RESUMEN
OBJECTIVE: The objective of this study is to report the efficacy and safety of microsurgical transsphenoidal surgery using a frame for sella guidance in a series of patients with untreated pituitary adenoma. METHODS: In this study, seven hundred and forty-seven patients undergoing transsphenoidal resection of a pituitary adenoma involving use of the frame were included. Follow-up of twelve to one hundred months was performed in all patients. RESULTS: During the procedures using the frame, pituitary adenomas were fully exposed, and no cavernous sinus haemorrhage due to anteroposterior displacement or internal carotid artery lesion due to right-and-left deviation occurred. The duration of the surgical procedure ranged from 28 min to 87 min with a mean of 44 min. The most frequent tumour type was prolactin-secreting adenoma (32.4%), followed by clinically non-functioning adenoma (NFPA) (28.5%), growth hormone-secreting adenoma (25.0%), and adrenocorticotropin-secreting adenoma (13.7%). Normalisation of visual defects occurred in 226 (42.2%) of the 535 patients with visual disturbances. Normalisation of hormone occurred in 458 of 551 patients with endocrine-active tumour in the follow-up period. Two patients died as a consequence of surgery. CONCLUSION: The endonasal transsphenoidal technique is a safe, quick, and effective approach to pituitary adenomas. Our guidance frame allows the surgeon to open and close the wound rapidly, which avoids trajectory deviation and shortens the duration of the surgical procedure.
Asunto(s)
Neuronavegación/instrumentación , Procedimientos Neuroquirúrgicos/instrumentación , Hueso Esfenoides/cirugía , Adenoma Hipofisario Secretor de ACTH/patología , Adenoma Hipofisario Secretor de ACTH/cirugía , Estudios de Seguimiento , Adenoma Hipofisario Secretor de Hormona del Crecimiento/patología , Adenoma Hipofisario Secretor de Hormona del Crecimiento/cirugía , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Microcirugia , Cavidad Nasal , Recurrencia Local de Neoplasia , Neuronavegación/efectos adversos , Neuronavegación/métodos , Procedimientos Neuroquirúrgicos/efectos adversos , Procedimientos Neuroquirúrgicos/métodos , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/cirugía , Silla Turca/anatomía & histología , Silla Turca/cirugía , Seno Esfenoidal/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
AIM: To investigate the feasibility of using diffusion-weighted MR imaging (DWI) to accurately measure breast cancer extension. MATERIALS AND METHODS: The extensions of 59 breast lesions were investigated on DW images and apparent diffusion coefficient (ADC) maps and compared to the pathological exams. RESULTS: Three groups were observed: accurate, overdiagnosis, and false negative. There were no significant differences seen in accurate or false-negative group when b was 500 and 1000 s/mm(2) when two lesions in the overdiagnosis group at both b values. CONCLUSION: DWI and the ADC value have potential for evaluating cancer extension.