Ahead of Print: Pure Endoscopic Transsphenoidal Surgery for Cushing’s Disease

Background: The efficacy of endoscopic transsphenoidal surgery (ETS) for Cushing’s Disease has not been clearly established.

Objective: To assess efficacy of a pure endoscopic approach for treatment of Cushing’s disease and determine predictors of remission.

Methods: A prospectively acquired database of 61 patients undergoing ETS was reviewed. Remission was defined as postoperative morning serum cortisol of <5 [mu]cg/dl or normal or decreased 24-hour UFC level in follow-up.

Ahead of Print: Embolization Intercavernous Transsphenoidal Cushing’s Disease

Background and Importance: Prominent intercavernous sinuses may result in vigorous bleeding during transsphenoidal resection of pituitary microadenomas and lead to incomplete or aborted tumor resection. We report the use of coil embolization of the intercavernous sinuses to prevent uncontrollable bleeding prior to reattempting transsphenoidal surgery.

Clinical Presentation: A 40-year-old man with Cushing’s disease underwent an attempt for transsphenoidal resection of an ACTH-producing pituitary microadenoma. This approach was aborted secondary to profuse intercavernous sinus bleeding. The patient underwent endovascular coil embolization of the anterior intercavernous sinuses with complete obliteration. Six weeks later he underwent successful transsphenoidal resection of the microadenoma.

Ahead of Print: Endoscopic Transsphenoidal Pituitary Surgery: Evidence of an Operative Learning Curve

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Paul Leach, FRCS, Ahmed A. Abou-Zeid, MD, Tara Kearney, MD, Julian Davis, PhD, Peter Trainer, PhD, Kanna K. Gnanalingham, PhD

BACKGROUND: The use of the fiberoptic endoscope is a recent innovation in pituitary surgery.

OBJECTIVE: To investigate the evidence of an operative learning curve after the introduction of endoscopic transsphenoidal surgery in our unit.

METHODS: The first 125 patients who underwent endoscopic transnasal transsphenoidal surgery for pituitary fossa lesions between 2005 and 2007 performed by 1 surgeon were studied. Changes in a number of parameters were assessed between 2 equal 15-month time periods: period 1 (53 patients) and period 2 (72 patients).

MDLinx Most Read Article: Intrasellar Ultrasound in Transsphenoidal Surgery: A Novel Technique

MDLinx, an online service that aggregates medical articles and research from more than 1,200 peer-reviewed journals and leading news media on a daily basis, currently lists the following article from Neurosurgery as its most read article in the field:

Intrasellar Ultrasound in Transsphenoidal Surgery: A Novel Technique

Authors: Solheim, Ole MD; Selbekk, Tormod MSc; Løvstakken, Lasse MSc; Tangen, Geir A. MSc; Solberg, Ole V. MSc; Johansen, Tonni F. MSc; Cappelen, Johan MD; Unsgård, Geirmund MD, PhD

OBJECTIVE: Residual tumor masses are common after transsphenoidal surgery. The risk of a residual mass increases with tumor size and parasellar or suprasellar growth. Transsphenoidal surgery is usually performed without image guidance. We aimed to investigate a new technical solution developed for intraoperative ultrasound imaging during transsphenoidal surgery, with respect to potential clinical use and the ability to identify neuroanatomy and tumor.

METHODS: In 9 patients with pituitary macroadenomas, intrasphenoidal and intrasellar ultrasound was assessed during transsphenoidal operations. Ultrasound B-mode, power-Doppler and color-Doppler images were acquired using a small prototype linear array, side-looking probe. The long probe tip measures only 3 × 4 mm. We present images and discuss the potential of intrasphenoidal and intrasellar and ultrasound in transsphenoidal surgery.