J Neurol Surg B Skull Base 2021; 82(02): 216-232
DOI: 10.1055/s-0039-1694051
Original Article

A Novel Technique for Transpalatal Hypophysectomy

Ilton Guenhiti Shinzato
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
2  COPPE, Universidade Federal do Rio de Janeiro, Brazil
,
Felipe Bouchabki de Almeida Guardini
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
3  Brazilian Neurosurgery Society, São Paulo, Brazil
4  Universidade Federal de São Paulo, Sao Paula, Brazil
,
Herbert de Abreu Cavalcanti
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
,
Tiago Fernando Scopel
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
,
Fernando Kobayashi
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
3  Brazilian Neurosurgery Society, São Paulo, Brazil
,
Anselmo Costa
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
3  Brazilian Neurosurgery Society, São Paulo, Brazil
,
Igor Issao Moreira Yamamura
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
,
Eurico Ribeiro Feltrin
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
3  Brazilian Neurosurgery Society, São Paulo, Brazil
,
Bruno Martins Ferreira de Andrade
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
3  Brazilian Neurosurgery Society, São Paulo, Brazil
,
Franklin Marques Ennes
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
3  Brazilian Neurosurgery Society, São Paulo, Brazil
,
Anderson Alves Silva
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
,
Tiago Andrade de Oliveira e Silva
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
,
Antonio Martins de Freitas Junior
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
,
Adalberto Santiago de Souza Junior
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
,
Danilo Horta Marcato
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
,
Lucas Rasi Cunha
5  Statistician, Faculdade Senai, Campo Grande, MS, Brazil
,
Neide Trindade Mendes
6  Universidade Federal de São Carlos, São Carlos, Brazil
,
Kleber Soline Monteiro Vargas
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
3  Brazilian Neurosurgery Society, São Paulo, Brazil
› Author Affiliations

Abstract

Objective A novel technique is described for transpalatal hypophysectomy as an option for sellar region surgery using a microscope and/or endoscope.

Technique A straight submucosal tunnel (approximately 20 mm in diameter; 40–50 mm long—half the length required by conventional transsphenoidal hypophysectomy) is dissected in favorable alignment with the main tumor axis, providing a direct view that allows the surgeon to operate on large suprasellar tumors, even in cases of extra-axial expansion.

Results In a 25-year period, over 50 patients benefited from this surgery. Macroadenomas devoid of extra-axial expansions were totally excised (76.5%), otherwise, partially (23.5%). Forty-nine patients (98%) were extubated soon after surgery. Mean surgery duration was 3 hour 32 minute, with 2 days 6 hour before free feeding was restored. Postoperative hospitalization under neurosurgical care averaged 6 days 6 hour. Currently, patients undergoing the procedure do not require nasal tampons and can eat soft foods soon after recovery from anesthesia. Although two patients (3.9%) presented with oronasal fistulae postoperatively, no episodes of severe hemorrhage occurred during surgery and there were no cases of liquoric fistulae, visual impairment, panhypopituitarism, or severe syndrome of inappropriate antidiuretic hormone secretion.

Conclusion The new surgical approach is safe, effective, and well accepted by patients, who reported low levels of discomfort. Postsurgical complications or sequela are currently rare, but further operations should be performed using more appropriate materials, instruments, and equipment to allow comparisons with other techniques.



Publication History

Received: 21 November 2018

Accepted: 11 June 2019

Publication Date:
18 September 2019 (online)

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