Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(05): 388-395
DOI: 10.1590/0004-282X20160042

ARTICLE

Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications

Resultados cirúrgicos do acesso endonasal endoscópico transesfenoidal para adenomas hipofisários grandes e gigantes: experiência institucional com ênfase às complicações relacionadas ao acesso cirúrgico

Edson Rocha Constantino

Universidade Federal Fluminense, Hospital Universitário Antçnio Pedro, Divisão de Neurocirurgia, Niterói RJ, Brazil.

,

Rafael Leal

Universidade Federal Fluminense, Hospital Universitário Antçnio Pedro, Divisão de Neurocirurgia, Niterói RJ, Brazil.

,

Christian Cândido Ferreira

Universidade Federal Fluminense, Hospital Universitário Antçnio Pedro, Divisão de Neurocirurgia, Niterói RJ, Brazil.

,

Marcus André Acioly

Universidade Federal Fluminense, Hospital Universitário Antçnio Pedro, Divisão de Neurocirurgia, Niterói RJ, Brazil.

,

José Alberto Landeiro

Universidade Federal Fluminense, Hospital Universitário Antçnio Pedro, Divisão de Neurocirurgia, Niterói RJ, Brazil.

› Author Affiliations

ABSTRACT

Objective In this study, we investigate our institutional experience of patients who underwent endoscopic endonasal transsphenoidal approach for treatment of large and giant pituitary adenomas emphasizing the surgical results and approach-related complications.

Method The authors reviewed 28 consecutive patients who underwent surgery between March, 2010 and March, 2014.

Results The mean preoperative tumor diameter was 4.6 cm. Gross-total resection was achieved in 14.3%, near-total in 10.7%, subtotal in 39.3%, and partial in 35.7%. Nine patients experienced improvement in visual acuity, while one patient worsened. The most common complications were transient diabetes insipidus (53%), new pituitary deficit (35.7%), endonasal adhesions (21.4%), and cerebrospinal fluid leak (17.8%). Surgical mortality was 7.1%.

Conclusions Endoscopic endonasal transsphenoidal surgery is a valuable treatment option for large or giant pituitary adenomas, which results in high rates of surgical decompression of cerebrovascular structures.

RESUMO

Objetivo Neste manuscrito investigamos a experiência institucional com o acesso endonasal endoscópico transesfenoidal no tratamento de adenomas hipofisários grandes e gigantes com ênfase às complicações relacionadas ao acesso cirúrgico.

Método Foram incluídos neste estudo 28 pacientes consecutivos submetidos à cirurgia entre Março de 2010 e Março de 2014.

Resultados O diâmetro médio pré-operatório dos tumores era 4,6 cm. Uma ressecção total foi obtida em 14,3%; quase total, em 10,7%; subtotal, em 39,3% e parcial, em 35,7%. Nove pacientes evoluíram com melhora na acuidade visual, enquanto um paciente apresentou piora da função visual. As complicações mais comuns foram diabetes insipidus transitório (53%), novo défice hipofisário (35,7%), sinéquias endonasais (21,4%) e fistula liquórica (17,8%). A mortalidade cirúrgica foi 7,1%.

Conclusões A cirurgia por via endonasal endoscópica transesfenoidal é uma opção terapêutica extremamente útil para adenomas hipofisários grandes e gigantes, a resultar numa significativa descompressão das estruturas cerebrovasculares.

endoscopic endonasal approach - giant pituitary adenomas - large pituitary adenomas - complication rates

acesso endoscópico endonasal - adenoma hipofisário gigante - adenoma hipofisário grande - índices de complicação

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