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  • Endonasal endoscopic approach. Pinar del Río. 2015-2017

    Final Number:

    Nilo Alvarez-Toledo MD; Frank Reinaldo Perez Nogueiras

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting - Late Breaking Science

    Introduction: Endonasal endoscopic approach is one of the most important advences in neurosurgery. Since the begining of the XX century until now, the evolution has allow to increse the security, the extension and the results.

    Methods: We performed a descriptive and retrospective work of the first 39 cases operated in our center by endonasal endoscopic approach. The sample includes 39 cases operated in Abel Santamaría Cuadrado General Hospital between 2015 and 2017. The source of information were the clinical histories as well as the operatory documents. Age, sex, pathology, etc. were collect and processed. Descriptive statistical analysis was performed. Based in our initial experience, we suggest some high yield tenets for the beginners in this approach.

    Results: From 39 patients operated by endonasal endoscopic approach, 29 corresponded to pituitary macroadenoma, 5 were cerebro-spinal fluid (csf) leaks, 3 were craniopharyngioma, 1 was a meningioma of the optic nerve sheath and 1 chordoma of the clivus. The 85% of pituitary macroadenoma were non-functional and 65% presented with improvement of the visual defect after the surgery. The 5 cases with csf leaks were traumatic and the use of polyuretano locally contribute to the seal of the defect. The craniopharyngiomas presented all 3 with hyponatremia and diabetes insipidus. Though 2 patients get recovered 1 dead. The meningioma of the optic nerve sheath stayed vision equal after surgery. Only one report of this approach was found. The giant chordoma of the clivus was partially resected and irradiated. The patient died 1 year later. HIGH YIELD TENETS FOR THE BEGGINERS: 1. Team work is essential. 2. Hard pre-surgery preparation. 3. Philosophy of work.

    Conclusions: In our center we have incorporated the endonasal endoscopic approach with good results based in hard preparation and team working. This surgery most be apply with a new philosophy of work, keeping our minds opened.

    Patient Care: This work reflects our young experience with endonasal endoscopic approach and how do the young neurosurgeons can face with success this challenging begining. So better initiation, better results with the patients.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1. Know the young experience of our center in the endonasal endoscopic approach. 2. Appreciate a the same standard approach butsince our iniciating experience. 3. Share with our collegues what we consider is the cornerstone in the successful begining of this surgery since our results.

    References: 1. Donald TJ, Laws ER. Historical aspects of the management of pituitary disorders with emphasis on transsphenoidal surgery. En: Management of pituitary adenomas and related lesions with emphasis on transsphenoidal microsurgery [Internet]. New York: Appleton-Century-Crofts; 1982 [citado 26 May 2017]. Disponible en: 2. Schloffer H. Zur Frage der Operationen an der Hypophyse. Beitr Klin Chir. 1906; 50: 767-817. 3. Cushing H. Surgical experiences with pituitary disorders. JAMA. 1914; 63: 1515-25. 4. Henderson WR. The pituitary adenomata. a follow-up study of the surgical results in 338 cases (Dr Harvey Cushing’s series). Br J Surg [Internet]. 1939 [citado 26 May 2017]; 26: 911-21. Disponible en: 5. Rosegay H. Cushing’s legacy to transsphenoidal surgery. J Neurosurg [Internet]. 1981 [citado 26 May 2017]; 54: 448-54. Disponible en: 6. Hardy J. Microneurosurgery of the hypophysis. En: Microneurosurgery. St Louis: Mosby, 1969. p. 87. 7. Guiot G, Thibault T. L’extirpation des adenomes hypophysaires par voie transsphenoidale. Neurochirurgie. 1959; 1: 133-50. 8. Dehdashti AR, Ganna A, Karabatsou K, Gentili F. Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery [Internet]. 2008 [citado 26 May 2017]; 62: 1006-15. Disponible en: 9. Tucker HM, Hahn JF. Transnasal-transseptal sphenoidal approach to hypophysectomy. Laryngoscope [Internet]. 1996 [citado 26 May 2017]; 106: 914-8. Disponible en: 10. Papay FA, Benninger MS, Levine HL. Transnasal transseptal endoscopic repair of sphenoidal cerebral spinal fluid fistula. Otolaryngol Head Neck Surg [Internet]. 1989 [citado 26 May 2017]; 101:595-7. Disponible en: 11. Maddox DE, Kennedy DW. Endoscopic management of cerebrospinal fluid leaks and cephaloceles. Laryngoscope [Internet]. 1990 [citado 26 May 2017]; 100: 857-62. Disponible en: 12. Papay FA, Maggiano H, Dominiquez S, Hassenbach SJ, Levine H. Rigid endoscopic repair of paranasal sinus cerebrospinal fluid fistula. Laryngoscope [Internet]. 1989 [citado 26 May 2017]; 99: 195-201. Disponible en: 13. Stankiewicz JA. Cerebrospinal fluid fistula and endoscopic sinus surgery. Laryngoscope [Internet]. 1991 [citado 26 May 2017]; 101: 250-6. Disponible en: 14. Jankowski R, Aunque J, Simon C, Marchal JC, Hepner H, Wayoff M. Endoscopic pituitary tumor surgery. Laryngoscope [Internet]. 1992 [citado 26 May 2017]; 102: 198-202. Disponible en: 15. Gamea A, Fathi M, El-Guindy A. The use of the rigid endoscope in trans-sphenoidal pituitary sugery. J Laryngol Otol [Internet]. 1994 [citado 26 May 2017]; 108: 19-22. Disponible en: 16. Sethi DS, Pillay PK. Endoscopic pituitary surgery: a minimally invasive technique. Am J Rhinol [Internet]. 1996 [citado 26 May 2017]; 10: 141-8. Disponible en: 17. Jho HD, Carrau RL, Daly MA. Endoscopic pituitary surgery: an early experience. Surg Neurol [Internet]. 1997 [citado 26 May 2017]; 47: 213-23. Disponible en: 18. Carrau RL, Jho HD, Ko Y. Transnasal-transsphenoidal endoscopic surgery of the pituitary gland. Laryngoscope [Internet]. 1996 [citado 26 May 2017]; 106: 914-8. Disponible en: 19. Jho HD, Carrau RL. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg [Internet]. 1997 [citado 26 May 2017]; 87: 44-51. Disponible en: 20. Carrau RL, Jho HD, Ko Y. Transnasal-transsphenoidal endoscopic surgery of the pituitary gland. Laryngoscope [Internet]. 1996 [citado 26 May 2017]; 106: 914-8-51. Disponible en: 21. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus [Internet]. 2005 Jul 15 [citado 26 May 2017]; 19(1): 3. Disponible en: 22. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus [Internet]. 2005 Jul 15 [citado 26 May 2017]; 19(1): 4. Disponible en: 23. Rhoton AL, Hardy DG, Chambers SM. Microsurgical anat¬omy and dissection of the sphenoid bone, cavernous sinus and sellar region. Surg Neurol [Internet]. 1979 [citado 26 May 2017]; 12: 63-104. Disponible en: 24. Rhoton AL. Anatomy of the pituitary gland and sellar region. In: Thapar K, Kovacs K, Scheithauer BW, Lloyd RV. Diagnosis and Management of Pituitary Tumors [Internet]. New York: Springer Science Business; 2001 [citado 26 May 2017]. Disponible en: 25. Fujii K, Chambers SM, Rhoton AL. Neurovascular relation¬ships of the sphenoid sinus: a microsurgical study. J Neurosurg [Internet]. 1979 [citado 26 May 2017]; 50: 31–9. Disponible en: 26. Rhoton AL, Yamamoto DA. Peace, Microsurgery of the third ventricle: part 2. Operative approaches. Neurosurgery [Internet]. 1981 [citado 26 May 2017]; 8: 357–73. Disponible en: 27. Rhoton AL. The sellar region. Neurosurgery [Internet]. 2002 [citado 26 May 2017]; 51: 335–74. Disponible en: 28. F.S. Harris AL, Rhoton Jr. Anatomy of the cavernous sinus: a microsurgical study. J Neurosurg [Internet]. 1976 [citado 26 May 2017]; 45: 169–80. Disponible en: 29. Ono M, Rhoton AL. Microsurgical anat¬omy of the region of the tentorial incisura. J Neurosurg [Internet]. 1984 [citado 26 May 2017]; 60: 365–99. Disponible en: 30. Laws ER, Thapar K. Surgical management of pituitary ade¬nomas, baillieres. Clin Endocrinol Metab [Internet]. 1995 [citado 26 May 2017]; 9 (2): 391–405. Disponible en: 31. Gohar MS, Niazi SA, Niazi SB. Functional Endoscopic Sinus Surgery as a primary modality of treatment for primary and recurrent nasal polyposis. Pak J Med Sci [Internet]. 2017 Mar-Apr [citado 26 May 2017]; 33(2): 380-2. Disponible en: 32. Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella Branger D, Cavenee WK, et al. The 2016 World Health Organisation Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol [Internet]. 2016 [citado 26 May 2017]; 131: 803-20. Disponible en: 33. Wilson CB. Neurosurgical management of large and invasive pituitary tumors. In: Tindall GT, Collins WF. Clinical management of pituitary disorders. New York: Raven Press; 1979. p. 335-42. 34. López Arbolay O, Rojas Manresa JL, y Hernandez Galvez Y. Endonasal endoscopic approach in pituitary adenomas: surgical results [Internet]. Cuba, La Habana: Neurosurgery Department of "Hermanos Ameijeiras" Hospital, 701 San Lazaro, St. Centro Habana. Disponible en: 35. Daniel E, Newell Price J. Recent advances in understanding Cushing disease: resistance to glucocorticoid negative feedback and somatic USP8 mutations. F1000Res [Internet]. 2017 May 2 [citado 26 May 2017]; 6: 613. Disponible en: 36. Zhou HJ, Pan DS, Ba XQ, Zhan RY, Zheng XJ, Ma YH. 'Ectopic' suprasellar type IIa PRL-secreting pituitary adenoma. [Internet]. [citado 26 May 2017]. Disponible en: 37. Zaidi HA, Wang AJ, Cote DJ, Smith TR, Prevedello D, Solari D, et al. Preoperative Stratification of Transsphenoidal Pituitary Surgery Patients Based on Surgical Urgency [Internet]. [citado 26 May 2017]. Disponible en: 38. Øystese KA, Zucknick M, Casar Borota O, Ringstad G, Bollerslev J. Early postoperative growth in non-functioning pituitary adenomas; A tool to tailor safe follow-up. Endocrine [Internet]. 2017 May 17 [citado 26 May 2017]. Disponible en: 39. Park S, Kim HS, Park KS, Nam TK, Park YS, Kwon JT, et al. A Case of Coincidental Intrasellar Chordoma and Pituitary Adenoma. Brain Tumor Res Treat [Internet]. 2017 Apr [citado 26 May 2017]; 5(1): 49-52 .Disponible en: 40. Shaid M, Korbonits M. Genetics of pituitary adenomas. Neurol India [Internet]. 2017 May-Jun [citado 26 May 2017]; 65(3): 577-87. Disponible en: 41. Wang X, Tong X, Zou Y, Tian X, Mao Z, Sun Z. The impact on cognitive functions of patients with pituitary adenoma before and after surgery. Neurol Sci [Internet]. 2017 May 6 [citado 26 May 2017]. Disponible en: 42. Hadad G, Bassagasteguy L, Carrau RL. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope [Internet]. 2006 [citado 26 May 2017]; 116: 1882–86. Disponible en: 43. Tortosa F, Webb SM. Novel aspects in histopathology of the pituitary gland. Endocrinol Diabetes Nutr [Internet]. 2017 Mar [citado 26 May 2017]; 64(3):152-61. Disponible en: 44. Linsler S, Fischer G, Skliarenko V, Stadie A, Oertel J. Endoscopic Assisted Supraorbital Keyhole Approach or Endoscopic Endonasal Approach in Case of Tuberculum Sellae Meningioma: which Surgical Route Should be Favoured. World Neurosurg [Internet]. 2017 May 13 [citado 26 May 2017]; 17: 30711-8. Disponible en: 45. Ding H, Gu Y, Zhang X, Xie T, Liu T, Hu F, et al. Learning curve for the endoscopic endonasal approach for suprasellar craniopharyngiomas. J Clin Neurosci [Internet]. 2017 May 13 [citado 26 May 2017]. Disponible en: 46. Park HR, Kshettry VR, Farrell CJ, Lee JM, Kim YH, Won TB, et al. Clinical Outcome after Extended Endoscopic Endonasal Resection of Craniopharyngiomas: Two-institution Experience. World Neurosurg [Internet]. 2017 Apr 19 [citado 26 May 2017]; 17: 30542-9. Disponible en: 47. Zwagerman NT, Tormenti MJ, Tempel ZJ, Wang EW, Snyderman CH, Fernandez Miranda JC, et al. Endoscopic endonasal resection of the odontoid process: clinical outcomes in 34 adults. J Neurosurg [Internet]. 2017 May 12 [citado 26 May 2017]: 1-9. Disponible en: 48. Shohdy KS, Rashad W. Endocrine Disorders Developing after Surgical Intervention of Craniopharyngioma in Children. Rev Pediatr Endocrinol [Internet]. 2017 Mar [citado 26 May 2017]; 14(3): 298-301. Disponible en: 49. Nagata Y, Watanabe T, Nagatani T, Takeuchi K, Chu J, Wakabayashi T. Fully endoscopic combined transsphenoidal and supraorbital keyhole approach for parasellar lesions. J Neurosurg [Internet]. 2017 Apr 28 [citado 26 May 2017]: 1-10. Disponible en: 50. Apps JR, Martinez Barbera JP. Genetically engineered mouse models of craniopharyngioma: an opportunity for therapy development and understanding of tumor biology. Brain Pathol [Internet]. 2017 May [citado 26 May 2017]; 27(3): 364-9. Disponible en: 51. Narla S, Govindraj J, Chandrasekar K, Sushama P. Craniopharyngioma with malignant transformation: Review of literature. Neurol India [Internet]. 2017 Mar-Apr [citado 26 May 2017]; 65(2): 418-20. Disponible en: 52. Sahm F, Reuss DE, Giannini C. WHO 2016 Classification: Changes and Advancements in the Diagnosis of Miscellaneous Primary CNS Tumours. Neuropathol Appl Neurobiol [Internet]. 2017 Mar 12 [citado 26 May 2017]. Disponible en: 53. Jeong TS, Yee GT, Kim NR. Malignant Transformation of craniopharyngioma without Radiation Therapy: Case Report and Review of the Literature. J Korean Neurosurg Soc [Internet]. 2017 Jan 1 [citado 26 May 2017]; 60(1): 108-13. Disponible en: 54. Rootman J. Thyroid orbitopathy. En: Orbital disease. Present status and future challenges. Taylor and Francis [Internet]. 2005 [citado 26 may 2017]: 147-310. Disponible en: 55. Sahli E, Gündüz K. Thyroid-associated Ophthalmopathy. Turk J Ophthalmol [Internet]. 2017 Apr [citado 26 May 2017]; 47(2): 94-105. Disponible en: 56. Ferreira C, Meireles C, Marques O, Antunes A. Therapeutic challenge of a paediatric case of Graves' disease with severe ophthalmopathy. BMJ Case Rep [Internet]. 2017 Mar 16 [citado 26 may 2017]. Disponible en: 57. Braun TL, Bhadkamkar MA, Jubbal KT, Weber AC, Marx DP. Orbital Decompression for Thyroid Eye Disease. Semin Plast Surg [Internet]. 2017 Feb [citado 26 May 2017]; 31(1): 40. Disponible en: 58. Krieger CC, Neumann S, Marcus-Samuels B, Gershengorn MC. TSHR/IGF-1R Cross-Talk, Not IGF-1R Stimulating Antibodies, Mediates Graves' Ophthalmopathy Pathogenesis. Thyroid [Internet]. 2017 May [citado 26 May 2017]; 27(5): 746-7. Disponible en: 59. Sadeghi Y, Obéric A, Theintz G, Hamédani M. Graves' Ophthalmopathy in a Paediatric Population. Klin Monbl Augenheilkd [Internet]. 2017 Apr [citado 26 may 2017]; 234(4): 591-4. Disponible en: 60. Wang N, Chen FE, Long ZW. Mechanism of MicroRNA-146a/Notch2 Signaling Regulating IL-6 in Graves Ophthalmopathy. Cell Physiol Biochem [Internet]. 2017 [citado 26 May 2017]; 41(4): 1285-97. Disponible en:

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