Preservation of hormonal function by identifying pituitary gland at endoscopic surgery.

Autor: Linsler S; Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland, Germany. Electronic address: stefan.linsler@uks.eu., Hero-Gross R; Gesundheitszentrum am Markplatz, Praxis für Endokrinologie, Homburg, Deutschland, Germany., Friesenhahn-Ochs B; Klinik für Innere Medizin II, Gastroenterologie, Hepatologie, Endokrinologie, Diabetologie und Ernährungsmedizin, Universitätsklinikum des Saarlandes, Homburg, Deutschland, Germany., Sharif S; Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan., Lammert F; Klinik für Innere Medizin II, Gastroenterologie, Hepatologie, Endokrinologie, Diabetologie und Ernährungsmedizin, Universitätsklinikum des Saarlandes, Homburg, Deutschland, Germany., Oertel J; Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland, Germany.
Jazyk: angličtina
Zdroj: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia [J Clin Neurosci] 2017 Sep; Vol. 43, pp. 240-246. Date of Electronic Publication: 2017 Jul 04.
DOI: 10.1016/j.jocn.2017.06.045
Abstrakt: Objective: The endonasal endoscopic approach has been established for perisellar tumor surgery with a higher resection rate and reduced complications. We analyzed the potential to identify the pituitary gland under endoscopic view, at surgery and see its relation to postoperative hormonal insufficiency in endonasal endoscopic procedures.
Methods: Between January 2011 and January 2014, 70 cases of pituitary adenomas with preoperative intact pituitary function underwent endoscopic endonasal transsphenoidal procedures for intrasellar pathologies. Endocrinologists and neurosurgeons followed these patients prospectively. Special attention was paid to intraoperative identification of gland tissue, surgical complications, degree of resection and postoperative hormonal insufficiency.
Results: The pituitary gland was identified in 57 out of 70 procedures (81.4%). Eleven percent (8 of 70 patients) had persistent pituitary insufficiency. Two of these 8 patients belonged to the group with pituitary gland identification (2 out of 57); thus, when the pituitary gland was identified during the procedure postoperative hormonal insufficiency was seen in 3.5% of cases. Failure of pituitary gland identification presented with hormonal insufficiency of 46.2%. In analysis with Fisher's exact test, there was a high significant correlation between the identification of the pituitary gland intraoperatively and normal pituitary function postoperatively (p<0.005). On follow up radical tumor resection was seen in 88% (62 of 70 patients).
Conclusions: This study indicates that identification and preservation of pituitary gland tissue and function is possible in endoscopic transsphenoidal surgery. This preservation of gland tissue is a positive predictor of postoperative normal pituitary function.
(Copyright © 2017 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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