1
|
Chang YC, Tsao YN, Chuang CC, Li CY, Lee TJ, Fu CH, Wei KC, Huang CC. Risk Factors for Isolated Sphenoid Sinusitis after Endoscopic Endonasal Transsphenoidal Pituitary Surgery. Diagnostics (Basel) 2024; 14:758. [PMID: 38611671 PMCID: PMC11011803 DOI: 10.3390/diagnostics14070758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Transsphenoidal pituitary surgery can be conducted via microscopic or endoscopic approaches, and there has been a growing preference for the latter in recent years. However, the occurrence of rare complications such as postoperative sinusitis remains inadequately documented in the existing literature. (2) Methods: To address this gap, we conducted a comprehensive retrospective analysis of medical records spanning from 2018 to 2023, focusing on patients who underwent transsphenoidal surgery for pituitary neuroendocrine tumors (formerly called pituitary adenoma). Our study encompassed detailed evaluations of pituitary function and MRI imaging pre- and postsurgery, supplemented by transnasal endoscopic follow-up assessments at the otolaryngology outpatient department. Risk factors for sinusitis were compared using univariate and multivariate logistic regression analyses. (3) Results: Out of the 203 patients included in our analysis, a subset of 17 individuals developed isolated sphenoid sinusitis within three months postoperation. Further scrutiny of the data revealed significant associations between certain factors and the occurrence of postoperative sphenoid sinusitis. Specifically, the classification of the primary tumor emerged as a notable risk factor, with patients exhibiting nonfunctioning pituitary neuroendocrine tumors with 3.71 times the odds of developing sinusitis compared to other tumor types. Additionally, postoperative cortisol levels demonstrated a significant inverse relationship, with lower cortisol levels correlating with an increased risk of sphenoid sinusitis postsurgery. (4) Conclusions: In conclusion, our findings underscore the importance of considering tumor classification and postoperative cortisol levels as potential predictors of postoperative sinusitis in patients undergoing transsphenoidal endoscopic pituitary surgery. These insights offer valuable guidance for clinicians in identifying at-risk individuals and implementing tailored preventive and management strategies to mitigate the occurrence and impact of sinusitis complications in this patient population.
Collapse
Affiliation(s)
- Yun-Chen Chang
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan; (Y.-C.C.); (Y.-N.T.); (T.-J.L.); (C.-H.F.)
| | - Yu-Ning Tsao
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan; (Y.-C.C.); (Y.-N.T.); (T.-J.L.); (C.-H.F.)
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan (C.-Y.L.)
| | - Cheng-Yu Li
- Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan (C.-Y.L.)
| | - Ta-Jen Lee
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan; (Y.-C.C.); (Y.-N.T.); (T.-J.L.); (C.-H.F.)
- Department of Otolaryngology-Head and Neck Surgery, Xiamen Chang Gung Hospital, Xiamen 361028, China
| | - Chia-Hsiang Fu
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan; (Y.-C.C.); (Y.-N.T.); (T.-J.L.); (C.-H.F.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan District, Taoyuan City 333, Taiwan
| | - Kuo-Chen Wei
- Department of Neurosurgery, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), No. 6, Sec. 2, Jincheng Rd., Tucheng Dist., New Taipei City 236, Taiwan;
| | - Chi-Che Huang
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan; (Y.-C.C.); (Y.-N.T.); (T.-J.L.); (C.-H.F.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan District, Taoyuan City 333, Taiwan
| |
Collapse
|
2
|
Sumislawski P, Piotrowska M, Regelsberger J, Flitsch J, Rotermund R. Sphenoid Sinus Mucosal Flap after Transsphenoidal Surgery-A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:282. [PMID: 38399569 PMCID: PMC10890001 DOI: 10.3390/medicina60020282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Skull base reconstruction is a crucial step during transsphenoidal surgery. Sphenoid mucosa is a mucosal membrane located in the sphenoid sinus. Preservation and lateral shifting of sphenoid mucosa as sphenoid mucosal flap (SMF) during the transsphenoidal exposure of the sella may be important for later closure. This is the first systematic review to evaluate the utility of sphenoid mucosal flap for sellar reconstruction after transsphenoidal surgery. Materials and Methods: A systematic literature search was performed in January 2023: Cochrane, EMBASE, PubMed, Scopus, and Web of Science. The following keywords and their combinations were used: "sphenoid mucosa", "sphenoid sinus mucosa", "sphenoid mucosal flap", "sphenoid sinus mucosal flap". From a total number of 749 records, 10 articles involving 1671 patients were included in our systematic review. Results: Sphenoid sinus mucosa used to be applied for sellar reconstruction as either a vascularized pedicled flap or as a free flap. Three different types of mucosal flaps, an intersinus septal flap, a superiorly based flap and an inferiorly based flap, were described in the literature. Total SMF covering compared to partial or no SMF covering in sellar floor reconstruction resulted in fewer postoperative CSF leaks (p = 0.008) and a shorter duration of the postoperative lumbar drain (p = 0.003), if applied. Total or partial SMF resulted in fewer local complications (p = 0.012), such as fat graft necrosis, bone graft necrosis, sinusitis or fungal infection, in contrast to no SMF implementation. Conclusions: SMF seems to be an effective technique for skull base reconstruction after transsphenoidal surgery, as it can reduce the usage of avascular grafts such as fat along with the incidence of local complications, such as fat graft necrosis, bone graft necrosis, sinusitis and fungal infection, or it may improve the sinonasal quality of life by maintaining favorable wound healing through vascular flap and promote the normalization of the sphenoid sinus posterior wall. Further clinical studies evaluating sphenoid mucosal flap preservation and application in combination with other techniques, particularly for higher-grade CSF leaks, are required.
Collapse
Affiliation(s)
- Piotr Sumislawski
- Department of Neurosurgery, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany;
| | - Martyna Piotrowska
- Faculty of Medicine and Dentistry, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Jan Regelsberger
- Department of Neurosurgery, Diako Krankenhaus Flensburg, 24939 Flensburg, Germany;
| | - Jörg Flitsch
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany;
| | - Roman Rotermund
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany;
| |
Collapse
|
3
|
Aibar-Durán JÁ, Oladotun-Anka M, Asencio-Cortés C, Valassi E, Webb S, Gras-Cabrerizo JR, Monserrat-Gili J, Ribó PT, Muñoz-Hernández F. Complication Rates after Endoscopic Transsphenoidal Surgery for ACTH-Secreting Pituitary Adenomas: A Comparative Analysis with GH and Nonfunctioning Adenomas. Skull Base Surg 2022; 83:e274-e283. [DOI: 10.1055/s-0041-1725029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
Abstract
Objectives Some complications have been more frequently reported after surgery for adrenocorticotropin hormone (ACTH)-secreting pituitary adenomas. We compared complication rates in patients with ACTH-secreting pituitary adenomas with those in patients with growth hormone secreting pituitary adenomas (growth hormone [GH] group) and nonfunctioning adenomas (nonfunctioning group).
Design A comparative three-group analysis was performed for all patients who had endoscopic transsphenoidal surgery for pituitary adenomas at our center between January 2011 and May 2019. Variables included demographics, preoperative clinical and radiological characteristics, and postoperative radiological and endocrinological outcomes. Complications were divided into four categories: endocrinological, neurosurgical, medical, and ENT (ear–nose–throat)-related complications. Univariate and multivariate statistical analysis were performed.
Results A total of 111 patients with pituitary adenomas and a mean age of 53.7 years were included (25 ACTH, 35 GH, and 51 nonfunctioning adenomas). Overall, 28 patients had microadenomas (25.2%) and 83 had macroadenomas (74.8%). Univariate statistical analysis for complications between groups showed no differences in neurosurgical and medical complications. Transient diabetes insipidus and postsurgical bacterial sinusitis were the only variables more frequently seen in the ACTH group (p = 0.01 and 0.04, respectively). Multivariate analysis for transient diabetes insipidus showed no differences between groups (p = 0.58).
Conclusion Complication rates were similar in all three adenoma groups, particularly concerning major infections, thrombotic events, postoperative cerebrospinal fluid (CSF) leak, and transient diabetes insipidus. Transient diabetes insipidus was related with adenoma size and intraoperative CSF leak. Despite postoperative bacterial sinusitis was statistically higher in the ACTH group, this data should be interpreted with caution given the low number of patients with this complication.
Collapse
Affiliation(s)
- Juan Á. Aibar-Durán
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain
| | - Michael Oladotun-Anka
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain
| | - Carlos Asencio-Cortés
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain
| | - Elena Valassi
- Department of Endocrinology, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain
- Sant Pau Research Institut, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain
| | - Susan Webb
- Department of Endocrinology, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain
- Sant Pau Research Institut, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain
| | - Juan R. Gras-Cabrerizo
- Department of ENT Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain
| | - Joan Monserrat-Gili
- Department of ENT Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain
| | - Pere Tresserras Ribó
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain
| | - Fernando Muñoz-Hernández
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain), Autonomous University of Barcelona (AUB), Barcelona, Spain
| |
Collapse
|
4
|
Chung HJ, Lee H, Oh J, Chang JH. Isolated Fungal Sphenoid Sinusitis After Endonasal Transsphenoidal Approach. EAR, NOSE & THROAT JOURNAL 2020; 101:NP238-NP239. [PMID: 32965127 DOI: 10.1177/0145561320961205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hyo Jin Chung
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Hoyoung Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jangwon Oh
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Jung Hyun Chang
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| |
Collapse
|
5
|
Janakiram TN, Karunasagar A. Sphenoid Mucocele: A Complication of Skull Base Reconstruction with Nasoseptal Flap-A Critical Review and Our Experience. Indian J Otolaryngol Head Neck Surg 2019; 71:2151-2156. [PMID: 31763313 DOI: 10.1007/s12070-019-01713-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/11/2019] [Indexed: 11/26/2022] Open
Abstract
The evolution of expanded endoscopic skull base surgery has enabled development of minimally invasive approaches for resection of large skull base tumors with the nasoseptal flap proving to be an indispensable tool in skull base reconstruction. We here present our experience of sphenoid mucocele development after skull base reconstruction with the nasoseptal flap along with a comprehensive review of the limited literature on the same. With the expanding scope of endoscopic skull base surgery, the nasoseptal flap is increasingly being used for reconstruction. Despite adherence to standard recommendations and use of meticulous technique during flap placement, the potential risk of mucocele formation under the flap should always be borne in mind. In our experience, displacement of the flap pedicle could lead to ostial obstruction and mucocele formation. Hence, in addition to meticulous technique, a close follow up of such patients via nasal endoscopy or imaging is important to further our knowledge and understanding of the long-term effects and complications of this flap.
Collapse
Affiliation(s)
- T N Janakiram
- Department of Otorhinolaryngology and Skull Base Surgery, Royal Pearl Hospital, Tiruchchirappalli, Tamil Nadu India
| | - Abhilasha Karunasagar
- 2Department of Otorhinolaryngology and Head and Neck Surgery, Sri Devaraj Urs Medical College, Kolar, Karnataka India
| |
Collapse
|
6
|
Sphenoid Sinus Mucocele Caused by Complications After Transsphenoidal Pituitary Surgery. J Craniofac Surg 2018; 29:1859-1861. [PMID: 29944560 DOI: 10.1097/scs.0000000000004693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to review the clinical characteristics, treatment methods, and surgical outcomes of sphenoid sinus mucocele after transsphenoidal pituitary surgery. PATIENTS AND METHODS A total of 404 patients who underwent transsphenoidal pituitary surgery between January 2010 and December 2016 were identified. Among them, 5 patients with sphenoid sinus mucocele were included in this study. In our hospital, a single-nostril endonasal endoscopic wide sphenoidotomy is routinely used for pituitary tumor surgery. RESULTS The occurrence rate of sphenoid sinus mucocele was 1.2% (5/404). Of the 5 patients, 2 were males and 3 were females. Four lesions (80.0%) were located in the right sphenoid sinus and 1 lesion (20.0%) was located in the left sphenoid sinus. Endoscopic marsupialization for sphenoid sinus mucocele was performed under local anesthesia in all patients. There were no major complications resulting from the surgical intervention, and there was no recurrence at the time of the last follow-up. CONCLUSION Sphenoid sinus mucocele after endonasal transsphenoidal pituitary surgery is an extremely rare complication. Nasal endoscopy and MRI are useful for diagnosing this lesion. Endoscopic marsupialization is a safe and effective procedure for sphenoid sinus mucocele after endonasal transsphenoidal pituitary surgery.
Collapse
|
7
|
Is Coincidental Rhinosinusitis a Predisposing Factor for Postoperative Central Nervous System Infection After Endoscopic Endonasal Transsphenoidal Surgery? J Craniofac Surg 2018; 29:e319-e322. [PMID: 29485571 DOI: 10.1097/scs.0000000000004443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To investigate the effect of rhinosinusitis in patients who undergo surgery via the endoscopic endonasal transsphenoidal approach (EETSA). METHODS The authors retrospectively reviewed the medical records of patients who underwent surgery via the EETSA between February 2009 and November 2016. In total, 505 patients were included in the study. Preoperative paranasal sinus computed tomography, sellar magnetic resonance imaging, and nasal endoscopy were performed for all the patients. RESULTS Fifteen patients without sphenoid sinusitis underwent surgery with the concomitant transsphenoidal approach and functional endoscopic sinus surgery, and showed no central nervous system (CNS) complication. During surgery via the EETSA, the presence of rhinosinusitis did not significantly affect the incidence of postoperative CNS infection (P = 0.051), except for sphenoid sinusitis (P = 0.003). Conversely, the incidence of postoperative CNS infection was not related significantly to the Lund-Mackay score or tumor size. The risk of CNS infection was 12.151-fold higher in patients with sphenoid sinusitis (95% confidence interval, 3.153-46.827; P ≤ 0.001). CONCLUSION Surgery via the EETSA and functional endoscopic sinus surgery can be safely performed together in most patients with rhinosinusitis. However, sphenoid sinus infection appears to be a predisposing factor for postoperative CNS infection. Therefore, a separate surgical procedure for sphenoid lesions should be considered in these patients before the use of the EETSA.
Collapse
|
8
|
Li Z, Yang C, Bao X, Yao Y, Feng M, Deng K, Liu X, Xing B, Wang R. Clinical Features and Treatment of Secondary Pituitary Abscess After Transsphenoidal Surgery: A Retrospective Study of 23 Cases. World Neurosurg 2018; 113:e138-e145. [DOI: 10.1016/j.wneu.2018.01.197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/27/2018] [Accepted: 01/29/2018] [Indexed: 01/26/2023]
|
9
|
Cossu G, Daniel RT, Francois P, Destrieux C, Messerer M. Sphenoid Mucocele with Intracranial Extension: An Anatomic Perspective. World Neurosurg 2018; 113:40-46. [PMID: 29438786 DOI: 10.1016/j.wneu.2018.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Isolated sphenoid mucoceles are rare, but because of their close proximity to important vasculonervous structures, local extension may result in serious consequences. CASE DESCRIPTION A 47-year-old patient presented with headaches, meningismus, and a left homonymous lateral hemianopia. We report the atypical evolution of a posttraumatic sphenoid mucocele invading the sellar region and extending into the subarachnoid space with compression of the right optic tract, and we describe its surgical management. Further, with the aid of cadaveric specimens, we aim to analyze the precise pathway followed by the expanding collection from an anatomic perspective. CONCLUSIONS Anatomic knowledge of the sellar and parasellar regions is the key to understand the process of how sphenoid mucoceles may extend intracranially. Early endoscopic drainage with a large sphenoidotomy allows favorable outcomes and prevents serious consequences.
Collapse
Affiliation(s)
- Giulia Cossu
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland; Department of Neurosurgery, CHRU de Tours, Tours, France.
| | - Roy T Daniel
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Christophe Destrieux
- Department of Neurosurgery, CHRU de Tours, Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Mahmoud Messerer
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
| |
Collapse
|
10
|
Alzhrani G, Sivakumar W, Park MS, Taussky P, Couldwell WT. Delayed Complications After Transsphenoidal Surgery for Pituitary Adenomas. World Neurosurg 2018; 109:233-241. [DOI: 10.1016/j.wneu.2017.09.192] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
|
11
|
Ismail M, Fares AA, Abdelhak B, D'Haens J, Michel O. Sellar reconstruction without intrasellar packing after endoscopic surgery of pituitary macroadenomas is better than its reputation. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2016; 14:Doc07. [PMID: 27408609 PMCID: PMC4928027 DOI: 10.3205/000234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 04/22/2016] [Indexed: 11/30/2022]
Abstract
Objectives: Sellar reconstruction with intrasellar packing following endoscopic resection of pituitary macroadenomas remains a subject of clinical and radiological discussion particularly, when an intraoperative cerebrospinal fluid (CSF) leakage is absent. This study was conducted to contribute our experience with sellar reconstruction after a standard endoscopic surgery of pituitary macroadenomas without intraoperative CSF leakage to the ongoing discussion between techniques with and without intrasellar packing. Methods: A consecutive series of 47 pituitary macroadenomas undergoing excision via a standard endoscopic endonasal transsphenoidal surgery (EETS) without evident intraoperative CSF leakage were retrospectively evaluated over a 10-months mean follow-up period. According to the sellar reconstruction technique, three groups could be identified: Group A – with no intrasellar packing, Group B – with haemostatic materials packing, and Group C – with abdominal fat packing. Postoperative clinical and radiological assessments of the three groups were documented and analyzed for differences in outcome. Results: Postoperative clinical assessment did not differ significantly between the three groups. In group A, postoperative CSF leakage, sphenoid sinusitis and empty sella syndrome were not observed. However, a significant difference in radiological assessment could be identified; the interpretation of sellar contents in postoperative MRI of group A succeeded earlier and more reliably than in other groups with intrasellar packing. Conclusions: There is no difference in the incidence of postoperative CSF leakage and empty sella syndrome among the various reconstructive techniques with and without intrasellar packing, irrespective of size and extension of the pituitary adenoma. Sellar reconstruction without intrasellar packing following a standard EETS is not inferior to other techniques with packing and even shows more radiological advantages, which made it our preferred technique, at least if no intraoperative CSF leakage is evident.
Collapse
Affiliation(s)
- Mostafa Ismail
- Department of Otorhinolaryngology, University Hospital Brussels, Vrije Universiteit Brussels, Brussels, Belgium; Department of Otorhinolaryngology, Minia University Hospital, Minia University, Minya, Egypt
| | - Abd Alla Fares
- Department of Radiology, University Hospital Brussels, Vrije Universiteit Brussels, Brussels, Belgium
| | - Balegh Abdelhak
- Department of Otorhinolaryngology, Minia University Hospital, Minia University, Minya, Egypt
| | - Jean D'Haens
- Department of Neurosurgery, University Hospital Brussels, Vrije Universiteit Brussels, Brussels, Belgium
| | - Olaf Michel
- Department of Otorhinolaryngology, University Hospital Brussels, Vrije Universiteit Brussels, Brussels, Belgium
| |
Collapse
|
12
|
Matsuo S, Matsumoto K. Free Air in the Cavernous Sinus Secondary to Acute Isolated Sphenoid Sinusitis. NMC Case Rep J 2016; 3:49-51. [PMID: 28663997 PMCID: PMC5386151 DOI: 10.2176/nmccrj.cr.2015-0260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 11/16/2015] [Indexed: 11/20/2022] Open
Abstract
Pneumocephalus is a rare but important complication of acute isolated sphenoid sinusitis (ISS). If not adequately treated, it may cause serious neurological and life-threatening complications. We report the presence of free air in the cavernous sinus arising from intracranial extension of acute ISS. A 41-year-old healthy man presented to our department with a 7-day history of headache. Neurological examination revealed no meningitis, and cerebrospinal fluid culture was negative. A head computed tomography (CT) and magnetic resonance imaging on admission revealed sinusitis in the sphenoid sinus and presence of air in the cavernous sinus. We started an antibiotic treatment and the patient’s fever immediately decreased and the inflammatory response improved. In addition, the bilateral retro-orbital headache diminished. A repeated head CT scan revealed that fluid retention in the sphenoid sinus and air in the cavernous sinus had disappeared. To our knowledge, this is the fifth case of pneumocephalus accompanied by acute ISS reported in the literature and the first case report of intracranial air located only in the cavernous sinus. Meningitis accompanied by pneumocephalus can be a warning sign for poor outcome in patients with ISS.
Collapse
Affiliation(s)
- Satoshi Matsuo
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka; Fukuoka
| | - Kenichi Matsumoto
- Department of Neurosurgery, Saga-Ken Medical Centre Koseikan, Saga, Saga
| |
Collapse
|
13
|
Smith TR, Hulou MM, Huang KT, Nery B, de Moura SM, Cote DJ, Laws ER. Complications after transsphenoidal surgery for patients with Cushing's disease and silent corticotroph adenomas. Neurosurg Focus 2015; 38:E12. [PMID: 25639314 DOI: 10.3171/2014.10.focus14705] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The purpose of this study was to describe complications associated with the endonasal, transsphenoidal approach for the treatment of adrenocorticotropic hormone (ACTH)-positive staining tumors (Cushing's disease [CD] and silent corticotroph adenomas [SCAs]) performed by 1 surgeon at a high-volume academic medical center. METHODS Medical records from Brigham and Women's Hospital were retrospectively reviewed. Selected for study were 82 patients with CD who during April 2008-April 2014 had consecutively undergone transsphenoidal resection or who had subsequent pathological confirmation of ACTH-positive tumor staining. In addition to demographic, patient, tumor, and surgery characteristics, complications were evaluated. Complications of interest included syndrome of inappropriate antidiuretic hormone secretion, diabetes insipidus (DI), CSF leakage, carotid artery injury, epistaxis, meningitis, and vision changes. RESULTS Of the 82 patients, 68 (82.9%) had CD and 14 (17.1%) had SCAs; 55 patients were female and 27 were male. Most common (n = 62 patients, 82.7%) were microadenomas, followed by macroadenomas (n = 13, 14.7%). A total of 31 (37.8%) patients underwent reoperation. Median follow-up time was 12.0 months (range 3-69 months). The most common diagnosis was ACTH-secreting (n = 68, 82.9%), followed by silent tumors/adenomas (n = 14, 17.1%). ACTH hyperplasia was found in 8 patients (9.8%). Of the 74 patients who had verified tumors, 12 (16.2%) had tumors with atypical features. The overall (CD and SCA) rate of minor complications was 35.4%; the rate of major complications was 8.5% (n = 7). All permanent morbidity was associated with DI (n = 5, 6.1%). In 16 CD patients (23.5%), transient DI developed. Transient DI was more likely to develop in CD patients who had undergone a second operation (37.9%) than in those who had undergone a first operation only (12.8%, p < 0.05). Permanent DI developed in 4 CD patients (5.9%) and 1 SCA patient (7.1%). For 1 CD patient, intraoperative carotid artery injury required endovascular sacrifice of the injured artery, but the patient remained neurologically intact. For another CD patient, aseptic meningitis developed and was treated effectively with corticosteroids. One CD patient experienced major postoperative epistaxis requiring another operative procedure to achieve hemostasis. For 2 CD patients, development of sinus mucoceles was managed conservatively. For 1 SCA patient, an abdominal wound dehisced at the fat graft site. No patients experienced postoperative CSF leakage, visual impairment, or deep vein thrombosis. CONCLUSIONS Transsphenoidal surgery is the treatment of choice for patients with CD and other ACTH-positive staining tumors. Recent advances in endoscopic technology and increasing surgeon comfort with this technology are making transsphenoidal procedures safer, faster, and more effective. Serious complications are uncommon and can be managed successfully.
Collapse
Affiliation(s)
- Timothy R Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | | | | | | |
Collapse
|
14
|
Wang L, Yao Y, Feng F, Deng K, Lian W, Li G, Wang R, Xing B. Pituitary abscess following transsphenoidal surgery: the experience of 12 cases from a single institution. Clin Neurol Neurosurg 2014; 124:66-71. [PMID: 25019455 DOI: 10.1016/j.clineuro.2014.06.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 06/20/2014] [Accepted: 06/22/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore possible reasons for the incidence of a pituitary abscess following transsphenoidal surgery and determine the most effective treatment. METHODS A series of 12 patients who had undergone transsphenoidal surgery in other hospitals before being treated at Peking Union Medical College Hospital were reviewed. The presence of a pituitary abscess was confirmed when pus was intraoperatively observed within the sella turcica. All patients were treated with debridement of the abscess, nine among whom through a transsphenoidal approach and the other three via a craniotomy, followed by antibiotic treatment and hormone replacement therapy. The mean follow-up time was 27.0 months (range from 3.0 to 79.0 months). RESULTS Headache (92%), panhypopituitarism (58%) and visual disturbance (50%) were the most common clinical indicators of a pituitary abscess. Imaging tests demonstrated a pituitary mass in all patients, with seven (58%) manifested with typical magnetic resonance features of an abscess. Ten patients (83%) were correctly diagnosed preoperatively. During surgical exploration, six presented with severe inflammation or an abscess within the sphenoidal sinus. Causative organisms were identified in five patients (42%). After surgical and antibiotic therapies, all patients fully recovered except for two presenting with severe visual impairment. Six patients (50%) required hormone replacement therapy. CONCLUSION Retrograde infection from the sphenoid sinus may be a vital mechanism underlying the formation of a pituitary abscess following transsphenoidal surgery. Debridement of the abscess through surgical approaches combined with antibiotic treatment has been found to yield positive outcomes.
Collapse
Affiliation(s)
- Lei Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; Peking University Wu-Jieping Urology Center, Peking University Shougang Hospital, Peking University Health Science Center, Beijing 100144, China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Kan Deng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wei Lian
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Guilin Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| |
Collapse
|
15
|
Hsu YW, Ho CY, Yen YS. Reconstructed bone chip detachment is a risk factor for sinusitis after transsphenoidal surgery. Laryngoscope 2013; 124:57-61. [PMID: 24375023 DOI: 10.1002/lary.23964] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/06/2012] [Accepted: 12/06/2012] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Sphenoid sinusitis is a complication associated with endoscopic transsphenoidal pituitary surgery. Studies that address the relationship between methods of sellar defect reconstruction and postoperative sinusitis are rare. The purpose of this study was to investigate the incidence, the possible risk factors, and the causative pathogens of sphenoid sinusitis after endoscopic transsphenoidal pituitary surgery. STUDY DESIGN Prospective cohort study. METHODS We performed a prospective analysis of 182 patients with benign pituitary tumor who underwent endoscopic transsphenoidal pituitary surgery and sellar defect reconstruction with bone chip, from July 2008 through July 2011. All patients were followed up with nasal endoscopy for at least 6 weeks. RESULTS Fifty-seven (31.3%) patients developed postoperative sphenoid sinusitis. Comparing the sinusitis and nonsinusitis groups, we found that bone chip detachment was a significant risk factor for postoperative sinusitis, with a relative risk of 2.86 (64.1% vs. 22.4%). The most common pathogens present in cases of postoperative sinusitis were methicillin-sensitive Staphylococcus aureus, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus. CONCLUSIONS Regular follow-up with nasal endoscopy can prevent delayed diagnosis of postoperative sphenoid sinusitis. Culture-directed antibiotics with aggressive endoscopic debridement are an effective treatment for these patients. An optimal reconstruction strategy should be further developed to reduce bone chip detachment and secondary sinusitis.
Collapse
Affiliation(s)
- Yao-Wen Hsu
- Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan
| | | | | |
Collapse
|
16
|
Tang IP, Chai CK, Kumar G, Prepageran N, Waran V. Intrasellar pituitary mucocele: diagnostic dilemma. Br J Neurosurg 2013; 28:390-2. [PMID: 23875880 DOI: 10.3109/02688697.2013.817535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Isolated intrasellar pituitary mucocele following transsphenoidal sinus surgery is extremely rare. The clinical features resemble a pituitary tumor, therefore careful radiological interpretation is crucial to reach the correct diagnosis. We report a case of intrasellar mucocele who had transsphenoidal sinus surgery performed 15 years prior.
Collapse
Affiliation(s)
- Ing Ping Tang
- Department of ORL-HNS, Faculty of Medicine, University Malaysia Sarawak , Sarawak , Malaysia
| | | | | | | | | |
Collapse
|
17
|
Pituitary abscess following expanding sphenoid sinus pyocele: complication of endoscopic endonasal transsphenoidal surgery. Clin Neurol Neurosurg 2013; 115:1502-5. [PMID: 23312616 DOI: 10.1016/j.clineuro.2012.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 07/28/2012] [Accepted: 11/25/2012] [Indexed: 11/21/2022]
|
18
|
Little AS, Jahnke H, Nakaji P, Milligan J, Chapple K, White WL. The anterior skull base nasal inventory (ASK nasal inventory): a clinical tool for evaluating rhinological outcomes after endonasal surgery for pituitary and cranial base lesions. Pituitary 2012; 15:513-7. [PMID: 22038032 DOI: 10.1007/s11102-011-0358-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The goal of this project was to develop a prospectively-validated, site-specific patient quality of life survey for assessing nasal outcomes following endonasal pituitary and skull base surgery. (ClinicalTrials.gov #NCT01322945) An 9-item patient survey (the ASK Nasal Inventory) focusing on the most common postoperative complaints, such as crusting, sinusitis, pain, and ease of breathing, was developed by the anterior skull base team at the Barrow Neurological Institute. Content was validated in structured patient interviews and by four subject matter experts. This survey was self-administered before and 3 months after surgery to 94 patients (52 endonasal surgery and 42 controls) between October 2010 and June 2011. Standard methods for psychometric evaluation were applied. Cronbach's alpha was 0.83 indicating good internal consistency. Test-retest reliability was excellent in both groups (r = 0.87 and 0.95; P < 0.001). Discriminant validity was determined by comparing mean scores at 3 months in the endonasal and control groups and the difference was significant (13.5 vs. 17.2, P = 0.001). Standardized response mean was 0.17 suggesting that the scale was sensitive to clinical change. Concurrent validity was determined by mean ASK Nasal score for each level of self-reported overall functioning at 3 months (P = 0.001). Preliminary psychometric evaluation of the performance of the ASK Nasal Inventory suggests that it meets criteria as a clinical and research instrument in endonasal surgery. This study also suggests modifications to the instrument, which will serve as key quality of life endpoint in an ongoing multicenter nasal outcomes study.
Collapse
Affiliation(s)
- Andrew S Little
- Division of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, 2910 North 3rd Avenue, Phoenix, AZ 85013, USA.
| | | | | | | | | | | |
Collapse
|
19
|
Yadav Y, Sachdev S, Parihar V, Namdev H, Bhatele P. Endoscopic endonasal trans-sphenoid surgery of pituitary adenoma. J Neurosci Rural Pract 2012. [PMID: 23188987 PMCID: PMC3505326 DOI: 10.4103/0976-3147.102615] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Endoscopic endonasal trans-sphenoid surgery (EETS) is increasingly used for pituitary lesions. Pre-operative CT and MRI scans and peroperative endoscopic visualization can provide useful anatomical information. EETS is indicated in sellar, suprasellar, intraventricular, retro-infundibular, and invasive tumors. Recurrent and residual lesions, pituitary apoplexy and empty sella syndrome can be managed by EETS. Modern neuronavigation techniques, ultrasonic aspirators, ultrasonic bone curette can add to the safety. The binostril approach provides a wider working area. High definition camera is much superior to three-chip camera. Most of the recent reports favor EETS in terms of safety, quality of life and tumor resection, hospital stay, better endocrinological, and visual outcome as compared to the microscopic technique. Nasal symptoms, blood loss, operating time are less in EETS. Various naso-septal flaps and other techniques of CSF leak repair could help reduce complications. Complications can be further reduced after achieving the learning curve, good understanding of limitations with proper patient selection. Use of neuronavigation, proper post-operative care of endocrine function, establishing pituitary center of excellence and more focused residency and endoscopic fellowship training could improve results. The faster and safe transition from microscopic to EETS can be done by the team concept of neurosurgeon/otolaryngologist, attending hands on cadaveric dissection, practice on models, and observation of live surgeries. Conversion to a microscopic or endoscopic-assisted approach may be required in selected patients. Multi-modality treatment could be required in giant and invasive tumors. EETS appears to be a better surgical option in most pituitary adenoma.
Collapse
Affiliation(s)
- Yr Yadav
- Department of Neurosurgery and Radiodiagnosis NSCB Medical College and MP MRI Jabalpur, Madhya Pradesh, India
| | | | | | | | | |
Collapse
|
20
|
Mucocele formation under pedicled nasoseptal flap. Am J Otolaryngol 2012; 33:634-6. [PMID: 22771247 DOI: 10.1016/j.amjoto.2012.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/19/2012] [Indexed: 11/24/2022]
Abstract
The pedicled nasoseptal flap has become an indispensible tool for the reconstruction of skull base defects. This flap is easily harvested, provides a large surface area of vascularized tissue, and has few reported complications. We describe the case of a 60-year-old man who underwent endoscopic, endonasal transsphenoidal surgery with septal flap reconstruction who developed a sphenoid sinus mucocele postoperatively. We also have reviewed the literature for similar findings and discuss this complication in the setting of pituitary surgery and endoscopic skull base repair. Although likely a rare occurrence, mucocele formation after septal flap reconstruction should be recognized and monitored with postoperative nasal endoscopy and radiologic imaging. Reoperation or mucocele drainage may be necessary if symptomatic or in cases of rapid enlargement.
Collapse
|
21
|
Giordano M, Gerganov VM, Draf W, Fahlbusch R. Sphenoid sinus pyocele after transsphenoidal approach for pituitary adenoma. Pituitary 2012; 15:188-92. [PMID: 21442274 DOI: 10.1007/s11102-011-0305-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Transsphenoidal pituitary adenoma surgery is related to a low morbidity rate. The complications that can occur are classified as intra- and extracranial. The aim of the study is to discuss one group of these complications involving the sphenoid sinus: mucocele and its possible transformation into pyocele. We evaluate clinical presentation, management strategy and the outcome after long-term follow-up presenting an explicative case and a review of the literature. A patient presented to our outpatient clinic 8 months after transsphenoidal surgery for selective removal of a pituitary adenoma because of an acute onset of frontal headache during an airplane travel, fever and pulsating sensation in left eye and ear. MRI revealed a contrast-enhancing lesion in the left inferior portion of the sphenoid sinus. An endonasal endoscopic revision of the sphenoid sinus was performed. After opening of the scar to enter in the left sinus a pyocele was found and treated with drainage and marsupialisation. Development of sphenoid sinus pyocele is an extremely rare postoperative complication of transsphenoidal surgery. This lesion should be taken in consideration in patients presenting with retroorbital headache of acute onset and fever after pituitary surgery. Diagnosis can be suspected on the MRI studies and confirmed by a targeted flexible endoscope examination. Endoscopic drainage with wide opening of the sphenoid sinus and marsupialisation is the treatment of choice to avoid recurrences.
Collapse
Affiliation(s)
- Mario Giordano
- Department of Neurosurgery, International Neuroscience Institute, Rudolf-Pichlmayer-Straße. 4, 30625, Hannover, Germany.
| | | | | | | |
Collapse
|