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Objective: To report outcomes of a large cohort of patients who underwent endoscopic endonasal transsphenoidal surgery (EETS) for resection of a pituitary adenoma with subsequent Resorb-X plate (RXP) sellar reconstruction. Methods: A retrospective review of 620 EETS operations performed at a single academic center between 2005 and 2020 was conducted. Results: A total of 215 EETS operations of 208 patients were identified between 2012 and 2020 who underwent reconstruction with the RXP after EETS for pituitary tumor resection with a final pathologic diagnosis of pituitary adenoma. Analysis of pooled data revealed a mean preoperative tumor volume of 6.8 cm3 (range: 0.038-51.03 cm3). Postoperative cerebrospinal fluid leak occurred in 2 patients (0.93%). Postoperative meningitis occurred in 1 patient (0.47%). There were no cases of RXP extrusion. Conclusions: The rate of postoperative CSF leak and meningitis after use of the RXP for sellar reconstruction compares favorably to other methods, including use of autologous grafts and flaps. Use of RXP during EETS is a safe and efficacious method of sellar reconstruction and may obviate the need for autologous tissue reconstruction after pituitary adenoma resection. [ABSTRACT FROM AUTHOR]

Background: Pituitary tumors surgery is increasingly performed via endoscopic transsphenoidal approach (TSP). This study describes outcomes of TSP surgery in the United States. Methods: A retrospective cross‐sectional analysis of adult patients with pituitary adenoma was performed using the Nationwide Readmissions Database, 2010–2015. Results: A total of 5891 patients were identified. The average age was 51.29 ± 0.29 years. The risk of postoperative epistaxis, diabetes insipidus, cerebrospinal fluid (CSF) leak, and other general postoperative complications was 0.71%, 10.20%, 8.35%, and 2.37%, respectively. Independent risk factors of CSF leak included: age <65‐year, male, body mass index ≥25, and multiple comorbidities (p < 0.001 each). The prevalence of CSF leak was not associated with hospital TSP volume and teaching status. Conclusion: This study provides a national epidemiological perspective on TSP in the United States. The risk of postoperative CSF leak appears to be associated with intrinsic patient factors rather than resource and expertise availability. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate the prevalence and contribution of humoral immunodeficiency in refractory chronic rhinosinusitis (RCRS). This study was performed at a tertiary care academic referral center. Methods: RCRS patients who had at least three episodes of documented sinusitis in the previous year despite antibiotic therapy, who had endoscopic sinus surgery performed at University of Iowa Health Care (UIHC), and who were evaluated by the UIHC Adult Immune Disorder Clinic were included. Exclusion criteria included allergic fungal sinusitis, human immunodeficiency virus, and other causes of secondary immunodeficiency. Sixty-seven patients fulfilled the inclusion and exclusion criteria. The results of their immunologic evaluation for atopy and humoral immune function were examined. Results: The average age of these patients was 50 years (±11.6 years). Twenty-eight (42%) patients had at least one positive result on allergy skin testing. Determination of quantitative immunoglobulins showed low IgG in 9%, low IgA in 3%, and low IgM in 12% of patients. Common variable immunodeficiency was diagnosed in one case. Immunoglobulin G subclasses were tested in 31 cases and found low in 6 patients. Fifty-one patients underwent a dynamic assessment of their antibody response by examining the increase in antibody titer to an unconjugated pneumococcal polysaccharide vaccine. Sixty-seven percent of patients failed to produce more than a fourfold increase in postimmunization antibody titer for >7 of 14 serotypes being tested and were considered to have functional antibody deficiency. Conclusion: This retrospective review shows an unexpectedly high prevalence of humoral immune dysfunction in patients with RCRS. These findings suggest that assessment of immune function should be undertaken routinely in RCRS. Immune assessment should first include measurement of serum immunoglobulin levels; if these are normal, then functional antibody responses should be evaluated. [ABSTRACT FROM AUTHOR]

Objectives: We hypothesized that the endoscopic approach to pituitary surgery improves rhinology-specific quality of life and has satisfactory tumor outcomes compared with the open approach. Methods: Cases of pituitary surgery from the Department of Neurosurgery database included an inception cohort of all patients who had endoscopic procedures and consecutive patients who had open procedures between January 1998 and February 2008. The Sino-Nasal Outcome Test-22 was mailed. Results: Since January 1998, 71 endoscopic and 122 open pituitary surgeries had been performed. The mean follow-up was longer for open procedures (49.3 months) than for endoscopic procedures (18.8 months). Recurrence was more common after open surgery (28.4%) than after endoscopic surgery (18.2%; p = 0.219). The most common diagnosis was macroadenoma (77.1 % of endoscopic procedures and 93.4% of open procedures). The mean hospital stay was shorter for endoscopic procedures (4.1 days) than for open procedures (6.0 days; p < 0.001). Of patients who presented with visual deterioration, 53.8% with endoscopic surgery and 46.7% with open surgery had improvement. Among patients with normal preoperative hormonal function, 27.5% of patients in the endoscopy group and 29.4% of patients in the open group required medication for more than 2 months after surgery. Complications occurred in 33.3% of endoscopic procedures and 43.4% of open procedures. Cerebrospinal fluid leaks were more common in the endoscopy group (p = 0.035), and diabetes insipidus lasting more than 30 days was more common in the open group (p - 0.017). The mean Sino-Nasal Outcome Test-22 score was lower for patients in the endoscopy group (20.4) than for those in the open group (23.2; p = 0.41). Patients in the endoscopy group had a significantly lower rhinology-specific mean score (6.5) than did patients in the open group (9.2; p = 0.03). Conclusions: The endoscopic approach to pituitary surgery offers tumor outcomes comparable to those of open surgery, with no greater incidence of complications and an improved rhinology-specific quality of life. [ABSTRACT FROM AUTHOR]

Surgical treatment of thyroid-related orbitopathy can be accomplished by transorbital or endoscopic techniques. Transorbital surgery has advantages in the orbital floor and lateral wall, and endoscopic decompression is best suited to the medial orbital wall. We describe a retrospective review of 16 orbits (10 patients) treated with surgery, combining endoscopic decompression of the medial wall and a transorbital approach to the floor and lateral wall. Follow-up averaged 20.8 months. Vision and field defects improved dramatically in compressive optic neuropathy cases. Hertel measurements improved, on average, 4.9 mm. Two patients with severe preoperative diplopia required strabismus surgery after decompression. Combined-approach decompression is a safe and efficacious operation with conceptual advantages over current surgical techniques. [ABSTRACT FROM AUTHOR]