Posts Tagged ‘transsphenoidal surgery’
Free Article: Pituitary Centers of Excellence
Pituitary tumors and associated neuroendocrine disorders pose significant challenges in diagnostic and therapeutic management. Optimal care of the “pituitary patient” is best provided in a multidisciplinary collaborative environment that includes not only experienced pituitary practitioners in neurosurgery and endocrinology, but also in otorhinolaryngological surgery, radiation oncology, medical oncology, neuro-ophthalmology, diagnostic and interventional neuroradiology, and neuropathology. We provide the background and rationale for recognizing pituitary centers of excellence and suggest a voluntary verification process, similar to that used by the American College of Surgeons for Trauma Center verification. Read the rest of this entry »
Free CME Article: Silent Corticotroph Adenomas
Background: Silent corticotroph adenomas (SCAs) are clinically nonfunctioning pituitary adenomas (NFPAs) with positive staining for corticotropin (ACTH) by immunohistochemistry. Whether SCAs behave more aggressively than NFPAs without ACTH immunoreactivity (ACTH negative) remains controversial.
Objective: To compare characteristics and outcomes of SCAs with ACTH-negative NFPAs and to identify predictors of aggressive outcome. Primary composite endpoint included the first of any of the following events: progression, recurrence, or death.
Methods: We reviewed all cases of SCAs and all ACTH-negative macroadenomas operated on between April 1995 and December 2007 by 1 neurosurgeon.
Free Editor Choice with CME: Transsphenoidal Surgery After Nondiagnostic IPSS
Background: Inferior petrosal sinus sampling (IPSS) is a useful technique for confirming a pituitary source of adrenocorticotropic hormone (ACTH) overproduction in Cushing disease. Uncertainty remains regarding the appropriate course of therapy when an ectopic tumor is predicted by IPSS but none can be found and in circumstances when the procedure cannot be successfully completed owing to technical or anatomic limitations.
Objective: To determine an appropriate course of action after nondiagnostic IPSS.
Methods: We reviewed 288 IPSS procedures in 283 patients between 1986 and 2010 at our center. An IPS:peripheral ACTH ratio ≥ 2 at baseline or ≥ 3 after corticotrophin-releasing hormone was considered predictive of a pituitary source of ACTH. A procedure was considered nondiagnostic if the procedure was successfully performed and the results predicted an ectopic source but none could be found despite extensive imaging or if the IPS could not be bilaterally cannulated because of technical difficulties or anatomic variants.
Ahead of Print: Silent Corticotroph Adenomas
Background: Silent corticotroph adenomas (SCA) are clinically non-functioning pituitary adenomas (NFPA) with positive staining for ACTH by immunohistochemistry. Whether SCA behave more aggressively than NFPA without ACTH-immunoreactivity (ACTH-negative) remains controversial.
Objective: To compare characteristics and outcomes of SCA with ACTH-negative NFPA and to identify predictors of aggressive outcome. Primary composite endpoint included the first of any of the following events: progression, recurrence, or death.
Methods: We reviewed all cases of SCA and all ACTH-negative macroadenomas operated between 4/1995-12/2007 by one neurosurgeon.
Ahead of Print: Optimal Surgical Approaches for Rathke Cleft Cyst with Consideration of Endocrine Function
Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.
BACKGROUND: Surgical indications for Rathke cleft cyst (RCC) are not clear.
OBJECTIVE: To evaluate postoperative outcomes in consideration of endocrine function.
METHODS: The study analyzed a total 73 patients who underwent transsphenoidal surgery (TSS). All patients underwent a visual field test, combined pituitary function test (CPFT), and magnetic resonance imaging (MRI) before and after surgery. A follow-up CPFT was performed at 1.5-year intervals.
