Medizinische Universität Graz - Research portal
Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Cardinal, T; Brunswick, A; Strickland, BA; Micko, A; Shiroishi, M; Liu, CJ; Wrobel, B; Carmichael, JD; Zada, G.
Safety and Effectiveness of the Direct Endoscopic Endonasal Approach for Primary Sellar Pathology: A Contemporary Case Series of More Than 400 Patients.
World Neurosurg. 2021; 148:e536-e546
Doi: 10.1016/j.wneu.2021.01.018
Web of Science
PubMed
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FullText_MUG
- Co-authors Med Uni Graz
- Micko Alexander
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- Abstract:
- BACKGROUND: The direct endoscopic endonasal approach (EEA) has become the primary technique used for resection of sellar pathology, meriting investigation into the risk factors for complications and predictors of postoperative outcomes after direct EEA. METHODS: We retrospectively analyzed the patient and tumor characteristics from 404 patients who had undergone direct EEA for sellar pathology at the USC Pituitary Center from September 2011 to December 2019. RESULTS: Of the 404 pathologic entities included, 349 (86%) were pituitary adenomas (PAs), 29 (7%) were Rathke cleft cysts, and 26 (6%) were other sellar lesions. The mean lesion diameter was 2.3 cm, with 34 microadenomas (10%) and 315 macroadenomas (90%). Cavernous sinus invasion was present in 39% of the PAs. No patient died. The surgical complications included internal carotid artery injury without neurological sequelae (0.2%), vision loss (0.7%), meningitis (0.7%), cerebrospinal fluid leak (4%), epistaxis (4%), sinusitis (1%), transient cranial nerve paresis (0.5%), and postoperative abscess (0.25%). New hypopituitarism developed in 3%. Gross total resection was achieved in 208 PA cases (58%). Clinical improvement of headaches and visual deficits were reported for 67% and 76% of cases, respectively. Hormonal remission was achieved in 82% of patients with functional PAs. The median hospital stay was 2 days, with 34 patients (8%) readmitted within 30 days and 10 (3%) undergoing early reoperation. Disease recurrence or progression developed in 10% and was less likely in the case of gross total resection and apoplexy. CONCLUSION: In the present, large, consecutive, mostly single-surgeon series, the patients experienced clinical improvement in most preoperative symptoms and had low rates of perioperative morbidity. We have demonstrated that direct EEA can be efficiently, safely, and successfully performed by a neurosurgical team.
- Find related publications in this database (using NLM MeSH Indexing)
- Adenoma - pathology, surgery
- Adult - administration & dosage
- Aged - administration & dosage
- Cavernous Sinus - pathology, surgery
- Female - administration & dosage
- Humans - administration & dosage
- Length of Stay - administration & dosage
- Magnetic Resonance Imaging - administration & dosage
- Male - administration & dosage
- Margins of Excision - administration & dosage
- Middle Aged - administration & dosage
- Nasal Cavity - surgery
- Natural Orifice Endoscopic Surgery - adverse effects, methods
- Neuroendoscopy - methods
- Neurosurgical Procedures - adverse effects, methods
- Patient Readmission - statistics & numerical data
- Pituitary Diseases - surgery
- Pituitary Function Tests - administration & dosage
- Pituitary Neoplasms - pathology, surgery
- Postoperative Complications - epidemiology
- Treatment Outcome - administration & dosage
- Find related publications in this database (Keywords)
- Direct endoscopic endonasal approach
- Endoscopic endonasal transsphenoidal surgery
- Pituitary adenoma
- Rathke cleft cyst
- Sellar pathology
- Single surgeon