removed and a 1.5 mm dural opening made to place a transducer into the pituitary adenoma. The transducer was connected to a pressure monitor. RESULTS: The intrasellar pressure, ranged from 2-51 mmHg and was measured based on the classification of Hardy-Vezina. The most elevated was in the type II macro adenomas with 32.6 mmHg, sharply superior to the value of a normal intracranial pressure. CONCLUSION: These values showed that the macroadenomas confined to the sella, without destruction of the floor and integrity of the diaphragm, type II of Hardy-Vezina, presented a value of ISP much higher than intra-extrasellar macroadenoma's.
Asunto(s)
Adenoma/patología , Presión Intracraneal , Neoplasias Hipofisarias/patología , Silla Turca/fisiopatología , Adenoma/fisiopatología , Adenoma/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Hipofisarias/fisiopatología , Neoplasias Hipofisarias/cirugía , Cuidados Preoperatorios , Transductores de PresiónRESUMEN
Giant intra and parasellar aneurysm with a spontaneous thrombosis of internal carotid artery is rare. We report the case of a 34 years old woman presenting a unique giant sellar and parasellar aneurysm associated with hypopituitarism and amenorrhea-galactorrhea syndrome. Computed tomographic scans and magnetic resonance images were suggestive of a sellar tumor with a cystic component. Digital cerebral angiography showed spontaneous thrombosis of a intrasellar and parasellar carotid artery aneurysm and left internal carotid artery in the neck. A transseptal endoscopic biopsy was done and confirmed a thrombosed aneurysm. No other surgical treatment was required in this patient but permanent endocrinological treatment was necessary.
Asunto(s)
Amenorrea/etiología , Trombosis de las Arterias Carótidas/complicaciones , Galactorrea/etiología , Hipopituitarismo/etiología , Aneurisma Intracraneal/complicaciones , Adulto , Trombosis de las Arterias Carótidas/diagnóstico , Arteria Carótida Interna , Angiografía Cerebral , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico , Espectroscopía de Resonancia Magnética , Síndrome , Tomografía Computarizada por Rayos XRESUMEN
Aneurismas selares e paraselares gigantes com trombose da artéria carótida cervical e intracraniana são raros. Apresentamos o caso de mulher de 34 anos apresentando hipopituitarismo e síndrome amenorréia-galactorréia. A tomografia computadorizada craniana e a ressonância magnética foram sugestivas de tumor selar com componente cístico. Angiografia digital cerebral mostrou aneurisma único gigante selar e parasselar e trombose completa da artéria carótida comum esquerda no pescoço. A biopsia transeptal endoscópica da lesão mostrou tratar-se de aneurisma carotídeo trombosado. Não foi realizado nenhum outro tratamento cirúrgico na paciente, mas apenas tratamento endocrinológico de reposição.
Asunto(s)
Humanos , Femenino , Adulto , Amenorrea , Trombosis de las Arterias Carótidas , Galactorrea , Hipopituitarismo , Aneurisma Intracraneal , Trombosis de las Arterias Carótidas , Arteria Carótida Interna , Angiografía Cerebral , Aneurisma Intracraneal , Espectroscopía de Resonancia Magnética , Síndrome , Tomografía Computarizada por Rayos XRESUMEN
An endoscopic endonasal transsphenoidal approach to the sella was performed in 100 consecutive patients, with a follow up from 3 to 55 months: 57 females and 43 males, age ranging from 14 and 70 years. 76 cases pituitary adenomas: 22 were acromegaly (7 microadenomas and 15 macroadenomas); 21 null cell adenomas (3 microadenomas and 18 macroadenomas); 19 Cushing disease (11 microadenomas and 8 macroadenomas), 10 prolactinomas (6 microadenomas and 4 macroadenomas), and 4 LH adenomas (4 macroadenomas). In this serie, remission was achieved in 44.8% for macroadenomas, 60% for acromegaly, 27.7% for null cell adenoma, 50% for Cushing disease, 50% for prolactinomas and 50% for LH adenomas, and 81.4% for microadenomas 85% for acromegaly, 100% for null cell adenoma, 81.8% for Cushing disease, 66% for prolactinoma. We had also four craniopharyngiomas, four sphenoidal mucocele, three sphenoidal aspergillus, one Rathke cyst, one hypophysitis, one cavernous aneurysm, one encefalocele, one intrasellar meningioma, one intrasellar tuberculoma and a sphenoid fibrous dysplasia. In this series we also had six fistulas of the anterior base that were completely cured. We had a mortality of 2, one null cell giant adenoma in a 57 years old man and another patient, 38 years old, with a giant craniopharyngioma. The morbidity was: two cured meningitis, three cured fistulas, and two permanent diabetes insipidus. Endoscopic endonasal transsphenoidal surgery in this series resulted with comparable surgical outcomes to conventional microscopic transsphenoidal surgery. The advantages of this technique have been represented by an easier access to the lesion, better visualisation and increased illumination of the surgical sites, microdissection of the tumor with maximum preservation of the pituitary function, and reduction of hospitalization times and coasts. The main limits have been the reduction of field depth, constant need of manual control of the endoscope, and required experience of the endoscope technique.
Asunto(s)
Adenoma/cirugía , Endoscopía/métodos , Neoplasias Hipofisarias/cirugía , Silla Turca/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cavidad NasalRESUMEN
A abordagem neuroendoscópica transnasal para a sela túrcica foi realizada em 100 pacientes consecutivos com um seguimento variando entre 3 e 55 meses: 57 mulheres e 43 homens, com idade compreendida entre 14 e 70 anos; 76 eram adenomas hipofisários: 22 acromegálicos (7 microadenomas e 15 macroadenomas), 21 adenomas näo secretores (3 microadenomas e 18 macroadenomas), 19 doença de Cushing (11 microadenomas e 8 macroadenomas), 10 prolactinomas (6 microadenomas e 4 macroadenomas), 4 adenomas secretor de LH (4 macroadenomas). A remissäo da sintomatologia foi conseguida em 44,8 por cento para os macroadenomas (60 por cento para acromegalia, 27,7 por cento para os adenomas näo secretores, 50 por cento para os pacientes com doença de Cushing, 50 por cento para os prolactinomas, e 50 por cento para os adenomas secretantes de LH), e 81,4 por cento para os microadenomas (85 por cento para acromegalia, 100 por cento para os adenomas näo secretores, 81,8 por cento para os pacientes com doença de Cushing, e 66 por cento para os prolactinomas). Na série tivemos ainda quatro craniofaringeomas, quatro mucoceles esfenoidal, três aspergilose esfenoidal, e um caso de cada uma das patologias seguintes: cisto de Rathke, hipofisíte, aneurisma da carótida cavernosa, encefalocele, meningeoma intraselar, tuberculoma intra-selar e displasia fibrosa esfenoidal. Na série encontramos ainda seis fístulas liquóricas que foram todas fechadas através dessa via. A mortalidade foi de 2 por cento, um paciente de 57 anos com um adenoma gigante näo produtor e um outro paciente de 38 anos com um volumoso craniofaringeoma predominantemente cístico. Como complicaçöes tivemos duas meningites pós-operatórias curadas com antibioticoterapia e três fístulas pós-cirúrgica que foram reoperadas. Dois pacientes desenvolveram diabetes insípidus permanente. As vantagens desta técnica säo representadas por um acesso mais fácil, melhor iluminaçäo e visualizaçäo da lesäo, mais fácil distinçäo entre tumor e hipófise normal, reduçäo do tempo de hospitalizaçäo e dos custos hospitalares. As desvantagens säo a diminuiçäo da profundidade de campo, a necessidade de constante controle do endoscópio e a necessidade de maior experiência com as técnicas de endoscopia
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Adenoma , Endoscopía , Neoplasias Hipofisarias , Silla Turca , Cavidad NasalRESUMEN
Paciente masculino de 39 anos, com quadro de abdomen agudo de evoluçao de 72 horas, foi submetido a apendicectomia. Desenvolveu 14 dias após, quadro de cefaléia, vômitos, afasia, torpor, hemiplegia à direita e rigidez de nuca. A tomografia computadorizada craniana mostrou múltiplos abscessos cerebrais supra tentoriais bilateralmente. Após punçao aspirativa do maior deles foi instituída antibióticoterapia resultando em cura do paciente.
Asunto(s)
Humanos , Masculino , Adulto , Apendicectomía/efectos adversos , Apendicitis/cirugía , Absceso Encefálico/etiología , Complicaciones Posoperatorias , Absceso Encefálico , Absceso Encefálico/tratamiento farmacológico , Absceso Encefálico/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Paciente masculino, cor branca, de 39 anos foi submetido a uma apendicectomia e desenvolveu, 14 dias após, quadro de hipertensäo intracraniana, com afasia, torpor e hemiplegia. A tomografia computadorizada craniana mostrou múltiplos abcessos cerebrais supratentoriais, bilateralmente. Após punçäo aspirativa do maior, foi instituído um tratamento antibiótico específico, resultando em cura, com alta hospitalar assintomático.
Asunto(s)
Humanos , Masculino , Adulto , Apendicectomía/efectos adversos , Apendicitis/cirugía , Absceso Encefálico/etiologíaRESUMEN
Os autors mostram o estudo em 98 pacientes nos quais a anestesia peridural com bupivacaína foi utilizada no tratamento cirúrgico da hérnia de disco lombar. A técnica cirúrgica é baseada na exploraçäo da hérnia com o paciente em decúbito lateral, deitado sobre o lado sadio. As vantagens deste tipo de anestesia siao o baixo custo, a mobilidade precoce do paciente, diminuiçäo da hospitalizaçäo, menor risco anestésico, e menor sangramento operatório. As dificuldades e contra-indicaçöes säo: aracnoidite detectada na mielografia, incapacidade de atingir o espaço peridural coagulopatia e recusa do doente em submeter-e a anestesia peridural