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1.
Eur J Med Res ; 29(1): 262, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38698484

RESUMO

OBJECTIVES: Pituitary abscess (PA) accounts for only 0.3-0.5% of sellar masses, and the lack of specific clinical symptoms makes diagnosing PA difficult without a surgical biopsy. In clinical practice, PA is often mistaken for cystic pituitary adenoma, craniopharyngioma, and Rathke's cyst. Thus, this study aims to investigate challenges in diagnosing PA and evaluate the importance of combining intraoperative surgery with postoperative antibiotic treatment. METHODS: We conducted a retrospective analysis of 19 patients diagnosed with PA through histopathology. All patients underwent transsphenoidal surgery (TSS) for pituitary adenomas after undergoing comprehensive preoperative evaluations, including routine tests, endocrine assay, and imaging examination. Furthermore, we compared different treatments for pituitary abscess (PA) to determine the most effective approach for achieving a favorable prognosis. RESULTS: The most prevalent symptom of PA was headache, especially in the frontal-temporal and vertex regions, ranging from mild to moderate severity. Hypopituitarism-related symptoms were also frequently observed, including hypaphrodisia, cold sensitivity, fatigue, weight loss, polyuria, and amenorrhea. Twelve patients exhibited abnormalities in endocrinology examinations. Diagnosing PA correctly is challenging. In our study, none of the patients were correctly diagnosed with PA prior to surgery, and many sellar lesions were misdiagnosed. The favorable prognosis was largely attributed to surgical intervention and active postoperative antibiotic therapy. CONCLUSIONS: Given the lack of clarity in preoperative diagnosis, typical intraoperative findings and effective antibiotics treatment are more indicative of the correct diagnosis than other tests. In terms of therapy, optimal surgical intervention and active postoperative antibiotic treatment contribute to resolving the challenges posed by PA.


Assuntos
Doenças da Hipófise , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Estudos Retrospectivos , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/cirurgia , Doenças da Hipófise/terapia , Idoso , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/cirurgia , Neoplasias Hipofisárias/terapia , Neoplasias Hipofisárias/patologia , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/terapia , Abscesso/diagnóstico , Abscesso/terapia , Antibacterianos/uso terapêutico
2.
Front Endocrinol (Lausanne) ; 15: 1235441, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38590825

RESUMO

Introduction: Transsphenoidal surgery (TSS) is the preferred surgical method for most pituitary adenomas owing to high efficacy and low mortality. This study aimed to evaluate the influence of metabolic syndrome (MetS) on postoperative outcomes of TSS for pituitary adenoma. Methods: This population-based, retrospective observational study extracted data of adults 20-79 y receiving TSS for pituitary adenoma from the US Nationwide Inpatient Sample (NIS) between 2005-2018. Primary outcomes were pituitary-related complications, poor outcomes (i.e., in-hospital mortality or unfavorable discharge), prolonged length of stay (LOS), and patient safety indicators (PSIs). Univariate and multivariate regressions were performed to determine the associations between study variables and outcomes. Results: 19,076 patients (representing a 93,185 US in-patient population) were included, among which 2,109 (11.1%) patients had MetS. After adjustment, pre-existing MetS was not significantly associated with presence of pituitary-related complications and poor outcomes. In contrast, MetS was significantly associated with an increased risk for prolonged LOS (adjusted OR (aOR) = 1.19; 95% CI: 1.05-1.34), PSIs (aOR = 1.31; 95% CI: 1.07-1.59) and greater hospital costs (adjusted ß = 8.63 thousand USD; 95% CI: 4.98-12.29). Among pituitary-related complications, MetS was independently associated with increased risk of cerebrospinal fluid (CSF) rhinorrhea (aOR = 1.22, 95% CI: 1.01, 1.47) but lowered diabetes insipidus (aOR = 0.83, 95% CI: 0.71, 0.97). Discussion: MetS does not pose excessive risk of in-hospital mortality or unfavorable discharge. However, MetS independently predicted having PSIs, prolonged LOS, greater hospital costs, and CSF rhinorrhea. Study findings may help clinicians achieve better risk stratification before TSS.


Assuntos
Adenoma , Síndrome Metabólica , Doenças da Hipófise , Neoplasias Hipofisárias , Adulto , Humanos , Neoplasias Hipofisárias/epidemiologia , Neoplasias Hipofisárias/cirurgia , Neoplasias Hipofisárias/complicações , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/complicações , Pacientes Internados , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Doenças da Hipófise/epidemiologia , Doenças da Hipófise/cirurgia , Doenças da Hipófise/complicações , Adenoma/cirurgia
3.
World Neurosurg ; 186: e440-e448, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38583567

RESUMO

OBJECTIVE: As the coronavirus disease 2019 (COVID-19) pandemic spread to the United States in 2020, there was an impetus toward postponing or ceasing nonurgent transsphenoidal pituitary surgeries to prevent the spread of the virus. Some centers encouraged transcranial approaches for patients with declining neurologic function. However, no large-scale data exist evaluating the effects that this situation had on national pituitary practice patterns. METHODS: Pituitary surgeries in the National Inpatient Sample were identified from 2017 to 2020. Surgeries in 2020 were compared with the 3 years previously to determine any differences in demographics, surgical trends/approaches, and perioperative outcomes. RESULTS: In 2020, there was a decline in overall pituitary surgeries (34.2 vs. 36.3%; odds ratio (OR), 0.88; P < 0.001) yet transsphenoidal approaches represented a higher proportion of interventions (69.0 vs. 64.9%; P < 0.001). Neurosurgical complications were higher (51.9 vs. 47.4%; OR, 1.13; P < 0.001) and patients were less likely to be discharged home (86.4 vs. 88.5%; OR, 0.84; P < 0.001). This finding was especially true in April 2020 during the first peak in COVID-19 cases, when transcranial approaches and odds of mortality/complications were highest. CONCLUSIONS: In 2020, transsphenoidal surgery remained the preferred approach for pituitary tumor resection despite initial recommendations against the approach to prevent COVID-19 spread. Pituitary surgeries had a higher risk of periprocedural complications despite accounting for preoperative comorbidities, COVID-19 infection status, and surgical approach, suggesting that an overwhelmed hospital system can negatively influence surgical outcomes in noninfected patients.


Assuntos
COVID-19 , Procedimentos Neurocirúrgicos , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Masculino , Feminino , Procedimentos Neurocirúrgicos/métodos , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto , Idoso , Neoplasias Hipofisárias/cirurgia , Pandemias , Doenças da Hipófise/cirurgia , Complicações Pós-Operatórias/epidemiologia , Hipófise/cirurgia
4.
Pituitary ; 27(2): 151-159, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38243126

RESUMO

PURPOSE: Pituitary surgery can lead to post-surgical adrenal insufficiency with the need for glucocorticoid replacement and significant disease related burden. In patients who do not receive hydrocortisone replacement before surgery, at our center, an early morning plasma cortisol concentration using a cut-off value of 450 nmol/L 3 days after surgery (POD3) is used to guide the need for hydrocortisone replacement until dynamic confirmatory testing using metyrapone. The aim of this study was to critically assess the currently used diagnostic and treatment algorithm in patients undergoing pituitary surgery in our pituitary reference center. METHODS: Retrospective analysis of all patients with a POD3 plasma cortisol concentration < 450 nmol/L who received hydrocortisone replacement and a metyrapone test after 3 months. Plasma cortisol concentration was measured using an electrochemiluminescence immunoassay (Roche). All patients who underwent postoperative testing using metyrapone at Amsterdam UMC between January 2018 and February 2022 were included. Patients with Cushing's disease or those with hydrocortisone replacement prior to surgery were excluded. RESULTS: Ninety-five patients were included in the analysis. The postoperative cortisol concentration above which no patient had adrenal insufficiency (i.e. 11-deoxycortisol > 200 nmol/L) was 357 nmol/L (Sensitivity 100%, Specificity 31%, PPV:32%, NPV:100%). This translates into a 28% reduction in the need for hydrocortisone replacement compared with the presently used cortisol cut-off value of 450 nmol/L. CONCLUSION: Early morning plasma cortisol cut-off values lower than 450 nmol/L can safely be used to guide the need for hydrocortisone replacement after pituitary surgery.


Assuntos
Insuficiência Adrenal , Doenças da Hipófise , Humanos , Hidrocortisona , Metirapona/uso terapêutico , Estudos Retrospectivos , Hipófise/cirurgia , Insuficiência Adrenal/diagnóstico , Insuficiência Adrenal/tratamento farmacológico , Doenças da Hipófise/cirurgia , Doenças da Hipófise/diagnóstico
5.
No Shinkei Geka ; 51(4): 577-585, 2023 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-37491054

RESUMO

The hypothalamus is part of the diencephalon and regulates not only endocrine functions but also various physiological functions, including controlling sleep and wakefulness, eating and drinking, and regulating body temperature. The pituitary gland can be divided into the adenohypophysis and neurohypophysis based on its developmental origin. The hypothalamus and pituitary gland play important roles in maintaining homeostasis by closely coordinating hormones. In the treatment of hypothalamic and pituitary diseases, it is important to understand the functions of the hypothalamus and pituitary gland, preserve hypothalamic function, evaluate the endocrine function, and follow up appropriately throughout life, including hormone replacement without excess or deficiency. Additionally, when interpreting hormone data, it is necessary to understand the factors that influence test values.


Assuntos
Doenças da Hipófise , Hipófise , Humanos , Hipotálamo , Doenças da Hipófise/cirurgia , Hormônios
6.
World Neurosurg ; 176: 168-178, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37201788

RESUMO

BACKGROUND: A reliable strategy for predicting long-term adrenal insufficiency after pituitary surgery can reduce the risk of glucocorticoid overexposure or missing patients with pituitary insufficiency. For this purpose, we aimed to assess the predictive value of early postoperative morning serum cortisol level for the detection of hypothalamic-pituitary-adrenal axis dysfunction in patients who underwent pituitary surgery. METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-based systematic review was conducted to include articles investigating morning blood cortisol levels after pituitary surgery for lesions of the pituitary gland as a determinant for administration of long-term supplemental glucocorticoids. Bayesian statistics were used to pool the sensitivity and specificity rates. Sensitivity and specificity were also determined for each potential cortisol level on postoperative day (POD) 1 and POD 2. RESULTS: The study included 17 articles encompassing 1648 patients. Morning cortisol levels on POD 1 and POD 2 showed pooled sensitivity rates of 86.4% and 86.6% and pooled specificity rates of 73.1% and 78.2%, respectively, for predicting long-term glucocorticoid replacement after surgery. A cortisol level of 2.1 µg/dL showed the highest sensitivity rate (98.78%), and 22.5 µg/dL showed the highest specificity rate (72.5%) on POD 1. CONCLUSIONS: In this review and Bayesian meta-analysis, we found that postoperative serum cortisol measurement may have high accuracy in prediction of the long-term need for glucocorticoid administration in patients who underwent pituitary surgery.


Assuntos
Doenças da Hipófise , Neoplasias Hipofisárias , Humanos , Glucocorticoides/uso terapêutico , Hidrocortisona , Sistema Hipotálamo-Hipofisário , Teorema de Bayes , Neoplasias Hipofisárias/cirurgia , Sistema Hipófise-Suprarrenal , Hipófise/cirurgia , Doenças da Hipófise/cirurgia
7.
World Neurosurg ; 176: 143-148, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37149088

RESUMO

OBJECTIVE: There is currently no consensus on the appropriate timing of noninvasive positive pressure ventilation (PPV) resumption in patients with obstructive sleep apnea (OSA) after endoscopic pituitary surgery. We performed a systematic review of the literature to better assess the safety of early PPV use in OSA patients following surgery. METHODS: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases in English were searched using the keywords: "sleep apnea," "CPAP," "endoscopic," "skull base," "transsphenoidal" and "pituitary surgery." Case reports, editorials, reviews, meta-analyses, unpublished and abstract-only articles were all excluded. RESULTS: Five retrospective studies were identified, comprising 267 patients with OSA who underwent endoscopic endonasal pituitary surgery. The mean age of patients in four studies (n = 198) was 56.3 years (SD = 8.6) and the most common indication for surgery was pituitary adenoma resection. The timing of PPV resumption following surgery was reported in four studies (n = 130), with 29 patients receiving PPV therapy within two weeks. The pooled rate of postoperative cerebrospinal fluid leak associated with PPV resumption was 4.0% (95% CI: 1.3-6.7%) in three studies (n = 27) and there were no reports of pneumocephalus associated with PPV use in the early postoperative period (<2 weeks). CONCLUSIONS: Early resumption of PPV in OSA patients after endoscopic endonasal pituitary surgery appears relatively safe. However, the current literature is limited. Additional studies with more rigorous outcome reporting are warranted to assess the true safety of re-initiating PPV postoperatively in this population.


Assuntos
Doenças da Hipófise , Neoplasias Hipofisárias , Apneia Obstrutiva do Sono , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Hipófise/cirurgia , Hipófise , Neoplasias Hipofisárias/cirurgia , Neoplasias Hipofisárias/complicações , Apneia Obstrutiva do Sono/cirurgia , Apneia Obstrutiva do Sono/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório
8.
Ann Endocrinol (Paris) ; 84(4): 413-423, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37019429

RESUMO

PURPOSE: Endocrine disorders are the most frequent postoperative complications in patients undergoing pituitary surgery. Given the absence of recent guidelines on the postoperative care following pituitary surgery, this article summarizes the available evidence on the topic. METHOD: We conducted a systematic search of PubMed up to 2021 and updated the search in December 2022. We retrieved 119 articles and included 53 full-text papers. RESULTS: The early postoperative care consists of the assessment for cortisol deficiency and diabetes insipidus (DI). Experts suggest that all patients should receive a glucocorticoid (GC) stress dose followed by a rapid taper. The decision for GC replacement after discharge depends on the morning plasma cortisol level on day 3 after surgery. Experts suggest that patients with a morning plasma cortisol<10 mcg/dL should receive GC replacement at discharge, and those with 10-18 mcg/dL a morning dose only, with formal assessment of the hypothalamic-pituitary-adrenal axis at week 6 postoperatively. When the cortisol level is>18 mcg/dL, the patient can be discharged safely without GC, as suggested by observational studies. Postoperative care also includes a close monitoring of water balance. If DI develops, desmopressin is used only in case of uncomfortable polyuria or hypernatremia. The assessment of other hormones is indicated at 3 months postoperatively and beyond. CONCLUSION: The evaluation and treatment of patients following pituitary surgery are based on expert opinion and a few observational studies. Further research is needed to provide additional evidence on the most appropriate approach.


Assuntos
Doenças da Hipófise , Neoplasias Hipofisárias , Complicações Pós-Operatórias , Humanos , Diabetes Insípido/etiologia , Glucocorticoides/uso terapêutico , Hidrocortisona , Sistema Hipotálamo-Hipofisário , Doenças da Hipófise/cirurgia , Neoplasias Hipofisárias/cirurgia , Sistema Hipófise-Suprarrenal , Protocolos Clínicos/normas , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia
9.
Sci Rep ; 13(1): 6073, 2023 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-37055468

RESUMO

Training kits for laparoscopes for deep suturing under endoscopes are commercially available; however, previously reported training kits for endoscopic transnasal transsphenoidal pituitary/skull base surgery (eTSS) were not available in the market. Moreover, the previously reported low cost, self-made kit has the drawback of being unrealistic. This study aimed to create a low cost training kit for eTSS dura mater suturing that was as close to real as possible. Most necessary items were obtained from the 100-yen store ($1 store) or from everyday supplies. As an alternative to the endoscope, a stick-type camera was used. Through the assembly of the materials, a simple and easy-to-use training kit was created, which is almost identical to the actual dural suturing situation. In eTSS, a simple and easy-to-use training kit for dural suturing was successfully created at a low cost. This kit is expected to be used for deep suture operations and the development of surgical instruments for training.


Assuntos
Procedimentos Neurocirúrgicos , Doenças da Hipófise , Humanos , Endoscopia , Doenças da Hipófise/cirurgia , Dura-Máter/cirurgia , Suturas , Base do Crânio/cirurgia
10.
Pituitary ; 26(2): 197-208, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36862266

RESUMO

PURPOSE: The histopathological study of brain tissue is a common method in neuroscience. However, efficient procedures to preserve the intact hypothalamic-pituitary brain specimens are not available in mice for histopathological study. METHOD: We describe a detailed procedure for obtaining mouse brain with pituitary-hypothalamus continuity. Unlike the traditional methods, we collect the brain via a ventral approach. We cut the intraoccipital synchondrosis, transection the endocranium of pituitary, broke the spheno-occipital synchondrosis, expose the posterior edge of pituitary, separate the trigeminal nerve, then the intact pituitary gland was preserved. RESULT: We report an more effective and practical method to obtain continuous hypothalamus -pituitary preparations based on the preserve of leptomeninges. COMPARED WITH THE EXISTING METHODS: Our procedure effectively protects the integrity of the fragile infundibulum preventing the pituitary from separating from the hypothalamus. This procedure is more convenient and efficient. CONCLUSION: We present a convenient and practical procedure to obtain intact hypothalamic-pituitary brain specimens for subsequent histopathological evaluation in mice.


Assuntos
Doenças da Hipófise , Neuro-Hipófise , Camundongos , Animais , Hipófise/patologia , Neuro-Hipófise/patologia , Hipotálamo/patologia , Sistema Hipotálamo-Hipofisário , Doenças da Hipófise/cirurgia , Doenças da Hipófise/patologia
11.
Eur Arch Otorhinolaryngol ; 280(9): 4091-4099, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36988686

RESUMO

PURPOSE: We aimed to summarize the available data on the objective rhinologic outcome after endoscopic transnasal-transsphenoidal (ETT) surgery. METHODS: Retrospective study on a consecutive cohort of treatment-naïve patients undergoing ETT pituitary gland surgery. Additionally, a systematic review and meta-analysis with focus on the rhinologic outcome, including postoperative smell function was performed. RESULTS: The institutional series incorporated 168 patients. A concomitant endoscopic septoplasty was performed in 29/168 patients (17.3%). A nasoseptal flap was used for reconstruction of large skull-base defects or high-flow CSF leaks in 4/168 (2.4%) patients. Early postoperative rhinologic complications (< 4 weeks) included epistaxis (3%), acute rhinosinusitis (1.2%) and late postoperative complications (≥ 8 weeks) comprised prolonged crusting (15.6%), symptomatic synechiae (11.9%) and septal perforation (0.6%). Postoperative smell function was not impaired (Fisher's exact test, p = 1.0). The systematic review included 19 studies on 1533 patients with a median postoperative epistaxis rate of 1.4% (IQR 1.0-2.2), a postoperative acute rhinosinusitis rate of 2.3% (IQR 2.1-3.0), a postoperative synechiae rate of 7.5% (IQR 1.8-19.1) and a postoperative septal perforation rate of 2.2% (IQR 0.5-5.4). Seven studies including a total of 206 patients reported adequate outcome measures for smell function before and after ETT surgery. Only 2/7 studies reported an impairment of smell function postoperatively, especially in patients with nasoseptal flap harvesting. CONCLUSION: Early and late postoperative rhinologic complication rates after ETT surgery for pituitary lesions seem to be low. A thorough evaluation of smell function, in particular in patients at risk for nasoseptal flap harvesting, may be an important factor in optimal postoperative care.


Assuntos
Doenças da Hipófise , Neoplasias Hipofisárias , Humanos , Estudos Retrospectivos , Epistaxe/epidemiologia , Epistaxe/etiologia , Retalhos Cirúrgicos , Endoscopia/efeitos adversos , Hipófise , Base do Crânio/cirurgia , Doenças da Hipófise/cirurgia , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento
12.
Medicina (Kaunas) ; 59(3)2023 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-36984566

RESUMO

Background and Objectives: Pituitary abscess (PA) is a rare occurrence, representing less than 1% of pituitary lesions, and is defined by the presence of an infected purulent collection within the sella turcica. Pas can be classified as either primary, when the underlying pituitary is normal prior to infection, or secondary, when there is associated a pre-existing sellar pathology (i.e., pituitary adenoma, Rathke's cleft cysts, or craniopharyngioma), with or without a recent history of surgery. Preoperative diagnosis, owing to both non-specific symptoms and imaging features, remains challenging. Treatment options include endonasal trans-sphenoidal pus evacuation, as well as culture and tailored antibiotic therapy. Methods: A retrospective multicenter study, conducted on a prospectively built database over a 20-year period, identified a large series of 84 patients harboring primary sellar abscess. The study aimed to identify crucial clinical and imaging features in order to accelerate appropriate management. Results: The most common clinical presentation was a symptom triad consisting of various degrees of asthenia (75%), visual impairment (71%), and headache (50%). Diagnosis was achieved in 95% of cases peri- or postoperatively. Functional recovery was good for visual disturbances and headache. Pituitary function recovery remained very poor (23%), whereas the preoperative diagnosis represented a protective factor. Conclusions: In light of the high prevalence of pituitary dysfunction following the management of PAs, early diagnosis and treatment might represent a crucial issue. Currently, there are no standard investigations to establish a conclusive preoperative diagnosis; however, new, emerging imaging methods, in particular nuclear imaging modalities, represent a very promising tool, whose potential warrants further investigations.


Assuntos
Doenças da Hipófise , Neoplasias Hipofisárias , Humanos , Abscesso , Doenças da Hipófise/complicações , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/cirurgia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/cirurgia , Hipófise/patologia , Cefaleia , Imageamento por Ressonância Magnética
13.
Br J Neurosurg ; 37(5): 1135-1142, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36727284

RESUMO

PURPOSE: Patterns of surgical care, outcomes, and quality of care can be assessed using hospital administrative databases but this requires accurate and complete data. The aim of this study was to explore whether the quality of hospital administrative data was sufficient to assess pituitary surgery practice in England. METHODS: The study analysed Hospital Episode Statistics (HES) data from April 2013 to March 2018 on all adult patients undergoing pituitary surgery in England. A series of data quality indicators examined the attribution of cases to consultants, the coding of sellar and parasellar lesions, associated endocrine and visual disorders, and surgical procedures. Differences in data quality over time and between neurosurgical units were examined. RESULTS: A total of 5613 records describing pituitary procedures were identified. Overall, 97.3% had a diagnostic code for the tumour or lesion treated, with 29.7% (n = 1669) and 17.8% (n = 1000) describing endocrine and visual disorders, respectively. There was a significant reduction from the first to the fifth year in records that only contained a pituitary tumour code (63.7%-47.0%, p < .001). The use of procedure codes that attracted the highest tariff increased over time (66.4%-82.4%, p < .001). Patterns of coding varied widely between the 24 neurosurgical units. CONCLUSION: The quality of HES data on pituitary surgery has improved over time but there is wide variation in the quality of data between neurosurgical units. Research studies and quality improvement programmes using these data need to check it is of sufficient quality to not invalidate their results.


Assuntos
Doenças da Hipófise , Melhoria de Qualidade , Adulto , Humanos , Inglaterra , Hipófise/cirurgia , Doenças da Hipófise/cirurgia , Hospitais , Transtornos da Visão
14.
World Neurosurg ; 172: e357-e363, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36640831

RESUMO

BACKGROUND: We implemented a streamlined care pathway for patients undergoing endoscopic transsphenoidal (TSA) pituitary surgery. Select patients are recovered in the postanesthesia care unit and transferred to a step-down unit for intermediate neurologic care (INCU), with clinicians trained to manage cerebrospinal fluid leak, diabetes insipidus (DI), and other complications. METHODS: We evaluated all TSA surgeries performed at 1 academic medical center from 7th January, 2017 to 30th March, 2020, collecting patient factors, tumor characteristics, cost variables, and outcomes. The INCU pathway was implemented on 7th January 2018. Pathway patients were compared with nonpathway patients across the study period. Outcomes were assessed using multivariate regression, adjusting for patient and surgical characteristics, including intraoperative cerebrospinal fluid leak, postoperative DI, and tumor dimensions. RESULTS: One hundred eighty-seven patients were identified. Seventy-nine were on the INCU pathway. Mean age was 53.5 years. Most patients were male (66%), privately insured (62%), and white (66%). Mean total cost of admission was $27,276. Mean length of stay (LOS) was 3.97 days. Use of the INCU pathway was associated with total cost reduction of $6376.33 (P < 0.001, 95% confidence interval [CI]: $3698.21-$9054.45) and LOS reduction by 1.27 days (P = 0.008, 95% CI: 0.33-2.20). In-hospital costs were reduced across all domains, including $1964.87 in variable direct labor costs (P < 0.001, 95% CI: $1142.08-$2787.64) and $1206.52 in variable direct supply costs (P < 0.001, 95% CI: $762.54-$1650.51). Pathway patients were discharged earlier despite a higher rate of postoperative DI (25% vs. 11%, P = 0.011), with fewer readmissions (0% vs. 6%, P = 0.021). CONCLUSIONS: A streamlined care pathway following TSA surgery can reduce in-hospital costs and LOS without compromising patient outcomes.


Assuntos
Diabetes Insípido , Doenças da Hipófise , Neoplasias Hipofisárias , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Tempo de Internação , Neoplasias Hipofisárias/cirurgia , Neoplasias Hipofisárias/complicações , Procedimentos Clínicos , Complicações Pós-Operatórias/etiologia , Doenças da Hipófise/cirurgia , Diabetes Insípido/etiologia , Vazamento de Líquido Cefalorraquidiano/complicações , Estudos Retrospectivos
15.
Acta Neurochir (Wien) ; 165(3): 685-692, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36662287

RESUMO

BACKGROUND: Surgical treatment of pituitary lesions causing hormonal overproduction or mass effect is standard procedure. There are few reports on the results and complications related to these surgeries from Northern Europe. Our aim was to evaluate the outcome and complications of a single tertiary surgical center over more than a decade. METHODS: This was a retrospective study on all patients that underwent pituitary surgery from 1st of January 2005 to 31st of December 2017. The analysis included type of lesion, surgical method, pre- and postoperative need for hormonal substitution, hormonal outcome, complications to surgery, survival, need for revision surgery, or stereotactic radiation. Appropriate statistical analyses were made to evaluate surgical results, complications, and survival. RESULTS: Five hundred seventy-eight patients were included in the study. Remission was achieved in 58% of patients with GH-producing and 94% of ACTH-releasing adenomas. Sixty-six percent had no preoperative hormonal substitution compared to 39% postoperatively. Rhinosinusitis (10%) was the most commonly reported postoperative complication followed by leakage of cerebrospinal fluid (8%) and meningitis (4%). Standardized mortality rate for the study population was higher (p = 0.18) when compared to the general population. CONCLUSION: Our results regarding remission rates and complications are in comparison with previous studies. Surgery of pituitary lesion can be considered a safe and efficient surgery. We noted lower rates of CSF leakage in the later part of the study period and believe that this, in part, was an effect by the introduction of a multidisciplinary surgical skull base team and increased surgical experience.


Assuntos
Doenças da Hipófise , Neoplasias Hipofisárias , Humanos , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos , Suécia , Resultado do Tratamento , Doenças da Hipófise/cirurgia , Complicações Pós-Operatórias
16.
Head Neck ; 44(12): 2678-2685, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36039744

RESUMO

BACKGROUND: Pituitary tumors surgery is increasingly performed via endoscopic transsphenoidal approach (TSP). This study describes outcomes of TSP surgery in the United States. METHODS: A retrospective cross-sectional analysis of adult patients with pituitary adenoma was performed using the Nationwide Readmissions Database, 2010-2015. RESULTS: A total of 5891 patients were identified. The average age was 51.29 ± 0.29 years. The risk of postoperative epistaxis, diabetes insipidus, cerebrospinal fluid (CSF) leak, and other general postoperative complications was 0.71%, 10.20%, 8.35%, and 2.37%, respectively. Independent risk factors of CSF leak included: age <65-year, male, body mass index ≥25, and multiple comorbidities (p < 0.001 each). The prevalence of CSF leak was not associated with hospital TSP volume and teaching status. CONCLUSION: This study provides a national epidemiological perspective on TSP in the United States. The risk of postoperative CSF leak appears to be associated with intrinsic patient factors rather than resource and expertise availability.


Assuntos
Doenças da Hipófise , Neoplasias Hipofisárias , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estudos Transversais , Doenças da Hipófise/complicações , Doenças da Hipófise/cirurgia , Neoplasias Hipofisárias/cirurgia , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia
17.
World Neurosurg ; 166: e427-e434, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35840092

RESUMO

BACKGROUND: Endoscopic endonasal surgery is the main transsphenoidal approach for pituitary surgery in many centers; however, few studies compare the endoscopic and microscopic surgical approaches with regard to long-term follow-up. This single-center study aimed to compare the 2 techniques over 15 years. METHODS: Medical records and magnetic resonance images from 40 patients with primary transsphenoidal surgery for Cushing's disease at Sahlgrenska University Hospital between 2003 and 2018 were reviewed. 14 patients who underwent microscopic surgery and 26 patients who underwent endoscopic surgery were included in this study. RESULTS: In the microscopic group, 12 of 14 patients achieved endocrine remission, compared to 19 of 26 patients in the endoscopic group (n. s.). Three patients in each group developed a late recurrence. Complications were seen in 5 patients in the microscopic group and in 8 patients in the endoscopic group (n. s.). No serious complications, such as carotid artery damage, cerebrovascular fluid leakage, epistaxis, or meningitis, occurred in any group. The postoperative hospital stay was shorter in the endoscopic than in the microscopic group. CONCLUSIONS: Endoscopic endonasal surgery for Cushing's disease showed no difference in remission, recurrence, and complication rates compared to the microscopic approach. The endoscopic group had a shorter postoperative hospital stay than the microscopic group, which in part may be due to the minimal invasiveness of the endoscopic approach.


Assuntos
Hipersecreção Hipofisária de ACTH , Doenças da Hipófise , Neoplasias Hipofisárias , Endoscopia/efeitos adversos , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Hipersecreção Hipofisária de ACTH/etiologia , Hipersecreção Hipofisária de ACTH/cirurgia , Doenças da Hipófise/cirurgia , Hipófise/cirurgia , Neoplasias Hipofisárias/patologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
18.
World Neurosurg ; 164: e824-e829, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35654330

RESUMO

BACKGROUND: We evaluated the frequency of nasal pathologies and the significance of surgical access to the sellar region in patients who underwent an operation for sellar mass using the endonasal and microscopic transsphenoidal approaches. METHODS: We retrospectively evaluated all patients who underwent surgery for pituitary macroadenoma using microscopic (n = 78) and endonasal (n = 20) transsphenoidal approaches. Patients' epicrisis, preoperative, and postoperative imaging as well as their operative notes were reviewed. Nasal pathologies and surgeries performed before or during the pituitary surgery were also documented. All endonasal surgeries were binostril and performed jointly by an ear, nose, and throat specialist and neurosurgeon. To determine the feasibility of endonasal and microscopic approaches, we developed an algorithm using the septum deviation classifications to determine the need for septoplasty. RESULTS: The most common nasal pathology was septum deviation (n = 17; 17.3%). Of the other nasal pathologies, 6 cases (6%) were chronic sinusitis and 2 were (2.1%) middle turbinate bullosa. CONCLUSIONS: The preoperative evaluation of patients undergoing endonasal transsphenoidal surgery by an ear, nose, and throat surgeon allows for the detection and treatment of nasal pathologies that may lead to serious perioperative and postoperative complications. Evaluating patients with septum deviation using our classification will help determine the necessity of preoperative or perioperative septum surgery, depending on the preferred pituitary surgical method.


Assuntos
Doenças da Hipófise , Neoplasias Hipofisárias , Rinoplastia , Humanos , Septo Nasal/cirurgia , Doenças da Hipófise/cirurgia , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
19.
Neurocirugia (Astur : Engl Ed) ; 33(2): 99-104, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35248305

RESUMO

Pituitary abscesses are very uncommon. They are divided into primary, arising within a healthy gland, and secondary, observed with an underlying pre-existing lesion. Here we present the eighth case reported of a secondary abscess within a craniopharyngioma. A 59-year-old-woman presented with a 3-week history of headache, and fever. Physical examination was unremarkable. An Magnetic Resonance Imaging (MRI) showed a pituitary lesion suggestive of a chronic inflammatory process. She was diagnosed with lymphocytic meningitis with hypophysitis and she was treated with corticosteroids. Two months later she presented with headache and fever again. Control MRI showed enlargement of the pituitary lesion. Therefore, a transsphenoidal biopsy was performed. During the procedure, purulent material was released. Histological study demonstrated a craniopharyngioma and meningeal inflammation. Empiric antibiotics were started. Three months post-operatively, a follow-up MRI showed a suspect minimal residual mass. Secondary pituitary abscesses are rare. The key to successful management is a high index of suspicion. Transsphenoidal surgical evacuation plus antibiotics is the mainstay of treatment. Although most symptoms resolve, endocrinopathies improve only rarely.


Assuntos
Abscesso Encefálico , Craniofaringioma , Doenças da Hipófise , Neoplasias Hipofisárias , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/etiologia , Craniofaringioma/complicações , Craniofaringioma/diagnóstico por imagem , Craniofaringioma/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/patologia , Doenças da Hipófise/cirurgia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia
20.
Sci Rep ; 11(1): 17240, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34446748

RESUMO

Copeptin levels reflect arginine vasopressin (AVP) release from the hypothalamus. Pituitary surgery often impairs AVP release and results in central diabetes insipidus (CDI). Here, we aimed to investigate how serum copeptin level changes 3 months after pituitary surgery and whether it has a diagnostic value for postoperative permanent CDI. Consecutive patients who underwent endoscopic transsphenoidal surgery at a single tertiary hospital were recruited. Serum copeptin levels were measured preoperatively and 3 months postoperatively. Among 88 patients, transient and permanent CDI occurred in 17 (19.3%) and 23 (26.1%), respectively. Three-month postoperative copeptin levels significantly declined from preoperative levels in permanent CDI group (P < 0.001, percentage difference = - 42.2%) and also in the transient CDI group (P = 0.002, - 27.2%). Three months postoperative copeptin level < 1.9 pmol/L under normal serum sodium levels was the optimal cutoff value for diagnosing permanent CDI with an accuracy of 81.8%, while 3-month postoperative copeptin level ≥ 3.5 pmol/L excluded the CDI with a negative predictive value of 100%. Conclusively, 3 months postoperative copeptin levels significantly decreased from preoperative levels in the transient CDI group as well as the permanent CDI group. Three-month postoperative copeptin levels ≥ 3.5 pmol/L under normal serum sodium levels may be diagnostic for excluding postoperative CDI.


Assuntos
Diabetes Insípido Neurogênico/diagnóstico , Glicopeptídeos/sangue , Procedimentos Neurocirúrgicos/métodos , Doenças da Hipófise/cirurgia , Complicações Pós-Operatórias/diagnóstico , Seio Esfenoidal/cirurgia , Adulto , Idoso , Diabetes Insípido Neurogênico/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/efeitos adversos , Neuroendoscopia/métodos , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Período Pré-Operatório , Curva ROC , Estudos Retrospectivos , Fatores de Tempo
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