The authors performed three consecutive cases of stereotaxic radiofrequency hypophy-sectomies for patients with disseminated cancer from breast or prostate at Severance Hospital, Yonsei University. The procedures were essentially the same, in large part, as the technique first introduced by Zervas. The authors modified the-original technique to reduce the known risks of cerebrospinal fluid rhinorrhea and meningitis. Surgical details and clinical cases are presented.
Breast Neoplasms/surgery* ; Female ; Human ; Hypophysectomy/methods* ; Male ; Middle Age ; Prostatic Neoplasms/surgery* ; Radio Waves/therapeutic use* ; Stereotaxic Techniques*

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 clarify the frequency and presentation associated factors, pathogenetic mechanism, treatment and outcome of hyponatremia after surgery of pituitary adenoma.

METHODSRetrospectively reviewed the data of 186 patients who underwent pituitary surgery between January 1999 and June 2000 in the department.

RESULTS72 (38.7%, 72/186) patients had suffered post-operative hyponatremia. Among them, 43 (59.7%, 43/72) cases the hyponatremia appeared at 4 to 7 days postoperatively. 43 (59.7%, 43/72) cases presented with nausea, vomiting, headache, dizziness, confusion and weakness. The symptoms of hyponatremia was related to the age, tumor size and adenoma cell type, but not to the sex, surgical approach and degree of removal. Treatment consisted of salt replacement and mild fluid restriction in 4 patients and salt and fluid replacement in 68 patients. Hyponatremia had been resolved within 7 days in 63 patients.

CONCLUSIONSHyponatremia often appeared about 7 days after surgery of pituitary adenoma, especially in elderly and in patients with macroadenomas. The principle of treatment was salt and fluid replacement.

Adenoma ; surgery ; Adult ; Female ; Humans ; Hyponatremia ; etiology ; Hypophysectomy ; methods ; Male ; Middle Aged ; Pituitary Neoplasms ; surgery ; Postoperative Complications ; etiology ; Retrospective Studies

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

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

OBJECTIVETo clarify the frequency, presentation, associated factors, treatment and outcome of hyponatremia after transphenoidal surgery of pituitary adenomas.

METHODSRetrospectively reviewed the database of 183 patients who underwent transphenoidal surgery of pituitary adenoma between January 1999 and June 2000 in our department.

RESULTS38.8% (71/183) had postoperative hyponatremia. Among them, 59.2% (42/71) appeared on the 4th to 7th day postoperatively. 59.2% (42/71) presented with nausea, vomiting, headache, dizziness, confusion and weakness. Hyponatremia was related to age, tumor size and adenoma type, but not related to sex and degree of resection. Treatment consisted of salt replacement and mild fluid restriction in 4 patients and salt and fluid replacement in 67 patients. Hyponatremia resolved within 16 days in all the patients.

CONCLUSIONSHyponatremia often appeared about 7 days after transsphenoidal surgery of pituitary adenomas, especially in elderly and patients with macroadenomas and huge pituitary adenomas. The principle of treatment was salt and fluid replacement.

Adenoma ; pathology ; surgery ; Adult ; Age Factors ; Female ; Humans ; Hyponatremia ; etiology ; therapy ; Hypophysectomy ; methods ; Male ; Middle Aged ; Pituitary Neoplasms ; pathology ; surgery ; Postoperative Complications ; therapy ; Retrospective Studies

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

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 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