جستجوی مقالات مرتبط با کلیدواژه "transsphenoidal surgery" در نشریات گروه "پزشکی"

Context: 

Pituitary adenomas are amongst the most common tumors with a low mortality rate compared to other intracranial malignancies. Delayed hyponatremia (DH) is a common finding after transsphenoidal resection (TSS), which is the basis for the management of these tumors. Although DH is one of the leading causes of readmission after TSS, no unified guidelines exist with regard to the prevention of this electrolyte disturbance.

 This study aims to evaluate and compare existing preventive protocols for DH in order to identify and signify their common grounds.

 After a search in electronic databases, including PubMed (NCBI), Embase, Scopus, and Google Scholar with the keywords of “pituitary adenoma,” “hyponatremia,” “transsphenoid surgery”, “water electrolyte balance,” “patient readmission", six original articles were included in the study.

 We found that a protocol that both identifies groups susceptible to DH (males, older individuals, and those with a lower BMI) and consists of fluid restriction, sodium supplementation, and regular serum sodium monitoring could be utilized to prevent DH in patients with pituitary adenomas after TSS.

 Further studies with a larger sample size must be conducted to compare existing protocols for preventing DH and also investigate post-surgery optimal fluid-restricted diets and corticosteroid therapy in these patients.

The comparative outcomes between endoscopic and microscopic transsphenoidal approaches (ETSA and MTSA) for pituitary adenomas (PAs) remain controversial; however, the numerous literatures have been investigated for decades. This study evaluated the effectiveness of these two techniques using comprehensive measurements and rigorous statistical methods.

A retrospective review of patients who underwent transsphenoidal surgery for PAs at our institution between January 2010 and December 2019 was performed. We included only cases treated by surgeons who have independently performed more than 30 transsphenoidal surgeries. Patients’ characteristics, surgical outcomes, complications, and recurrence were collected for statistical analysis

A total of 210 patients, including 138 ETSA patients, and 72 MTSA patients, were analyzed. The baseline characteristics of the two groups were comparable. ETSA patients showed less intraoperative blood loss (191.9 mL vs. 369.9 mL, P < 0.01), a higher rate of gross total resection (GTR) (84.1% vs. 72.2%, P = 0.04), a higher rate of extent of resection (EOR) (95.1% vs. 87.4%, P < 0.01), and shorter hospital stay (10 days vs. 13.5 days, P < 0.01). These better outcomes of ETSA persisted in multivariable regression analysis. Complications were not significantly different between groups. There was no statistical difference between recurrence-free survival of the two groups (P = 0.06, log-rank test)

Our study showed that ETSA provided better outcomes and attained similar complications compared to MTSA for the resection of PAs.

Acromegaly defines as chronic elevations of insulin-like growth factor-1 (IGF-1) and growth hormone (GH), which results in enlargement of organs and soft tissues. Cardiovascular complications of acromegaly such as cardiomegaly, hypertension contributing to a high risk of cardiovascular events. This study aimed to identify the determinants of the prevalence of cardiomegaly as cardiovascular comorbidity of acromegaly and the potential effect of the curative intervention.

A total of 160 patients with acromegaly due to pituitary adenoma participated in this study. Acromegaly diagnosed was based on clinical manifestations, age-adjusted plasma IGF-I, and elevated plasma GH levels, not suppressible during an oral glucose tolerance test (75 g). Electrocardiogram and chest X-ray obtained in all patients. Treatment approaches included transsphenoidal surgery and hormonal evaluation performed before and six months after surgery.

The GH serum level was elevated in all patients before surgery, with a mean of 33.7 ng/mL that reached 5.7 ng/mL after surgery. Mean IGF-1 was 794.1 ng/mL that reached 395.6 ng/mL postoperatively. The prevalence of cardiomegaly was 15% that improved in 5% of patients after trans sphenoidal surgery.

Appropriate surgical intervention in acromegaly that complicated by cardiomegaly may result in significant improvement of the cardiac structure.

Pituitary adenomas are the most common space-occupying lesions in the sellar region. Pituitary adenomas are usually soft, but 5 to 13% of macroadenomas are fibrous. The resection of firm tumors by curettage or suction is challenging. Therefore, preoperative knowledge of the pituitary adenomas consistency could help neurosurgeons plan more appropriate surgical procedures. In this regard, predicting fibrous adenomas by magnetic resonance imaging (MRI) is typically difficult and the results are controversial. We evaluated the correlation of pituitary adenoma consistency during tumor resection with preoperative diffusion-weighted images (DWI) findings and apparent diffusion coefficient (ADC) values.
45 consecutive patients (21 male, 24 female, mean age 43 ± 10) with pituitary macroadenoma were prospectively enrolled. Radiological evaluation with conventional MR and DWI images was done for all patients. Tumor consistency was evaluated at surgery and classified as soft, intermediated, and hard. Histological examination was performed on tumor specimens.
Based on the surgical findings, 12 (26.7%) tumors were classified as soft-, 30 (66.6%) as intermediate-, and 3 (6.7%) as hard-consistency macroadenomas. Although the collagen content showed an association with tumor consistency, neither tumor consistency nor collagen content and secretory status were correlated with conventional MRI measures and ADCs in different b values and planes.
Preoperative DW MRI was not useful to predict the tumor consistency, collagen content, and hormone-secreting status of pituitary macroadenomas.

This study aims at analyzing the outcomes of transsphenoidal surgery in 35 patients of Cushing’s disease (CD), the highest number of patients seen during 11 years from one center in Iran. Retrospective data from case records of all patients were retrieved. The diagnosis of CD was based on clinical presentation, hormone studies, adrenal and pituitary imaging, and thoracic imaging as and when considered appropriate. Age, sex, clinical parameters, laboratory investigations, intra-operative findings, post-operative complications, duration of hospital stay and follow up observations were evaluated using appropriate statistical methods. Of 35 patients, 26 were female and 9 male with a mean age of 28±10 years. The most frequent presenting symptom had been obesity (57%) which was present for 30±29 months. Four patients had macroadenoma and the other 31 (86%) had microadenoma. All patients were operated by transsphenoidal route; there were no intra-operative complications. Two patients had temporary CSF rhinorrhea and 9 had temporary diabetes insipidus in the post-operative period without any need for surgical intervention. Eight patients were lost to follow up and the remaining 27 were followed for 22±23 months (minimum 3 months and maximum 8.5 years). Remission was achieved in 32 patients (88%), while the.