Transsphenoidal Surgery

 

Description:

This work details contemporary clinical knowledge on the multidisciplinary management of pituitary and other sellar/parasellar tumors, with a focus on surgical techniques and a particular emphasis on complication avoidance and management. International experts provide guidance on natural history, radiologic and clinical aspects, surgical indications, and resection techniques.In addition, case presentations and clinical photographs help the reader reduce the risk of error and advance their own surgical skills. Readers also have access online to streaming videos of key procedures to help them provide the best possible outcomes for every patient. Transsphenoidal Surgery: Complication Avoidance and Management Techniques will be of great value to Neurosurgeons, Otolaryngologists, Endocrinologists, Radiation Oncologists, and residents and fellows in these specialties.

 

 

Table of Contents:

 

1: Evolution of Pituitary Surgery and the Transsphenoidal Approach

Introduction

Early Approaches to the Pituitary

Endoscopy in Transsphenoidal Surgery

Extended Transsphenoidal Approaches

Conclusions

References

2: The History of Trans-sphenoidal Surgery for Pituitary Tumours

Understanding and Diagnosis of Pituitary Tumours

Surgical Approaches

Transcranial Surgery

Trans-sphenoidal Surgery

Oscar Hirsch

Harvey Cushing

Norman Dott

Gerard Guiot

Jules Hardy

Image Guidance and Intraoperative MRI

Endoscopic Pituitary Surgery

Extended Trans-sphenoidal Surgery

Conclusion

References

3: Principles and Pitfalls of Anesthesia for Transsphenoidal Surgery

Background

Preoperative Assessment

Prolactinomas

Acromegaly

Cushing’s Disease

Thyrotropic Adenomas

Nonfunctioning Adenomas

Intraoperative Management

Surgical Factors

Airway Management

Positioning and Preparation for Surgery

Monitoring

Maintenance of Anesthesia

Postoperative Considerations

Pain

Nausea and Vomiting

CSF Leak, Cranial Nerve Injury, and Visual Field Deficits

Hypopituitarism and Postoperative Hormone Screening

Disorders of Water Balance: Diabetes Insipidus (DI) and Syndrome of Inappropriate Antidiuretic H

Conclusion

References

4: Operative Indications and Pitfalls in Patient Selection for Surgery of Pituitary Tumors

Preoperative Evaluation

Radiological Diagnosis

Rhinological Evaluation

Endocrinology Evaluation

Neuro-ophthalmology

Surgical Indications by Lesion

Prolactinomas

Acromegaly

Cushing’s Disease

Thyrotropic Adenoma

Nonfunctioning Tumors

Pituitary Apoplexy

Craniopharyngiomas

Meningiomas

Infundibular/Hypothalamic Tumors

Cysts

Metastasis

Reoperations

Conclusion

References

5: The Perioperative and Postoperative Care for Pituitary Patients

Introduction

Preoperative Hormonal Analysis

Disorders of Water Metabolism: Diabetes Insipidus and SIADH

Diabetes Insipidus

Incidence

Diagnosis

Postoperative Clinical Course of DI and Possible SIADH Phase

Indications for Treatment in DI

Adrenal Insufficiency

Special Considerations in Patients with Cushing’s Disease

Conclusions

References

6: Neuro-ophthalmology of Pituitary Tumors

Neuro-anatomy of the Optic Chiasm and Relation to Visual Symptoms

The Neuro-ophthalmic Examination

Perimetric Assessment of the Visual Fields

Patterns of Visual Field Loss

Structural Assessment of the Optic Pathways

Fundus Examination

Optical Coherence Tomography

Management of Visual Loss

Postoperative Visual Loss

Efferent Neuro-ophthalmic Complications of Sellar Tumors

Special Considerations

Conclusion

References

7: Rhinologic Evaluation of Patients Undergoing Transsphenoidal Surgery

Historical Perspective

Nasal Functions and Physiology

Paranasal Sinus Function and Physiology

Preoperative Considerations/Workup

Imaging

Postoperative Rhinologic Evaluation

References

8: Imaging of the Sella and Parasellar Region

Introduction

Imaging Anatomy of the Pituitary and Parasellar Region

Imaging Protocol

Pathology of Sella and Parasellar Region

Tumors

Pituitary Adenoma

Pituitary Apoplexy

Craniopharyngioma

Tuber Cinereum Hamartoma

Meningioma

Schwannoma

Hypothalamic Pilocytic Astrocytoma

Germ Cell Tumors

Chordoma

Chondrosarcoma

Tumor-like Lesions

Langerhans Cell Histiocytosis

Sarcoidosis

Cysts

Rathke’s Cleft Cyst

Epidermoid Cyst

Dermoid Cyst

Miscellaneous Nontumoral Conditions

Intracranial Hypotension

Empty Sella

Operative Planning

Postoperative Imaging Evaluation

Conclusion

References

9: Classification, Pathobiology, Molecular Markers, and Intraoperative Pathology

Pituitary Neuroendocrine Tumors

Introduction

Molecular Genetics of Pituitary Adenomas

Classification of Pituitary Adenomas

Specific Subtypes of Pituitary Adenomas

Lactotroph Adenomas

Somatotroph Adenomas

Adenomas Secreting GH and PRL

Corticotroph Adenoma

Thyrotroph Adenomas

Gonadotroph Adenomas

Null Cell Adenomas

Plurihormonal Adenomas

Tumor Grading

Pituitary Carcinoma

Pituitary Blastoma

Pituitary Non-neuroendocrine Tumors

Introduction

Specific Characteristics of the Tumors

Pituicytoma

Granular Cell Tumor of the Neurohypophysis

Spindle Cell Oncocytomas

Craniopharyngioma

References

10: Surgical Anatomy of the Sellar Region

Introduction

Sphenoid Bone

Pituitary Gland

Diaphragma Sellae

Cavernous Sinus

Suprasellar Region

Retrosellar Region: Interpeduncular Cistern

Conclusion

References

11: Combined Hybrid Microscopic and Endoscopic Transsphenoidal Surgery: Anatomy, Instrumentation, a

Introduction

Case Preparation

Periprocedural Communication and Safety

OR Setup

Patient Positioning and Preparation

Lumbar Drain

Surgical Technique

Postoperative Care

Conclusion

References

12: Transcranial Approaches to the Sellar and Parasellar Areas

Introduction

Surgical Considerations

Pterional Approach

Orbitozygomatic Approach

Bifrontal Approach

Unilateral Subfrontal

Supraorbital Keyhole Approach

Subtemporal Approach

Final Thoughts

References

13: Endoscopic Transsphenoidal Surgery: Anatomy, Instrumentation, and Technique

Introduction

Endoscopic Anatomy of the Skull Base: The Endonasal Perspective

The Anterior Skull Base

The Middle Skull Base

The Posterior Skull Base

Endoscopic Endonasal Approaches

Basic Concepts

Surgical Instrumentation

Patient Positioning

The Transtuberculum Transplanum Approach to the Suprasellar Area

Approach to the Ethmoidal Planum

Approaches to the Cavernous Sinus and Lateral Recess of the Sphenoid Sinus

Approach to the Medial Compartment of the Cavernous Sinus

Approach to the Lateral Compartment of the Cavernous Sinus and to the Lateral Recess of the

Approach to the Clivus, Cranio-vertebral Junction, and Anterior Portion of the Foramen Magnum

Reconstruction Techniques

Conclusions

References

14: Three-Dimensional Endoscopy for Skull Base Surgery

Introduction

Historical Developments in Endoscopic Transsphenoidal Surgery

Technical Basis of Three-Dimensional Endoscopy

Advantages of Three-Dimensional Visualization

Disadvantages of Three-Dimensional Visualization

Implementation of Three-Dimensional Endoscopy in Transsphenoidal Surgery

Senior Author’s Experience

Conclusions

References

15: Endoscopic Transsphenoidal Pituitary Surgery: Results and Complications

Introduction

Nonfunctional Adenomas

Functional Adenomas

Prolactinomas

GH-secreting Adenomas: Acromegaly

ACTH-secreting Adenomas: Cushing’s Disease

Complications

Conclusion

References

16: Intraoperative Imaging for Pituitary Surgery

Introduction

Intraoperative MRI

Basic Setup

Low-Field iMRI (Less Than 1.5 Tesla)

High-Field iMRI (1.5 Tesla and Greater)

Washington University Experience

Multimodality Image Integration

Intraoperative MRI and Endoscopy

Cost-Effectiveness of iMRI for Pituitary Surgery

Limitations of Current Studies

Other Modalities

Intraoperative CT

Intraoperative Ultrasound

Nonradiographic Imaging

Summary

References

17: The Role of Endoscopic Transsphenoidal Surgery in the Management of Complex Lesions Involvin

Introduction

Endoscopic Endonasal Corridors

Sagittal Plane Approaches

Transsellar Approach

Transcribriform Corridor

Transplanum Transtuberculum Approach

Transclival Approach

Transodontoid Approach

Coronal Plane Approaches

Transpterygoid Approach

Approach to the Petrous Apex

Transcavernous Approach

Operative Techniques

Patient Positioning

Sagittal Plane Approaches

Transsellar Approach

Transcribriform Approach

Transplanum Transtubercular Approach

Transclival and Transodontoid Approaches

Coronal Plane Approaches

Transpterygoid Approach

Approach to the Petrous Apex

Transcavernous Approach

Reconstruction

Complications

Combined Transcranial and Endoscopic Endonasal Approaches

Conclusions

References

18: Closure Methods Following Transsphenoidal Surgery

Introduction

Multilayer Reconstruction

Vascularized Reconstruction

Other Vascularized Flaps Following Pituitary/Parasellar Surgery

Middle Turbinate Flap

Inferior Turbinate/Lateral Nasal Wall Flap

Postoperative Care

Complications

Conclusions

References

19: Complications with Transsphenoidal Surgery: A Review

Introduction

Phases of Care

The Clinic: Patient Selection

Operating Suite – Preincision

Surgical Approach

Tumor Resection

Closure

Postoperative Management: Inpatient

Postoperative Management: Outpatient

Major Complications

Vascular Injury

Cranial Nerve Injury

Cerebrospinal Fluid Leakage

Repair

Meningitis

Hypopituitarism

Diabetes Insipidus

SIADH

Anterior Gland Dysfunction

“Minor” Endocrine Issues

Fluid and Sodium Issues

Minor Complications

Anesthesia-Related Complications

Invasive Catheters

Airway Issues

Urinary Catheters

Other Anesthesia-Related Issues

Positioning-Related Issues

Sinonasal Complications

Oral Complications

Fat Graft Harvest Site Complications

Conclusions

References

20: Rhinological Complications: Avoidance and Management

Perioperative Rhinological Management

Immediate Rhinological Complications

Vascular Perioperative Complications

Intraoperative Unplanned Cerebrospinal Fluid Leak

Nasal Vestibule Burns

Immediate Postoperative Cerebrospinal Fluid Leak

Postoperative Rhinological Management

Delayed Rhinological Complications

Crusting

Synechiae

Postoperative Sinusitis

Acute Rhinosinusitis

Chronic Rhinosinusitis

Olfaction Loss

Conclusion

References

21: Medical Management for Pituitary Adenoma Patients

Introduction

Background Physiology

Hypopituitarism

Background and Diagnosis

Medical Treatment of Hypopituitary Patients

Functional Pituitary Tumors: Background and Diagnosis

Prolactinoma

Medical Therapy for Cushing’s Disease

Introduction

Steroidogenesis Inhibitors: General Principles

Ketoconazole

Metyrapone

Mitotane

Etomidate

Cabergoline

Pasireotide

Glucocorticoid Receptor Antagonists (Mifepristone)

Combination Therapy

Medical Therapy of Acromegaly

Cabergoline Therapy in Acromegaly

Pegvisomant

Somatostatin Receptor Ligands

Combination Medical Therapy in Acromegaly

TSH-Secreting Pituitary Adenoma

Conclusion

References

22: Transsphenoidal Surgery for Recurrent Pituitary Disease

Introduction

Recurrent Disease

Indications for Repeat Surgery

Preoperative Management

Intraoperative Preparation and Positioning

Transsphenoidal Access

Endoscopic Approaches

Sphenoid Sinus Exploration

Sellar Phase

Tumor Removal

Image Guidance

Reconstruction and Closure

Postoperative Care

Complications

Outcomes

Summary

References

23: Transsphenoidal Surgery for Craniopharyngiomas

Introduction

Treatment Strategy and the Endoscopic Endonasal Transsphenoidal Approach

Preoperative Evaluation and Imaging Findings

Craniopharyngioma Classification and Preoperative Planning

Endoscopic Endonasal Transsphenoidal Surgical Technique for Craniopharyngiomas

Preparation and Positioning

Nasal and Sinus Exposure

Skull Base Exposure and Tumor Resection

Type I: Preinfundibular Craniopharyngiomas

Type II: Transinfundibular Craniopharyngiomas

Type III: Retroinfundibular Craniopharyngiomas

Reconstruction

Major Intraoperative Complication Avoidance and Management

Postoperative Care

References

24: Transsphenoidal Surgery for Cushing’s Disease

Preoperative Evaluation

Decision for Surgery

Surgical Indications

Preoperative Difficulties for Cushing’s Disease

Surgical Techniques

Endoscopic Versus Microscopic

Post-op

References

25: Transsphenoidal Surgery for Acromegaly

Introduction

Diagnostic Aspects

Surgical Considerations

Postoperative Management and Outcomes

Complication Avoidance in Endoscopic Pituitary Surgery

Conclusions

References

26: Transsphenoidal Surgery for Prolactinomas

Introduction

Interpreting Failure and Limitations of Medical Management

Prognostic Factors for Surgical Treatment

Assessing Postoperative Remission

Surgical Morbidity and Mortality

Consideration of Surgery as Primary Treatment Modality

Summary

References

27: Transsphenoidal Surgery for Nonfunctioning Pituitary Adenomas

Background

Preoperative Evaluation

Nonsurgical Options

Surgery

Postoperative Complications

Recurrence

Radiotherapy

Follow-Up

Conclusions

References

28: Pituitary Tumors in Pediatric Patients

Introduction

Transsphenoidal Surgery in Pediatric Patients

Pituitary Adenomas

Prolactinomas

Pediatric Cushing’s Disease

Growth Hormone Secreting Tumors

Craniopharyngioma

Complications from Transsphenoidal Surgery

Conclusions

References

29: Pituitary Apoplexy

Introduction

Epidemiology

Etiology and Pathophysiology

Precipitating Factors

Clinical Presentation

Headache

Endocrine Dysfunction

Visual Symptoms

Altered Consciousness

Other Findings

Differential Diagnosis

Radiologic Findings

Management

Operative Management

Is there a Role for Conservative Nonsurgical Management of Pituitary Apoplexy?

Pathology

Postoperative Care

Conclusions

References

30: Anatomical Approaches to Giant Pituitary Tumors

Introduction

Surgical Goals and Preoperative Planning

Challenges in Giant Pituitary Adenoma Resection

Management Strategy

Surgical Approaches

Microscopic and Endoscopic Endonasal Transsphenoidal Surgery

Open Transcranial Approaches

References

31: Postoperative Management of Patients Following Transsphenoidal Surgery

Introduction

Inpatient Considerations

Postoperative Steroids

Postoperative Hormone Testing

Sodium and Water Homeostasis

Imaging

Outpatient Considerations

Sinonasal Corridor

Visual Field Testing

Biochemical Follow-Up

References

32: Stereotactic Radiosurgery for Pituitary Adenomas

Introduction

History

Treatment Strategy and Patient Selection

Pre-SRS Evaluation

Radiosurgical Technique and Planning

Stereotactic Frame Replacement

Radiographic Images

Treatment Planning and Dose Selection

Outcomes of Radiosurgery for Nonfunctioning Pituitary Adenomas

Outcomes of Radiosurgery for Functioning Pituitary Adenomas

Complications

Hypopituitarism and Hypothalamic Dysfunction

Cranial Neuropathy

Late Adverse Radiation Effects

Special Considerations and Debates

Comparison of External Beam Radiation Therapy (EBRT) Versus Radiosurgery for the Management of

Role of Upfront Radiosurgery

Various Histological Entities of Nonfunctioning Adenomas Versus the Efficacy of SRS

Various Histological Entities Refine the Treatment Strategy of Functioning Adenomas

The Apparent Radioresistant Effects of Antisecreting Medications

Whole-sellar SRS for MR Indeterminate Functioning Adenomas

Conclusions

Reference

33: Radiation Therapy for Pituitary Tumors

Introduction

Modalities of Radiation Therapy

Fractionation

Gamma Knife Radiosurgery

Linear Accelerator-Based Stereotactic Radiosurgery

Fractionated Radiation Therapy

CyberKnife

Proton Therapy

Nonfunctioning Adenomas

Functioning Adenomas

Corticotroph Adenomas (Cushing’s Disease, ACTH-Secreting Pituitary Adenomas)

Somatotroph Adenomas (Acromegaly, Growth Hormone-�Secreting Pituitary Adenoma)

Lactotroph Adenomas (Prolactinoma, Prolactin-Secreting Pituitary Adenoma)

Other Pituitary Adenomas

Radiation-Related Adverse Effects

Hypopituitarism

Visual Pathway Injury

Other Cranial Nerve Deficits

Secondary Tumors

Strokes

Conclusion

References

34: Cytotoxic Chemotherapy and Targeted Therapy for Aggressive Pituitary Tumors

Introduction

Cytotoxic Chemotherapy

Biomarkers Predictive of Response

Anti-angiogenic Therapy

Targeted Therapy

Indications for Chemotherapy

The Future of Chemotherapy for Pituitary Tumors

Conclusions

References

35: Quality of Life in Patients with Pituitary Adenomas

Introduction to Quality of Life

Quality of Life Scales Used in Transsphenoidal Surgery and Pituitary Tumors

General HRQoL Scales

Karnofsky Performance Scale

12-Item Short Form Health Survey and 36-Item Short Form Health Survey

Site- and Disease-Specific QOL Scales

Anterior Skull Base Questionnaire

Anterior Skull Base Nasal Inventory

Sino-Nasal Outcome Test

Acromegaly Quality of Life Questionnaire

Cushing Quality of Life Survey

Factors Affecting QOL in Patients with Pituitary Tumors

Nonsurgical Factors

Hypopituitarism

Morbidity and Efficacy of Medical Therapy

Surgical Factors

Expected Perioperative Quality of Life Alterations

Endoscopic Versus Microscopic Transsphenoidal Surgical Approach

Nasoseptal Flaps

Middle Turbinate Resection

Olfaction

Complications

Specific QOL Concerns in Patients with Functional Pituitary Adenomas

Summary and Future Directions

References

Index

 

An aparitie	2017
Autor	Laws, Jr
Dimensiuni	16.74 x 3.96 x 24.49 cm
Editura	Springer
Format	Hardcover
ISBN	9783319566894
Limba	Engleza
Nr pag	646