Cases Of Microadenoma Research Articles

Clinical observation of 7 cases of functional pituitary neuroendocrine tumor treated by endoscopic transnasal selective resection of the cavernous sinus medial wall

The clinical data of 7 patients (3 males and 4 females) with functional pituitary neuroendocrine tumor treated by endoscopic transnasal resection of the cavernous sinus medial wall from May to October 2023 in the Department of Neurosurgery of the First Affiliated Hospital of University of Science and Technology of China were retrospectively analyzed. They ranged in age from 29 to 60, with an average age of 45. The clinical diagnosis was acromegaly in 5 cases and Cushing's disease in 2 cases. There were 1 cases of microadenoma and 6 cases of macroadenoma. Knosp grade: Grade 1 adenoma in 3 cases, grade 2 adenoma in 3 cases and grade 3A adenoma in 1 case. Intraoperative resection of cavernous sinus medial wall was performed on the side of tumor. Five cases were determined to be invaded by tumor, and 2 cases were uncertain. No internal carotid artery injury occurred in all patients. The average intraoperative blood loss was 156 ml, and no patient was transfused. Postoperative endocrine remission was found in 6 cases, and tumor cells were found in 6 cases by pathological examination of the medial wall of cavernous sinus. No serious complications occurred in all patients. For Knosp grade 1-3 functional pituitary neuroendocrine tumor surgery, if there is no clear false envelope or normal pituitary between the tumor and the cavernous sinus medial wall during the operation, the cavernous sinus medial wall should be actively removed to improve the postoperative endocrine remission rate.

Frequency of CSF Rhinorrhoea in Patients Undergoing Endoscopic Transsphenoidal Surgery (ETSS) for Pituitary Macroadenoma

Introduction: Pituitary adenoma resection via the transsphenoidal approach (TSS)is a safe and common neurosurgical procedure that can be done both through microscopic and endoscopic methods. Objectives: The main objective of the study is to find the frequency of CSF rhinorrhoea in patients undergoing endoscopic transsphenoidal surgery (ETSS) for pituitary macroadenoma. Material and methods: The study data was collected from 1st Oct to 1st Nov 2022, in the departments of Neurosurgery of Hayatabad Medical complex, Khyber Teaching Hospital, Lady Reading Hospital, Peshawar. The data was collected through non-probability consecutive sampling technique. There were 315 patients which were included in the study. The surgical procedure is done under general anesthesia. All patient data was collected and a standardized form was filled by the attending surgeon caring for the patient. Importantly, the primary end points to be recorded were: (1) techniques of intraoperative cranium base reconstruction used, and (2) postoperative CSF rhinorrhoea biochemically confirmed and/or requiring intervention (CSF diversion and/or operative restoration). Results: Of the 315 consecutive patients diagnosed with pituitary adenomas, a total of 250 patients met the inclusion criteria and were included. The pathology included 187 (74.8%) non-functioning adenomas, 40 (16.0%) GH-secreting pituitary adenomas, 3 (1.2%) PRL-secreting pituitary adenomas, and 20 (8.0%) ACTH-secreting pituitary adenomas. There were 30 (12.0%) cases of microadenomas, 205 (82.0%) cases of macroadenomas, and 15 (6.0%) cases of giant adenomas. Intraoperative CSF leakages were determined throughout surgical procedure in eighty patients (32.0%). Postoperative CSF leaks occurred in 9 patients (3.6%), including seven patients with intraoperative CSF leaks. Practical implication: Practical implications of this study is: (1) easily find the CSF leakage (2) frequency of CSF rhinorrhoea in patients undergoing endoscopic transsphenoidal surgery Conclusion: It is concluded that macroadenoma ETSS surgery should be strictly monitored for post-operative CSF leakage and lumber drain is an effective prophylactic strategy. Keywords: Postoperative CSF Leakage, Pituitary Adenomas, ETSS, Surgery, Lumber

Comparison of Cerebrospinal Fluid Leakage in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenoma with and without Sellar Floor Reconstruction

Objectives: This study aimed to compare CSF leak in endoscopic endonasal TSS of pituitary adenoma with and without reconstruction of the sellar floor with no intraoperative CSF leakage. Materials and Methods: It was a randomized controlled trial of 116 patients of both genders diagnosed case of pituitary adenoma who underwent endoscopic endonasal TSS over 1 year. The cases were randomized into 2 groups. In Group A endoscopic endonasal TSS and the sellar floor, reconstruction was done while in Group B only endoscopic endonasal transsphenoidal surgery was done without reconstruction. Results: The patient’s mean age in group A was 40.7 ± 9.56 years, and in group, B was 41.9 ± 10.5 years. The gender distribution, for group A, males and females were 29 each (50%) and in group B, the males were 36 (62%) and females were 22 (38%). There were 52 (89.7%) cases of macroadenoma and 6 (10.3%) cases of microadenoma in each group. On the 1st postoperative day, CSF leakage was noted in 2 (3.4%) patients of group A, and CSF leakage was observed in 2 (3.4%) patients of group B. Results revealed no difference in CSF leakage between both groups. There were minor nasal complications in both groups. Conclusion: There is an equal chance of success with endoscopic endonasal transsphenoidal surgery (TSS) of pituitary adenoma with and without reconstruction of the sellar floor, concerning post-operative CSF leak, in patients who have no intraoperative CSF leak which enlarges the pool of options for treatment.

Could hormonal remission in prolactinomas be achieved with surgery? Our experience

Objective. To determine the factors that lead to sustained hormonal remission in patients with pituitary adenomas. Material and methods. In this study, retrospective analysis of 33 patients with pituitary adenomas with no prior DA treatment was performed. Ten (30.3 %) patients experienced microprolactinomas, 19 (57.6 %) — macroprolactinomas, 4 (12.1 %) — giant prolactinomas. All patients underwent endoscopic endonasal transsphenoidal surgery. Plasma PRL levels were obtained before surgery, and then 1 day, 1 week, 1 month, 3 months later and every 6 th month after surgery. MRI monitoring was performed before surgery and then 3 and 12 months later, and then annually. Results . Average preoperative plasma PRL serum levels for all patients with no preoperative DA treatment were 530 ng/mL (ranging 65–1440 ng/mL). Cavernous sinus invasion (Knosp 3, Knosp 4) was observed in 16 (48.4 %) cases. Depending on cavernous sinus invasion, hormonal remission with no DA therapy after surgery was achieved in Knosp 0–2 — in 16 (94.1 %) cases, Knosp 3 — in 4 (44.4 %) cases. In cases of Knosp 4 biochemical remission was not achieved in all 7 (100 %) patients. Only with further DA therapy biochemical remission was achieved. The biochemical remission was achieved in 10 (100 %) cases of microadenomas, in 7 (58.3 %) cases of macroadenomas after surgery with no DA therapy. Remission of endocrine symptoms was achieved in 18 (81.8 %) cases with no DA therapy after surgery. The follow-up was up to 3 years. Conclusions . Biochemical remission could be surgically achieved in 100 % of cases with microprolactinomas. In cases of macroprolactinomas the adenoma size (up to 24 mm) has an important role in achieving biochemical remission. Cavernous sinus invasion (Knosp 0–2) is a prognostic factor. The ophthalmic disturbances regression in macro and giant pituitary adenomas was found to be achieved much faster in surgical management rather than using DA.

Пролактиноми: чи можлива хірургічна гормональна ремісія?

Prolactinomas: is it possible to achieve hormonal remission surgically? Purpose. Tо determine the efficacy of endoscopic endonasal transsphenoidal method for the treatment of prolactinomas.Materials and methods. Endoscopic endonasal trassphenoidal (EET) access was performed in all cases. Depending on the size, we were isolated: the pituitary microadenomas (up to 10mm) – 6 macroadenomas (10–40 mm) – 12 giant adenomas (>40 mm) – 3. Clinical manifestations were presented in: visual disorders – 9 patients, including: visual acuity – 6, visual field disorders – 3, diplopia – 2; hormonal disorders – 14 patients, including: menstruation disorders – 9, obesity – 4 galactorrhea – 3.Results and discussion. The average serum prolactin was 530 ng/ml, the maximum levels was – 1440 ng/ml, the minimum was – 65 ng/ml. Normal prolactin level was achieved postoperatively in 5 (100%) cases of microadenomas, and in 7 (58,3%) cases of macroadenomas without DA. After EET surgery normoprolactinemia was achieved in 12 (60%) patients, 8 (40%) cases required DA therapy within a year. Hormonal disorders’ remission after surgery was achieved in 10 (76,9%) cases. In 6 (30%) cases, any hormonal disorders ware identified. Visual acuity was improved in all cases. Any postoperative complications like CSF leak, meningitis, additional oculomotor disorders or any other visual disorders were identified. No mortality was observed in our research.Conclusions. Endoscopic endonasal transsphenoidal technique is effective for prolactinomas treatment and allows to improve rate of hormone level in 60%. In case of microprolactinomas improving hormone level and hormonal disorders is possible in 100% without DA therapy.

Endoscopic Trans Planum Trans Inter Cavernous Sinus (ETPTICS) approach to pituitary microadenoma: Introduction of a novel technique to enhance endocrinological outcome

Background and Objective: Endoscopic transnasal approach to pituitary adenoma surgery has been recently introduced as an efficient alternative for traditional transcranial and conventional microscopic transnasal approaches. Recent studies have shown the advantages of this technique such as better cosmetic outcomes, low complication rate, lower duration of the surgery, higher patient satisfaction, and better tumor resection, compared to microscopic technique especially in large tumors with extensions into adjacent structures and tissues. Surgery for secreting microadenoma has been always a big surgical challenge in term of achieving full treatment especially in Cushing’s syndrome. Methods: A total of 12 cases secretory microadenoma was performed during 2011. Transplanum trans-intercavernous sinus approaches were used for better searching of the gland for microadenoma and checking the dural side adjacent for microadenoma since they were very useful in multi microadenoma and bilateral cases detections. In this approach, conventional techniques step by step were followed until the sellar floor was perforated. At this step, more resection of sellar bone was performed both anteriorly and posteriorly toward planum sphenoidale to expose intercavernous sinuses. Then, following careful bipolar cautery of the intercavernous sinuses, they were incised along with dura of the sellar floor. This approach makes an excellent view of the sella and pituitary adenoma as well as the pituitary gland itself and its stalk. Results: A total of 330 cases of pituitary adenoma underwent the endoscopic transsphenoidal (ETSS) surgery during 2005-2012. Of them, there were 27 cases of microadenoma, 15 of which underwent the surgery through classic ETSS and the rest (12 patients) were operated using ETPTICS. In the first group (conventional ETSS), 11 patients (73%) were completely recovered and only 2 cases showed recurrence after one year (both were Cushing’s syndrome). In the second group (ETPTICS), postoperative follow-up (5 months) assessments showed that all of 12 patients showed remission criteria with no recurrence. There was no postoperative cerebrospinal fluid (CSF) leak or any complication in both groups. There were 2 cases of transient diabetes insipidus (DI, unrelated to diabetes mellitus) in the ETSS group, while the other group showed 4 cases. However no permanent DI was observed in both groups. Discussion: Findings of the present study showed that application of ETPTICS approach can increase the endocrinological remission rate that was a formidable task in cases with multiple microadenoma or Cushing’s syndrome with normal MRI and microadenoma touching the cavernous sinus or invading the dura. Hypothetically, the chance of CSF leak might be higher in this novel technique that was efficiently controlled using meticulous repair. Furthermore, meticulous care by pituitary stalk blood supply should be implemented to avoid anterior pituitary insufficiency and permanent DI. Tin tituitary insufficiency and permanent DI are to be avoided.

Clinical characteristics and diagnostic analysis of thyrotropinoma

Objective To analyze clinical charaCteristics and diagnostic experience on thyrotropinoma (TSHoma).Methods Clinical characteristics,laboratory findings,diagnostic experience,and surgical outcome were summarized from 16 cases of TSHoma in our hospital from January 2006 to September 2011.Results ( 1 )Among 16 cases ( 9 male,7 female ) aged ( 51.63 ± 13.23 ) years,14 ( 87.5 ％ ) cases presented with hyperthyroidism and 2 were diagnosed by physical examination. None of them had exophthalmos, acropachy, or pre-tibial myxedema.( 2 ) Serum FT4 and FT3 levels were all above normal range with serum TSH ( 4.37 ± 2.77 ) μIU/ml.There were 25％ (4/16) cases with positive serum thyroglobulin antibody and/or thyroid peroxidase antibody,none with positive TSH receptor antibody.TRH stimulating test was performed in 9 cases,3 were with positive response ( peak TSH level increased by 5.45-9.20 μIU/ml compared with baseline),and 6 without response (peak TSH level increased by -0.01-3.15 μIU/ml compared with baseline).TSH was suppressed to 27.15％ (5.19％-99.15 ％ ) of the baseline in 11 cases in which somatostatin suppression test was carried out.Prolactin and insulin-like growth factor-Ⅰ levels were increased in 2 cases.MRI performed in 15 patients showed 10 cases of microadenomas and 5 cases of pituitary adenoma.A mass in nasal cavity was found in one case,where no mass was found in the pituitary.( 3 )Surgery was made in 11 cases ( 9 patients underwent transsphenoidal operation,one craniotomy,and one underwent operation via endoscopic nasal septum ). All patients (11/11) were proved to yield pituitary adenoma pathologically.Conclusion Thyrotropinoma should be considered in hyperthyroidism with unsuppressed TSH level,and dynamic tests facilitated early diagnosis.Ectopic thyrotropinoma shoull be considered when normal pituitary morphology was shown by MRI. Key words: Thyrotropinoma; Pituitary tumour; Microadenoma; Dynamic test

Prolactin-secreting pituitary microadenomas. II. Evaluation of surgical treatment

The authors evaluated results of surgical treatment for 12 cases of prolactin-secreting pituitary microadenomas with respect to the effect on the endocrinological status and compared these results with those for 10 cases of macroadenomas. The cases of microadenomas were all female; 10 cases with amenorrhea and galactorrhea, a case with oligomenorrhea and galactorrhea and a case with only amenorrhea. Both microadenomas and macroadenomas were operated on through the transsphenoidal route. Microadenomas were considered to have been removed completely but macroadenomas were not always removed completely because of their larger size. The relation between operative findings of microadenomas and basal serum PRL levels was analysed. Two elastic and firm adenomas showed elevated serum PRL levels (p<0.001) exceeding 400 ng/ml and two eosinophilic and two mixed adenomas showed higher serum PRL levels than the chromophobes (p<0.01). Adenomas with serum PRL levels around or over 200 ng/ml were all peripheral types. Localization within the sella turcica or size of the tumors had little relation to serum PRL levels. In microadenomas, serum PRL levels fell to the normal level in nine cases (75.0%) within a month after the operation. Three cases with normal PRL levels, however, gradually returned to elevated levels in the follow-up after a month. Conversely, no drop to the normal level was observed in cases of macroadenomas. Surgical impacts on HGH, TSH, LH, FSH and ACTH reserves were examined. Only four out of 18 cases (22.2%) among the microadenomas and macroadenomas had impaired hormonal reserves after transsphenoidal surgery which was considered to be a safe procedure. Regular menses were restored in nine out of 12 cases (75.0%) of microadenomas after a mean interval of a month and a half after the operation. Six cases showed ovulatory menses. One case experienced normal delivery and two cases became pregnant among the six patients. Galactorrhea disappeared in nine out of 11 cases (81.8%) of microadenomas after a mean interval of 2 months and a half after the operation and another case showed a remarkable decrease in lactation. However, none of the seven cases of macroadenomas showed restored menses, only one out of six cases had cessation of lactation and another two cases showed a decrease in lactation after the operation. Transsphenoidal removal of prolactin-secreting microadenomas was a safe and satisfactory treatment of choice.