OBJECTIVETo describe the experience with surgical treatment of pituitary adenomas via a fully transnasal endoscopic approach.

METHODSClinical records of 375 cases with pituitary adenomas underwent pure endoscopic operations between December 2006 and December 2009 were carefully assembled. Among 375 pure endoscopic operations of pituitary adenomas, 201 cases were nonfunctional adenomas and 174 cases were functional adenomas. There were 27 giant pituitary adenomas (7.2%) and 41 pituitary adenoma invaded cavernous sinus (10.9%). Intraoperative 1.5 T MRI and neuro-navigation system were used during some operations. The postoperative and follow-up data of patients were analyzed.

RESULTSThere were 234 (79.3%) cases of total resection, 56 (19.0%) cases of subtotal resection, 5 (1.7%) cases of partial resection. Sixty-eight patients had vision improved in 73 patients with vision decreasing before operation. Sixty-eight (77.3%) patients got normal endocrine in 88 hyper-prolactin patient. Fifty-five (84.1%) patients got normal growth hormone in 63 patients with somatotrophinomas. Eighteen (78.2%) patients got normal in 23 patients with corticotrophinoma. These was no death case in this group. One case (0.3%) suffered post-operative coma. Transient decreasing of vision occurred in 2 cases (0.5%). Transient palsy of oculomotor nerve or abducens nerve occurred in 7 cases of operations involved cavernous sinus. Three (0.8%) patients had cerebral meningitis. Two patients (0.5%) suffered from cerebrospinal fluid leak but none underwent operation to repair. Fourteen patients (3.7%) had transient diabetes insipidus. Six patients (1.6%) had nose bleeding.

CONCLUSIONSTrans-nasal endoscopy provides a new device for operation of pituitary adenomas which is effective and safe. Comparing with microscope, endoscopic visual field is clearer, closer and wider.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Hypophysectomy ; methods ; Male ; Middle Aged ; Nose ; surgery ; Pituitary Neoplasms ; surgery ; Retrospective Studies ; Sphenoid Sinus ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVE: To recognize the causes, methods of prevention and cure of sinusitis complicated by endoscopic transnasal approach in surgical treatment of pituitary adenomas. METHOD: The data of 187 patients who underwent surgical treatments of pituitary adenomas through endoscopic transnasal approach were collected, and the surgical complications were analyzed. RESULT: Endoscopic transnasal transsphenoidal approach were used successfully in 187 cases, twelve cases (6.4%) were suffered from sinusitis complication after surgery. The most frequent sinusitis complication was sphenoiditis, 9 cases (4.8%) were suffered, 2 cases (1.1%) were suffered from ethmoidal sinusitis, 1 case (0.5%) was suffered from maxillary sinusitis. Ten cases were treated with correspond medication in clinic. Two cases were ineffective with expectant treatment, and cured by second endoscopic sinusitis operation at last. CONCLUSION Endoscopic transnasal transsphenoidal approach offered a simple and rapid access to the sella, and also, it is a safe, valuable and efficient procedure for removing pituitary adenomas. It was obviously that timely accurate diagnosis for the sinusitis complication and comprehensive perioperative management may lead to less incidence of postoperative sinusitis complication in surgical treatment of pituitary adenomas through endoscopic transnasal approach, increase the achievement rate and improve survival quality obviously.
Adult ; Aged ; Endoscopy ; Female ; Humans ; Hypophysectomy ; methods ; Male ; Middle Aged ; Nose ; surgery ; Pituitary Neoplasms ; surgery ; Postoperative Complications ; prevention & control ; Sinusitis ; prevention & control ; Sphenoid Sinus ; surgery ; Treatment Outcome

OBJECTIVETo analyze the transsphenoidal microsurgical results of non-invasive prolactinomas, in order to provide reference for their treatment choice.

METHODSTo review the transsphenoidal microsurgical results of 234 non-invasive prolactinomas treated in our department in recent 10 years, and to analyze the prognostic factors. There were 18 males and 216 females, aged between 13 and 58 years, averaged (31.1 +/- 8.5) years. The course ranged from half a month to 20 years, averaged (47.3 +/- 44.9) months. The preoperative serum PRL level ranged between 41 and 8406 ng/ml, averaged (400.5 +/- 888.0) ng/ml, with a median of 164.1 ng/ml. The primary symptoms were amenorrhea, galactorrhea and/or infertility in 211 cases. The tumor size was small (< 1 cm) in 100, large (> or = 1 cm) in 116 and giant (> or = 3 cm) in 18 cases. All the patients received transsphenoidal microsurgery and were followed-up for 12 to 132 months, averaged (43.8 +/- 35.0) months.

RESULTSThere was no mortality. One hundred and twenty-seven (54.3%) cases had transient postoperative imbalance of water and electrolytes. One hundred and eighty-eight cases (80.3%) were cured, 12 (5.1%) experienced clinical remission, 20 (8.5%) were improved, and 14 (6.0%) were ineffective. The male patient, the giant prolactinomas and those with higher preoperative serum PRL level had a relative poor postoperative prognosis. While the other factors had no influence on prognosis, including the course, preoperative bromocriptine intake, tumor texture, tumor apoplexy and intraoperative descending extent of the diaphragm of sella. The overall operative expense for transsphenoidal microsurgery ranged from 8323.8 to 22898.5 yuan, averaged (12912.0 +/- 2361.2) yuan.

CONCLUSIONSTranssphenoidal microsurgery may be chosen as the primary therapy for non-invasive prolactinomas, with the purposes of therapeutical efficacy, facilitating the patients, re-establishing the patients' self-confidence and reducing the overall expense.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Hypophysectomy ; methods ; Male ; Microsurgery ; Middle Aged ; Pituitary Neoplasms ; surgery ; Prolactinoma ; surgery ; Retrospective Studies ; Sphenoid Sinus ; surgery ; Treatment Outcome

Adolescent ; Adult ; Aged ; Cavernous Sinus ; injuries ; Female ; Humans ; Hypophysectomy ; adverse effects ; methods ; Intraoperative Complications ; Male ; Middle Aged ; Pituitary Neoplasms ; surgery ; Young Adult

OBJECTIVETo assess the clinical curative effect of the endonasal transsphenoidal approach for removing pituitary adenoma (PA) under neuroendoscope-assisted.

METHODSThere were 215 patients who had undergone neuroendoscopic transsphenoidal surgery. Each patient received CT or MRI examination which showed the size and surrounding structural of tumor.

RESULTSAmong the 215 patients, 190 cases (88.4%) had total removal, 17 cases (7.9%) achieved subtotal removal and the remaining 8 cases (3.7%) with fibrous tumor was carried out partial removal. Two patients (0.9%) died after operation. Postoperative follow-up period was 1 to 10 months (the average was 3.5 months). In 182 patients, 150 cases (90.9%) got vision recovered rapidly compared with their preoperative symptoms, such as diminished acuities and visual field defects, and 15 cases (9.1%) had gotten improvements to some extend among 165 who diagnosed as pituitary macroadenoma (PMaA); There were 17 patients who diagnosed as microadenoma (PMiA) showed that the pituitary dyshormonism recovered gradually.

CONCLUSIONSThe endonasal transsphenoidal surgery under the neuroendoscope-assisted appears to be a safe, effective and micro-invasive method for PA.

Adenoma ; surgery ; Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Hypophysectomy ; methods ; Male ; Middle Aged ; Nasal Cavity ; surgery ; Neuroendoscopy ; Pituitary Neoplasms ; surgery ; Retrospective Studies ; Sphenoid Sinus ; surgery ; Treatment Outcome

OBJECTIVETo evaluate the possibility of extended transsphenoidal approach for removing the giant and invasive pituitary adenomas.

METHODSThe clinical data of 64 cases with giant and invasive pituitary adenoma treated by extended transsphenoidal approach were studied retrospectively.

RESULTSAmong 64 patients, 51 had total resection and 13 had subtotal resection. 26 patients occurred transient diabetes insipidus, 5 patients with transient cerebrospinal rhinorrhoea and 1 patient occurred acute hypopituitarism postoperatively. There were no death or intracranial infection. After operation, 8 patients get radiotherapy, 6 patients receive medicine treatment. Postoperative follow-up period was 3 months to 6 years. No regrowth or recurrence was seen.

CONCLUSIONThe extended transsphenoidal approach has been proved to a safe and effective method to remove the giant and invasive pituitary adenomas. Patients who got subtotal resection need be close followed-up and receive radiotherapy or medicine treatment it necessary.

Adenoma ; pathology ; surgery ; Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Hypophysectomy ; methods ; Male ; Microsurgery ; Middle Aged ; Neoplasm Invasiveness ; Neuroendoscopy ; Pituitary Neoplasms ; pathology ; surgery ; Sphenoid Sinus ; surgery ; Treatment Outcome

OBJECTIVETo explore factors influencing the recurrence of patients with Cushing's disease after transsphenoidal surgery.

METHODSWe retrospectively analyzed the clinical data of 182 patients treated by transsphenoidal surgery with Cushing's disease in our department in PUMC Hospital from 1992 to 2002.

RESULTSThe recurrence rates were significantly different when patients had different radiological findings (P = 0.001), operative methods (P = 0.001), histological findings (P = 0.04), and postoperative cortisol levels (P = 0.02); however, such difference was not found in term of tumor size (P = 0.43).

CONCLUSIONRadiological findings, operative methods, histological findings, and postoperative cortisol estimates may be the factors influencing the recurrence of patients treated by transsphenoidal surgery.

Adenoma ; complications ; surgery ; Female ; Humans ; Hypophysectomy ; methods ; Male ; Pituitary ACTH Hypersecretion ; etiology ; surgery ; Pituitary Neoplasms ; complications ; surgery ; Recurrence ; Retrospective Studies

OBJECTIVE: To evaluate the outcome of gamma knife for prolactinomas. METHODS: Eighty-nine patients were treated by gamma knife and 51 were followed up. The dose to the tumor margin ranged from 18 Gy to 35 Gy (mean 26.1 Gy). The maximum radiation dose varied from 36 Gy to 60 Gy (mean 50.41 Gy). The mean tumor diameter was 15.5 mm (5 - 26 mm). RESULTS: The follow-up data were available for 51 patients ranging from 6 to 108 months (mean 37 months). The tumor growth control rate was 100%. The endocrinological remission rate was 40%. The rate of hypopituitarism was 17.6%. CONCLUSION Gamma knife radiosurgery can be used as a primary treatment for selected prolactinomas,especially for pituitary microadenomas.
Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Hypophysectomy ; methods ; Hypopituitarism ; etiology ; Male ; Middle Aged ; Pituitary Neoplasms ; surgery ; Prolactinoma ; surgery ; Radiosurgery ; adverse effects ; instrumentation ; Treatment Outcome

OBJECTIVETo assess the role of neuronavigation in assisting endoscopic transsphenoidal surgery for pituitary adenomas.

METHODSTen endoscopic endonasal transsphenoidal reoperations for pituitary adenomas were selected. Clinical records were reviewed retrospectively. Five of 10 patients had gigantic adenoma, 3 microadenoma, 2 large adenoma.

RESULTSThe mean setup time was 5 minutes, and the operative time was 50 minutes in image-guided procedures. In all cases, the system worked well without malfunction. Continuous information regarding instrument location and trajectory was provided to the surgeon. Measurements of intraoperative accuracy in the axial, coronal, and.sagittal planes indicated a mean verified system error of 1.5 mm. for pituitary adenomas. After operation, the symptoms relieved in all patients.

CONCLUSIONSNeuronavigation can be applied during endonasal transsphenoidal endoscopic surgery and requires a minimal amount of time. It makes reoperation easier, faster, and safer.

Adult ; Endoscopy ; Female ; Humans ; Hypophysectomy ; methods ; Male ; Middle Aged ; Pituitary Neoplasms ; surgery ; Retrospective Studies ; Sphenoid Sinus ; surgery ; Surgery, Computer-Assisted

OBJECTIVETo analyze the relationship between invasive pituitary adenomas and cavernus sinus and cariod artery and to predict their surgical outcomes.

METHODSTotally 270 patients with pituitary tumors were investigated in this retrospective study, including 113 men and 157 women, with a mean age of 40.8 years. The mean disease history was 3.6 years. Pituitary microadenomas were diagnosed in 56 cases, macroadenomas in 118 cases, and hugeadenomas in 96 cases. Adrenocorticotropic hormone-releasing adenomas (Cushing's diseases) were diagnosed in 40 cases, growth hormone-releasing adenomas in 58 cases, prolactinomas in 57 cases, and non-functional pituitary adenomas in 115 cases. Transsphenoidal microsurgery were performed on 260 patients, while transcranial microsurgery on 6 patients.

RESULTSThe percentage of invasive pituitary adenomas was about 3.6% in microadenomas, 20.4% in macroadenomas, and 61.4% in hugeadenomas. Rate of total removal was 94.1% in non-invasive pituitary adenomas, and was 58.8% in invasive pituitary adenomas.

CONCLUSIONSIt is important to analyze the grade of invasive pituitary adenomas to improve the removal of pituitary adenomas, avoid injuring cariod artery, and increase the rate of total removal.

Adenoma ; pathology ; surgery ; Adolescent ; Adult ; Aged ; Carotid Arteries ; pathology ; surgery ; Cavernous Sinus ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Hypophysectomy ; methods ; Magnetic Resonance Imaging ; Male ; Microsurgery ; Middle Aged ; Neoplasm Invasiveness ; Pituitary ACTH Hypersecretion ; pathology ; surgery ; Pituitary Neoplasms ; pathology ; surgery ; Radiotherapy, Adjuvant ; Retrospective Studies ; Treatment Outcome