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1.
Medicine (Baltimore) ; 99(44): e22713, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126308

RESUMO

PURPOSE: In this retrospective study, we investigated the status and validity of endoscopic transsphenoidal surgery (eTSS) for pituitary incidentalomas (PIs) as well as the value of basing the indication for surgery on the PI guidelines. METHODS: Patients who underwent eTSS at Fukuoka University Chikushi Hospital between 2012 and 2018 were divided into the PI group and the non-PI group in accordance with the PI guideline of the Endocrine Society and their clinicopathological characteristics and outcomes were compared and analyzed. RESULTS: A total of 59 patients were enrolled, with 35 patients in the PI group and 24 patients in the non-PI group. The diagnoses in the PI group were of non-functioning pituitary adenoma (NFPA) (n = 12, 34%), gonadotropin-producing pituitary adenoma (n = 8, 23%), Rathke cleft cyst (n = 7, 20%), meningioma (n = 4, 11%), and growth hormone-producing pituitary adenoma (n = 3, 9%); those in the non-PI group were of NFPA (n = 6, 25%), gonadotropin-producing pituitary adenoma (n = 3, 13%), Rathke cleft cyst (n = 3, 13%), growth hormone-producing pituitary adenoma (n = 3, 13%), and prolactin producing pituitary adenoma (n = 3, 13%). Regarding the preoperative factors, 1 patient in the PI group with panhypopituitarism was diagnosed with pituitary apoplexy (pure infarction) of an NFPA. The rates of postoperative anterior pituitary hormonal deficiencies (14% vs 46%, P = .015), residual tumor size (2 ±â€Š5 vs 6 ±â€Š7 mm, P = .008), and reoperation (n = 0, 0% vs n = 5, 21%, P = .005) were significantly different between the PI and non-PI groups. CONCLUSIONS: This study showed that, postoperatively, the incidence of anterior pituitary hormonal deficiencies was lower in the PI than in the non-PI group, although it was comparable between the 2 groups before the operation. The patients in the PI group also had smaller residual tumors and a lower risk of reoperation than those in non-PI group. PIs could have a better postoperative clinical outcome than non-PIs when the indication for eTSS is based on preoperative scrutiny according to the PI guidelines and eTSS is performed by an experienced pituitary surgeon. Hence, more aggressive scrutiny and treatment for PIs might be desirable.


Assuntos
Endocrinologia/normas , Endoscopia/métodos , Neoplasias Hipofisárias/cirurgia , Guias de Prática Clínica como Assunto , Adulto , Idoso , Feminino , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/patologia , Osso Esfenoide/cirurgia , Resultado do Tratamento
2.
BMC Neurol ; 20(1): 303, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32799821

RESUMO

BACKGROUND: Perioperative cerebrospinal fluid (CSF) leakage is a major complication of pituitary adenomas transsphenoidal surgery. Lumbar drainage (LD) is a common method of treating CSF leakage. But whether intraoperative LD can prevent CSF leakage during the perioperative period of pituitary adenomas transsphenoidal surgery remains controversial. Clarity on the appropriate use of LD is needed. METHODS: A systematic literature review was conducted in the PubMed, EMBASE, and Web of science databases. Articles were included when they compared intraoperative LD with intraoperative no-LD CSF leakage rates during pituitary adenomas transsphenoidal surgery. RESULTS: Overall, 5 studies containing 678 cases met the inclusion criteria. When data were provided on intraoperative CSF leakage rates, the meta-analysis showed a significant difference in favor of intraoperative LD. When data were provided on postoperative CSF leakage rates, the meta-analysis also demonstrated a significant difference in favor of intraoperative LD. CONCLUSIONS: Although the results of this meta-analysis suggest intraoperative LD can reduce the risk of CSF leakage during the perioperative period of pituitary adenomas transsphenoidal surgery, the available evidence is indefinite. To some extent the results suggest intraoperative LD's potential positive role. Further studies that include well-designed prospective, randomized controlled clinical trials are necessary for further verification.


Assuntos
Vazamento de Líquido Cefalorraquidiano , Drenagem/métodos , Região Lombossacral/cirurgia , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias , Adenoma/cirurgia , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Vazamento de Líquido Cefalorraquidiano/terapia , Humanos , Cuidados Intraoperatórios , Hipófise/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/terapia , Osso Esfenoide/cirurgia
3.
Artigo em Russo | MEDLINE | ID: mdl-32649815

RESUMO

RATIONALE: When removing the meningiomas of the sellar region, there is always a risk of visual impairment for various reasons, in particular, as a result of traction damage to the optic nerve. Decompression of the optic canal increases nerve mobility during tumor manipulation. In cases of meningioma growing into the canal, its decompression often seems necessary. AIM: Evaluation of the effectiveness and risks of performing decompression of the optic canal. MATERIALS AND METHODS: The study included patients with meningiomas of the parasellar location, who underwent surgical treatment at the Burdenko Neurosurgical Center for the period from 2001 to 2017. They were divided into two groups - main and control. The main group consisted of 129 patients who underwent decompression of the optic nerve canals when the tumor was removed. The tumor matrix in this group was most often located in the region of the tuberum sellae, supradiaphragmally, in the region of the anterior clinoid process and the optic canal. In 31 cases, decompression was bilateral - during one operation and using one access in 27 patients; in 4 cases, the decompression of the second canal was delayed for 1.5-3 months after the first operation. 160 decompressions were performed by the intradural and 7 - by extradural methods. During intradural decompression, the roof of the optic canal was resected, and during extradural decompression, the lateral wall of the canal was trephined. The control group consisted of 308 patients who did not undergo canal decompression when the tumor was removed. It included meningiomas with a predominant location of the matrix in the area of the tuberclum and diaphragm of the sella. Tumors in both groups were removed according to the same principles (matrix coagulation, mainly the gradual removal of the tumor, the use of ultrasonic aspirator, a situational decision on the radicality of the operation, etc.). The main difference between operations in these two groups was only canal related algorithms (with or without its trepanation), as well as the probable prevalence of significant lateral tumor growth in cases with canal trepanation. Visual functions in the «primary¼ group were evaluated before and after operations with trepanation of the canal depending on various factors - the initial state of vision and the radicality of the tumor excision, including removal from the canal. The differences in the postoperative dynamics of vision in the main and control groups were studied. The primary data processing was carried out using the program MSExcel. Secondary statistical processing was carried out using the program Statistica. To assess the statistical significance of differences in the results obtained in the compared patient groups, the Chi-square test was used, and in the case of small groups - the exact Fisher test was applied. RESULTS: In the main group postoperative vision improvement of varying degrees on the side of trepanation was registered in 36.9% (59 out of 160) cases, no vision changes were found in 36.9% (59 out of 160), and in 26,2% (42 out of 160) the eyesight deteriorated. If preserving vision is attributed to a satisfactory result, then in general the results of these operations should be considered good. A comparative study of the results of removal of meningiomas with trepanation of the canals (main group) or without it (control group) was carried out among patients with the most critical vision situation (visual acuity 0.1 and below, up to only light perception). These groups are comparable in the number of observations - 62 and 73 respectively. The predominance of cases with improved vision in the main group compared with the control group (50.0% versus 38.36%) and a lower incidence of vision impairment (22.58% versus 34.25%) were found. However, the revealed differences are statistically unreliable and make it possible for us to talk only about the trend. The complications associated with trepanation of the canal include mechanical damage to the nerve by the drill. In our series of observations, there was only 1 case of abrasion of the nerve surface with the burr, which did not lead to a significant visual impairment. With the intradural method of trepanation in the area of the medial wall of the canal, the sphenoid sinus may open (in our series, in 34 cases out of 160 trepanations). Immediately closure of these defects was performed by various auto- and allomaterials in various combinations (pericranium, fascia, muscle fragment, hemostatic materials, and fibrin-thrombin glue). A true complication - CSF rhinorrhea liquorrhea developed in only one case, which required transnasal plastic surgery of the CSF fistula using a mucoperiostal flap. CONCLUSIONS: 1. Trepanation of the optic canal in cases of meningiomas of parasellar localization is a relatively safe procedure in the hands of a trained neurosurgeon and does not worsen the results of operations compared with the excision of the same tumors without trepanation of the canal. 2. The literature data and the results of our study make it possible to consider the decompression of the optic canal as an optional, but in many cases, useful option that facilitates the transcranial removal of some meningiomas of the sellar region.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Descompressão Cirúrgica , Humanos , Procedimentos Neurocirúrgicos , Nervo Óptico/diagnóstico por imagem , Estudos Retrospectivos , Base do Crânio/cirurgia , Osso Esfenoide/cirurgia , Resultado do Tratamento
4.
J Craniofac Surg ; 31(5): e477-e479, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32516216

RESUMO

A 34-year-old man with Basedow disease consulted us to treat disfiguring proptosis. On examination, the patient showed right lower eyelid retraction and right inferior rectus muscle enlargement, which were consistent with thyroid eye disease. Hertel's exophthalmometric examination demonstrated proptosis of 25.5 and 24.0 mm on the right and left sides, respectively. Computed tomography (CT) images revealed absence of the sphenoid door jamb. To correct both exorbitism and exophthalmos, the patient underwent bilateral "shallow" decompression of the lateral and medial orbital walls with orbital fat removal under general anesthesia. The authors removed 2.5 and 1.0 mL of orbital fat from the inferolateral quadrant of the right and left orbits, respectively. At 3 months postoperatively, based on the measurements of the axial globe position on sagittal CT images, postoperative proptosis reductions of 7.5 and 6.5 mm were observed on the right and left sides, respectively.


Assuntos
Descompressão Cirúrgica , Exoftalmia/cirurgia , Órbita/cirurgia , Doenças da Glândula Tireoide/cirurgia , Tecido Adiposo/cirurgia , Adulto , Exoftalmia/diagnóstico por imagem , Exoftalmia/etiologia , Oftalmopatia de Graves , Humanos , Masculino , Músculos Oculomotores/cirurgia , Órbita/diagnóstico por imagem , Período Pós-Operatório , Osso Esfenoide/cirurgia , Doenças da Glândula Tireoide/complicações , Doenças da Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X
5.
Medicine (Baltimore) ; 99(19): e19855, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384430

RESUMO

The endoscopic endonasal transsphenoidal approach (EETA) is the primary treatment for growth hormone (GH) adenoma. This study aimed to investigate the outcomes of EETA in 33 patients with GH-secreting pituitary adenoma (PA).Thirty-three patients who underwent EETA in Eighth People's Hospital of Shenzhen between January 2013 and December 2017 were included in the comprehensive analysis. Factors affecting the extent of resection and postoperative remission rates were also reviewed.The total cut rate was 63.6% (21), and the total remission rate was 66.7% (22) in all patients after surgery. The cure rate was 60.6% (20) for 33 patients. The total removal rate and remission rate were significantly different (P = .01, P = .007) for microadenomas, macroadenomas, and giant adenomas. In addition, the total removal rate and remission rate were significantly different (P = .004, P = .007) for patients with noninvasive and invasive GH-secreting PAs. Furthermore, there were significant differences (P = .003, P = .005) in the total removal rate and remission rate of patients with different preoperative GH levels. All patients with hypertension and diabetes mellitus were normalized. Three patients exhibited recurrence after surgery. Several patients suffered from postoperative complications, including transient diabetes insipidus in 3 (9.1%) patients and postoperative transient cerebrospinal fluid leakage in 2 (6.1%) patients.EETA is an effective therapeutic approach for treating patients with GH-secreting PA with high remission and low complication rates. Therefore, EETA should be considered a primary treatment for patients with GH-secreting PA.


Assuntos
Adenoma/cirurgia , Endoscopia/métodos , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Nariz/cirurgia , Osso Esfenoide/cirurgia , Adulto , Idoso , Endoscopia/efeitos adversos , Feminino , Hormônio do Crescimento/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
World Neurosurg ; 140: 283-287, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32454194

RESUMO

BACKGROUND: We report a technique for the sphenoid ridge keyhole approach using the Lone Star (LS) retractor system as an extracranial tissue retractor in microsurgical clipping of unruptured middle cerebral artery aneurysms. METHODS: The LS retractor system is used as the extracranial tissue retractor. A skin incision (50-60 mm) without shaving is made. The temporal fascia is cut, and skin and fascia flap are reflected anteriorly. On the temporal muscle, keyhole craniotomy is registered using the navigation system such that the lateral edge of the sphenoid ridge is the center of the craniotomy. After the temporal muscle is split in the direction of the muscle fiber, keyhole craniotomy of approximately 30 mm in diameter is created. After dural incision, the Sylvian fissure is dissected by a standard microsurgical technique using brain retractors, and the target aneurysm is clipped. RESULTS: By precise registration of the sphenoid ridge keyhole craniotomy, the Sylvian fissure emerged in the center of the keyhole. Using the LS retractor system, a flat and shallow operative field was obtained. There were no complications using this method. CONCLUSIONS: We optimized the craniotomy, manipulating the target aneurysm in the center of the keyhole. It did not interfere with conventional microsurgical techniques.


Assuntos
Craniotomia/métodos , Aneurisma Intracraniano/cirurgia , Microcirurgia/métodos , Osso Esfenoide/cirurgia , Humanos , Instrumentos Cirúrgicos
7.
J Craniofac Surg ; 31(5): 1266-1269, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32282479

RESUMO

OBJECTIVE: This study aimed to investigate the clinical outcomes of endoscopic transnasal optic canal decompression (ETOCD) for patients with indirect traumatic optic neuropathy (TON) and identify the relevant prognostic factors. METHODS: Seventy-two indirect TON patients who underwent ETOCD surgery from August 2017 to May 2019 were analyzed retrospectively. The paired t-test was used to compare the visual acuity (VA) before and after ETOCD, and multiple linear regression analysis was used to distinguish the potential prognostic factors. RESULTS: Among the patients analyzed, postoperative VA (-2.87 ±â€Š0.19) was significantly higher than the preoperative VA (-3.92 ±â€Š0.13) (P < 0.05). Multiple linear regression analysis models showed that poor initial VA and longer time to surgery were independent risk factors for VA prognosis (P < 0.05), but surgical time alone was significantly associated with the improvement degree of visual acuity (IDVA) (P < 0.05). Optic canal fracture, orbital fracture, and hemorrhage within the ethmoid and/or sphenoid sinus were not significantly correlated with IDVA and VA prognosis (P > 0.05). CONCLUSIONS: ETOCD surgery could salvage VA impairment in patients with indirect TON. A better initial VA indicates better final VA outcomes after surgery. Additionally, shorter time to surgery implies better VA prognosis and higher IDVA.


Assuntos
Traumatismos do Nervo Óptico/cirurgia , Adolescente , Adulto , Idoso , Descompressão Cirúrgica , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Período Pós-Operatório , Prognóstico , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Osso Esfenoide/cirurgia , Acuidade Visual , Adulto Jovem
8.
J Craniofac Surg ; 31(4): e385-e388, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32209929

RESUMO

BACKGROUND: Craniosynostosis isolated to the frontosphenoidal suture is an extremely rare entity, distinct from other types of synostotic anterior plagiocephaly, from the embryologic, phenotypic and endocranial morphology viewpoints. Embryologically, the sphenoid bone has two origins, which morphogenetically represent 2 distinct subunits. Depending on the region involved, unique craniofacial features involving the forehead, temporal region and orbit will be demonstrated. A case of frontosphenoidal suture synostosis depicting these features is presented. In addition, a literature review was performed and a treatment algorithm is proposed.


Assuntos
Suturas Cranianas/cirurgia , Craniossinostoses/cirurgia , Osso Esfenoide/cirurgia , Osso Frontal/cirurgia , Humanos , Lactente , Órbita , Tomografia Computadorizada por Raios X
9.
J Craniofac Surg ; 31(5): 1469-1473, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32209927

RESUMO

PURPOSE: The main objective of this study was to display the morphologic properties of the anterior clinoid process (ACP) in human fetuses in term of early childhood surgeries. METHODS: Twenty-four (10 females and 14 males) fetal cadavers aged from 16th to 28th weeks of gestation (at mean, 21.54 ±â€Š3.11 weeks) were included in the present study. The dimensions of ACP were measured with a digital image analysis software. RESULTS: Taking into account the length, width, and angle of ACP, it was classified as Type 1 in 20.83% (10 cases), Type 2 in 10.42% (5 cases), Type 3 in 10.42% (5 cases), Type 4 in 2.08% (1 case), Type 5 in 8.33% (4 cases), Type 6 in 16.67% (8 cases), Type 7 in 8.33% (4 cases), and Type 8 in 22.92% (11 cases). According to the attachment site of the optic strut (OS) relative to ACP, OS was identified as the anterior 3/5 in 16.67% (8 cases), anterior 4/5 in 68.75% (33 cases), and posterior 1/5 in 14.58% (7 cases). Neither right-left nor male-female significant differences were observed between the quantitative values belonging to ACP and OS. CONCLUSION: The percentage of the most complex and challenging type of ACP (the long, narrow, and narrow-angled ACP) in fetuses was found to be close to adults. Thus, routine adult surgical procedures such as anterior clinoidectomy might be successfully used in young children and infants. The attachment site of OS relative to ACP in adults was more anterior according to fetuses probably due to postnatal development such as the pneumatization of the sphenoid bone. In this regard, for pediatric neurosurgeons to avoid iatrogenic injuries and to select appropriate surgical approaches, further studies conducted on the attachment of OS relative to ACP in children are needed.


Assuntos
Osso Esfenoide/embriologia , Osso Esfenoide/cirurgia , Cadáver , Olho , Feminino , Feto , Humanos , Masculino , Base do Crânio/cirurgia
10.
J Craniofac Surg ; 31(4): e399-e400, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32209940

RESUMO

Paranasal sinus mucocele is cystic, expansile, benign masses that contain mucus surrounded by epithelium. It causes significant locally destruction of the sinus wall and present with various symptoms depending on the pressure on neighboring structures. Sphenoid sinus mucocele constitutes 1% to 2% of all paranasal sinus mucoceles. Headache is the most common symptom that leads to correct diagnosis. In addition, the close proximity of the sphenoid sinus to important structures such as the optic nerve, cavernous sinus and the pituitary gland causes various symptoms. Treatment is surgical drainage of mucocele to reduce pressure.


Assuntos
Hipopituitarismo/etiologia , Mucocele/cirurgia , Doenças dos Seios Paranasais/cirurgia , Osso Esfenoide/cirurgia , Seio Esfenoidal/cirurgia , Seio Cavernoso/diagnóstico por imagem , Seio Cavernoso/cirurgia , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mucocele/complicações , Mucocele/diagnóstico por imagem , Nervo Óptico , Doenças dos Seios Paranasais/complicações , Doenças dos Seios Paranasais/diagnóstico por imagem , Osso Esfenoide/diagnóstico por imagem , Seio Esfenoidal/diagnóstico por imagem
11.
World Neurosurg ; 138: e405-e412, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32145421

RESUMO

BACKGROUND: Petroclival tumors and ventrolateral lesions of the pons present unique surgical challenges. This cadaveric study provides qualitative and quantitative anatomic comparison for an anterior petrous apicectomy through the transcranial middle fossa (TMF) and expanded endoscopic transsphenoidal-transclival approaches. METHODS: In 10 silicone-injected heads, the petrous apex and clivus were drilled extradurally using middle fossa and endonasal approaches. With in situ and frameless stereotactic navigation, we defined consistent points to compare working areas, bone removal volumes, approach angles, and surgical freedom. RESULTS: Mean exposed TMF area (21.03 ± 3.46 cm2) achieved a 44.71 ± 4.13° working angle to the brainstem between cranial nerves V and VI. Kawase's rhomboid area measured 1.76 ± 0.34 cm2, and bone removal averaged 1.20 ± 0.12 cm3 at the petrous apex. Surgical freedom on the lateral brainstem was higher halfway between cranial nerves V and VI at the center of the rhomboid compared with midline at the basilar sulcus (P < 0.01). After clivectomy and petrous apicectomy, mean exposed expanded endoscopic transsphenoidal-transclival area was 5.29 ± 0.66 cm2. Approach from either nostril showed no statistically significant differences in surgical freedom at the foramen lacerum and midpoint basilar sulcus. At the petrous apex, bone volume removed and area exposed were significantly larger for the TMF approach (P < 0.001). CONCLUSIONS: Expanded transclival anterior petrosectomy through the TMF approach provides an adequate corridor to lesions in the upper ventrolateral pons. The expanded endoscopic transsphenoidal-transclival approach better fits midline lesions not extending laterally beyond cranial nerve VI and C3 carotid when evaluating normal anatomic parameters.


Assuntos
Fossa Craniana Posterior/cirurgia , Craniotomia/métodos , Cavidade Nasal/cirurgia , Osso Petroso/cirurgia , Neoplasias da Base do Crânio/cirurgia , Seio Esfenoidal/cirurgia , Humanos , Osso Esfenoide/cirurgia
12.
J Neurosurg Anesthesiol ; 32(1): 36-40, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30628938

RESUMO

BACKGROUND: Patients who undergo transsphenoidal pituitary resection have an elevated risk of obstructive sleep apnea (OSA) yet their outcomes and the safety of continuous positive airway pressure (CPAP) remains unclear. Our study objective was to determine the incidence of complications related to the use of early positive airway pressure following pituitary resection. METHODS: We retrospectively identified all patients who underwent endoscopic transsphenoidal pituitary tumor resection between January 1, 2005 and March 24, 2016 at our institution, including those with diagnosed or suspected OSA. We compared characteristics and postoperative complications of OSA patients who did and did not receive CPAP postoperatively. RESULTS: In total, 427 patients underwent transsphenoidal pituitary resection. Of these, 64 (15%) had OSA. Acromegaly was more common in patients with OSA (42% vs. 10%; P<0.001) but not Cushing Disease (19% vs. 16%; P=0.54). Hypoxia was more common in patients with OSA as compared to those without (14% vs. 5%; P<0.001) and one patient with OSA was reintubated compared with none in the control group (P=0.017). Eight patients had CPAP applied in the immediate postoperative period and the incidence of postoperative cerebrospinal fluid (CSF) leak, infection, and pneumocephalus was similar between OSA patients with and without CPAP. DISCUSSION: Our case series of patients with OSA who received CPAP immediately following transsphenoidal pituitary resection resulted in similar rates of surgical complications. Our results support further investigation to establish the safety of CPAP in this population.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Hipófise/cirurgia , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/terapia , Apneia Obstrutiva do Sono/terapia , Osso Esfenoide/cirurgia , Acromegalia/cirurgia , Adulto , Idoso , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Feminino , Humanos , Hipóxia/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Hipersecreção Hipofisária de ACTH/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
13.
Ann R Coll Surg Engl ; 102(2): e42-e44, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31538800

RESUMO

Erdheim-Chester disease is a rare infiltrative histiocytic disorder with around 800 cases being reported worldwide. Patients most commonly present with skeletal pain, but the condition has been shown to affect multiple other organs. We describe a rare presentation in which the disease infiltrated the sinuses and affected an ex-RAF pilot's vision. After extensive investigation of the elusive diagnosis, repeating of a molecular test using polymerase chain reaction analysis allowed for identification of a mutation (BRAF V600) ultimately leading to the diagnosis of Erdheim-Chester disease.


Assuntos
Cegueira/etiologia , Doença de Erdheim-Chester/diagnóstico , Sinusite/etiologia , Cegueira/terapia , Análise Mutacional de DNA , Diagnóstico Diferencial , Doença de Erdheim-Chester/complicações , Doença de Erdheim-Chester/genética , Doença de Erdheim-Chester/terapia , Osso Etmoide/diagnóstico por imagem , Osso Etmoide/patologia , Osso Etmoide/cirurgia , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Pilotos , Proteínas Proto-Oncogênicas B-raf/genética , Sinusite/terapia , Osso Esfenoide/diagnóstico por imagem , Osso Esfenoide/patologia , Osso Esfenoide/cirurgia , Tomografia Computadorizada por Raios X
14.
Turk Neurosurg ; 30(4): 542-549, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31608974

RESUMO

AIM: To evaluate computed tomography (CT) and magnetic resonance imaging (MRI) findings of cranial intraosseous meningiomas (IOMs). MATERIAL AND METHODS: This study included ten patients (six females and four males) with IOMs who underwent cranial CT and/ or MRI examinations during May 2009?June 2018. Lesions were classified based on the following locations: the sphenoid ridge, the calvarial convexity, other skull base bones, and the sphenoid ridge + calvarial extension. Bony extension, contour irregularity or radial bone spiculation, bony changes (hyperostotic, lytic, or mixed patterns), dural calcification, cerebral edema, and the presence of soft tissue were evaluated. RESULTS: A total of eleven IOMs were identified in ten patients. The age of patients was 46?80 (mean: 55.30 ± 9.84) years. Five of the lesions were located in the sphenoid ridge + calvarium, three in the sphenoid ridge, two in the skull base, and one in the calvarial convexity. Seven lesions exhibited radial bone spiculation. Moreover, nine lesions exhibited hyperostotic CT pattern; while, two exhibited a mixed pattern. Three IOMs were accompanied with dural calcification, and peritumoral edema was observed in six IOMs. CONCLUSION: IOMs are predominantly low-grade tumors, commonly located in the periorbital area and often accompanied by soft tissue components and dural infiltrations. They most commonly lead to radial bone spiculation and bone expansion. Patients primarily have single lesions but may occasionally have multiple ones.


Assuntos
Imagem por Ressonância Magnética/métodos , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Osso Esfenoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/cirurgia , Calcinose/diagnóstico por imagem , Calcinose/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Pessoa de Meia-Idade , Osso Esfenoide/cirurgia
15.
J Clin Endocrinol Metab ; 105(1)2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31589293

RESUMO

CONTEXT: Craniopharyngioma is a rare neoplastic entity of the central nervous system. Childhood-onset craniopharyngioma is the subject of frequent research whereas the information on adult-onset craniopharyngioma is scarce. OBJECTIVE: The objective of this study was to examine the level of daily impairment in adult patients suffering from craniopharyngioma. DESIGN: Noninterventional patient registry indexed as PV4842 with the local ethics committee. SETTING: The study is set in a hospitalized and ambulatory setting. PATIENTS: 148 patients with adult-onset craniopharyngioma were recruited from 8 centers, 22 prospectively and 126 retrospectively. Mean follow-up was 31 months. INTERVENTIONS: No interventions performed. MAIN OUTCOME MEASURES: Complications, symptoms, body mass index (BMI), and quality of life (QoL; EORTC QLQ C30 and BN20) were recorded preoperatively and at follow-up. The hypotheses tested were generated after data collection. RESULTS: Complications were more frequent after transcranial than transsphenoidal approaches (31 % vs. 11%; P < 0.01). Preoperative obesity was present in 0% papillary and in 38% of all adamantinomatous craniopharyngiomas (P = 0.05), and diabetes insipidus was more frequent for papillary craniopharyngioma (36.8% vs. 16,7%; P < 0.05). Hormone deficits at follow-up were reduced in 16.9%, equal in 31.4%, and increased in 63.6% (P < 0.001). BMI increased from 28.7 ± 7.4 kg/m2 before surgery to 30.2 ± 7.4 kg/m2 at follow-up (P < 0.001). In QoL, a decrease of future uncertainty (62.5 vs. 36.8; P = 0.02) and visual disorders (38.9 vs. 12.0; P = 0.01) were observed in the prospective collective after surgery. CONCLUSIONS: Adult craniopharyngioma is associated with a complex sociological and psychological burden and hypothalamic dysfunction, warranting further investigation and emphasizing the need for a wider treatment approach.


Assuntos
Craniofaringioma , Neoplasias Hipofisárias , Adolescente , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Craniofaringioma/diagnóstico , Craniofaringioma/epidemiologia , Craniofaringioma/terapia , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/epidemiologia , Neoplasias Hipofisárias/terapia , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Osso Esfenoide/cirurgia , Adulto Jovem
16.
Laryngoscope ; 130(1): 18-24, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30933319

RESUMO

OBJECTIVES/HYPOTHESIS: Releasing the nasoseptal flap (NSF) pedicle from the sphenopalatine artery (SPA) foramen may considerably improve flap reach and surface area. Our objectives were quantify increases in pedicle length and NSF reach through extended pedicle dissection into the pterygopalatine fossa (PPF) through cadaveric dissections and present clinical applications. STUDY DESIGN: Anatomical study and retrospective clinical cohort study. METHODS: Twelve cadaveric dissections were performed. Following standard NSF harvest, the distance from the anterior edge of the flap to the anterior nasal spine while pulling the flap anteriorly was measured. As dissection into the SPA foramen and PPF continued, similar interval measurements were completed in four stages after release from the SPA foramen, release of the internal maxillary artery (IMAX), and transection of the descending palatine artery (DPA). The extended pedicle dissection technique was performed in seven consecutive patients for a variety of different pathologies. RESULTS: The mean length of the NSF from the anterior nasal spine and maximum flap reach were 1.91 ± 0.40 cm/9.3 ± 0.39 cm following standard harvest, 2.52 ± 0.61 cm/9.75±1.06 cm following SPA foramen release, 4.93 ± 0.89 cm/12.16 ± 0.54 cm following full IMAX dissection, and 6.18 ± 0.68 cm/13.41 ± 0.75 cm following DPA transection. No flap dehiscence or necrosis was observed in all seven surgical patients. CONCLUSIONS: Extended pedicle dissection of the NSF to the SPA/IMAX markedly improves the potential length and reach of the flap. This technique may provide a feasible option for reconstruction of large anterior skull base and craniocervical junction defects. Seven successful cases are presented here, but further studies with larger series are warranted to validate findings in a clinical setting. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:18-24, 2020.


Assuntos
Cavidade Nasal/cirurgia , Fossa Pterigopalatina/cirurgia , Retalhos Cirúrgicos , Adulto , Idoso , Artérias/anatomia & histologia , Cadáver , Dissecação , Endoscopia , Seio Etmoidal/anatomia & histologia , Seio Etmoidal/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/anatomia & histologia , Fossa Pterigopalatina/anatomia & histologia , Estudos Retrospectivos , Osso Esfenoide/anatomia & histologia , Osso Esfenoide/cirurgia
17.
Neurosurg Rev ; 43(2): 555-564, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30483973

RESUMO

To evaluate the safety and efficacy of intradural "limited drill" technique (ILDT) of anterior clinoidectomy (AC) and optic canal unroofing (OCU) for microneurosurgical management of ophthalmic segment and posterior communicating artery (PCOM) aneurysms. All the patients with ophthalmic segment and PCOM aneurysms who underwent AC and OCU by ILDT for microneurosurgical management of ophthalmic segment and PCOM aneurysms during 4-year period (2013-2016) at our Institute were included in this study. In ILDT of AC and OCU, the use of power drill is restricted to AC only and OCU is done exclusively with 1-mm Kerrison punch. AC and OCU by ILDT were done in 24 patients with 29 ophthalmic segment and 7 PCOM aneurysms. AC and OCU by ILDT helped in mobilization of optic nerve/internal carotid artery (ICA) and provided excellent exposure for all these aneurysms. There was no injury to ICA or optic nerve during drilling. AC and OCU facilitated clip ligation of 34 of these aneurysms. Remaining 2 aneurysms were considered not suitable for clipping. Check angiogram done for 33 aneurysms revealed complete obliteration of 26 aneurysms, very small residual neck in 5 aneurysms, and small residual aneurysm in 2 aneurysms. Deterioration in vision was noted in 1 patient (4.1%). In 6 patients with preoperative visual deficits, significant improvement in vision was noted in 4 patients (4/6-66.6%) after surgery. Good outcome (MRS < 2) was noted in 91.6% (22/24) of these patients. ILDT is a safe and effective technique of AC and OCU which provide good exposure for ophthalmic segment and PCOM aneurysms.


Assuntos
Artéria Cerebral Anterior/cirurgia , Artéria Carótida Interna/cirurgia , Aneurisma Intracraniano/cirurgia , Microcirurgia/instrumentação , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Nervo Oftálmico/cirurgia , Nervo Óptico/cirurgia , Osso Esfenoide/cirurgia , Adulto , Idoso , Angiografia Cerebral , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Instrumentos Cirúrgicos , Resultado do Tratamento , Transtornos da Visão/etiologia
18.
Neurosurg Rev ; 43(4): 1109-1116, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31227951

RESUMO

Perioperative management of patients with sellar lesion submitted to endoscopic transsphenoidal neurosurgery (TSS) lacks standardization and therefore it is committed to each center clinical practice. Although neurosurgical procedure remains the same for all sellar lesions, perioperative approach can require different measures depending on the underlying disease. With the aim of standardizing our perioperative procedures and sharing our experience with other centers involved in the management of pituitary disease, we developed a clinical care path for patients with sellar lesions candidate to endoscopic TSS. For the drafting of the following protocol, the national and international guidelines published in the last 5 years have been evaluated and integrated with our center experience accumulated in decades of clinical practice. A steering committee including medical doctors involved in management of patients with pituitary masses at the Padua Hospital reviewed current knowledge on this topic. The committee developed a first draft which was shared with a broader group of medical doctors to reach a preliminary consensus; when it was reached, the clinical care assistance pathway was confirmed, validated, and published in the local web-based health service. We want to present and share our experience with colleagues involved in the perioperative management of pituitary diseases in other centers.


Assuntos
Endoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Sela Túrcica/cirurgia , Osso Esfenoide/cirurgia , Protocolos Clínicos , Guias como Assunto , Humanos , Imagem por Ressonância Magnética , Modelos Anatômicos , Alta do Paciente , Assistência Perioperatória , Doenças da Hipófise/diagnóstico por imagem , Doenças da Hipófise/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Sela Túrcica/diagnóstico por imagem , Osso Esfenoide/diagnóstico por imagem , Resultado do Tratamento
19.
Br J Neurosurg ; 34(1): 35-39, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31709822

RESUMO

Background: The endonasal approach is the gold standard for the resection of pituitary tumours, with either microscopic endonasal transsphenoidal (MET) or endoscopic endonasal transsphenoidal (EET) technique. Advantages and disadvantages of both techniques have been widely described in the literature, although limited attention has been paid to its impact on the sense of smell.Objective: The present study aims to quantify the effect of transnasal surgery on pituitary patients and examine olfactory outcomes.Methods: A prospective cohort study assessing the sense of smell of 20 patients (10 MET and 10 EET) pre-operatively. Olfactory function was re-assessed 6 months after surgery, using the University of Pennsylvania Smell Identification Test (Sensonics Inc., Haddon Heights, NJ).Results: The UPSIT (Sensonics Inc.) results showed a median pre-operative score of 33 (IQR 31-37.5) (normosmia). The median post-operative result was 25 (IQR 19.5-32), consistent with moderate microsmia. Twenty percent of the patients had normal olfactory function post-operatively, all of whom were from the EET group. Twenty percent had mild microsmia, equally divided in MET and EET subgroups. Seven patients had severe microsmia. Four patients were completely anosmic at 6 months follow-up.Conclusions: Patients undergoing a transsphenoidal procedure are at risk of olfactory disturbance post-operatively, which may include loss of the sense of smell. This information is relevant to the patients' perioperative experience, and should be incorporated into counselling with regards to outcomes and expectations. Although the study size is small, the study results suggest the ETS technique may be less traumatic for the olfactory function. A larger study powered to fully examine potential differences in olfactory outcomes following ETS and MTS is warranted.


Assuntos
Endoscopia/métodos , Microcirurgia/métodos , Cavidade Nasal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Transtornos do Olfato/etiologia , Complicações Pós-Operatórias/epidemiologia , Osso Esfenoide/cirurgia , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/cirurgia , Estudos Prospectivos , Olfato , Resultado do Tratamento
20.
Acta Neurochir (Wien) ; 162(3): 567-579, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31748903

RESUMO

BACKGROUND: Microsurgical clipping is a viable option for managing high-riding basilar apex aneurysms (BAXs) using a transsylvian approach. Cutting the posterior communicating artery (PCoA) at the perforator-free zone provides sufficient exposure of BAX, although it is not always safe. The aim was to qualitatively predict sectioning of the interfering PCoA by using preoperative computed tomographic angiography (CTA). METHODS: A virtual trajectory from the lesser sphenoid wing to the neck of the aneurysm was simulated on CTA in 19 consecutive patients operated on BAX aneurysms from 2013 to 2018. The angles on CTA resembled the typical view through the extended pterional craniotomy. Next, the ipsilateral PCoA was tracked from the internal carotid to its end at the posterior cerebral artery in the trajectory. RESULTS: The opticocarotid and carotid-oculomotor window served as the corridors for entering the interpeduncular fossa in 16 patients (84.2%) and in 3 patients (15.8%), respectively. The PCoA was intentionally cut during nine surgeries and preserved in 10 of them. The PCoA was cut more often when positioned toward the cranial base and more medially in the corridor; both the Kernel density analysis and the data points representing the position of the PCoA supported this finding (p < 0.01). The CTA-based position of either ends of the PCoA in the trajectory did not differ between cut and not-cut groups (p = 0.19-0.96). Aneurysm projection, rupture, size, PCoA diameter, length, and other distances on CTA were not related to the sectioning of PCoA (p > 0.05). CONCLUSIONS: The probability of PCoA sectioning is higher when the PCoA is positioned medially and closer to the cranial base. If the anatomical course of the PCoA is recognized beforehand, it can contraindicate surgery. Preoperative CTA-based planning facilitates the surgery of BAX aneurysms. Therefore, CTA can make microsurgical clipping planning more predictable for the neurosurgeon and safer for the patient.


Assuntos
Aneurisma Roto/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Craniotomia/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Posterior/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adulto , Aneurisma Roto/diagnóstico por imagem , Círculo Arterial do Cérebro/diagnóstico por imagem , Círculo Arterial do Cérebro/cirurgia , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Posterior/diagnóstico por imagem , Osso Esfenoide/diagnóstico por imagem , Osso Esfenoide/cirurgia
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