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[Repeated transsphenoidal surgery for pituitary adenomas]
N Hashimoto1, T Yamagami, M Kojima
1Department of Neurosurgery, Kyoto University, Japan.
No Shinkei Geka. Neurological Surgery
|November 1, 1987
Summary
Repeated transsphenoidal surgery for pituitary adenomas is feasible and safe, even for recurrent cases or CSF leaks. Careful surgical technique ensures good outcomes, including optic nerve decompression and pituitary function preservation.
Area of Science:
- Neurosurgery
- Endocrinology
- Otolaryngology
Context:
- Transsphenoidal surgery is a common approach for pituitary adenomas.
- Repeated surgeries carry increased risks compared to primary procedures.
- Pituitary adenomas can recur or present complex challenges like CSF rhinorrhea.
Purpose:
- To evaluate the safety and efficacy of repeated transsphenoidal surgery.
- To describe technical considerations for re-operating via the transsphenoidal route.
- To present outcomes in patients undergoing staged operations, revision for recurrence, or repair of CSF leaks.
Summary:
- The study reviewed 18 cases of repeated transsphenoidal surgery.
- Indications included staged operations (7), recurrent adenomas (7), and CSF rhinorrhea (4).
- Technical aspects of re-opening and closure were detailed, noting reduced hemorrhage in some repeat surgeries and successful CSF leak management.
Impact:
- Repeated transsphenoidal surgery can be performed safely with appropriate techniques.
- Staged operations are effective for large adenomas with suprasellar extension.
- Recurrent adenomas can be managed by focusing on optic nerve decompression while preserving pituitary function.
- CSF rhinorrhea post-surgery is effectively treated with fat packing of the sella and sphenoid sinus.