Search

To evaluate the impact of nasoseptal flap (NSF) elevation on sinonasal quality of life (QOL) in patients with pituitary adenomas who underwent endoscopic endonasal trans-sphenoidal approach (EETSA), the data of 106 eligible patients were included from February 2011 to December 2014. The scores of Sinonasal Outcome Test (SNOT-22) Questionnaire were assessed in case (that received reconstruction with NSF) and control groups preoperatively as well as 1, 3, 6, and more than 12 months postoperatively. Nine most related sinonasal questions were evaluated separately (9Q). There were no significant inter-group differences in the mean SNOT-22, 9Q, and sense of taste/smell scores in preoperative and all postoperative assessments. Within each group, a significant improvement of SNOT-22 and 9Q scores were noted after 12 months of surgery compared to preoperative data. In the NSF group, comparison of the pre- and first postoperative evaluation revealed a significant deterioration in 9Q score ( p = 0.007) and 'sense of taste/smell' ( p < 0.001) which both returned to baseline in the 3rd month. Patients who used nasal paper mask for more than 100 'hour-days' showed a better SNOT-22 scores at 1st ( p = 0.04) and 3rd ( p < 0.001) months after surgery. Patients with adrenocorticotropic hormone (ACTH) secretory adenomas showed significantly higher scores of SNOT-22 in all postoperative assessments compared to the others. Although nasal symptoms deteriorated at first postoperative month (compare to preoperative data) in the NSF group, no negative impacts on the sinonasal QOL was showed comparing to the control group. ACTH-secreting adenomas could be assumed as a risk factor for poorer sinonasal QOL in EETSA. [ABSTRACT FROM AUTHOR]

Background: Nose is used as a corridor in endoscopic endonasal transsphenoidal approach (EETSA) for pituitary adenoma. Thus, it may affect the nasal airway patency, function and sinonasal-related quality of life. The aim of this study is to objectively and subjectively evaluate these effects. Methods: In this prospective study, 43 patients with pituitary adenoma who were candidates for EETSA from March 2012 to October 2013 were enrolled. The patients were evaluated preoperatively using acoustic rhinometry and rhinomanometry (with/without the use of decongestant drops) and asked to complete the 22-Item Sinonasal Outcome Test (SNOT-22) questionnaire. The tests were repeated at one and three months postoperatively. The preoperative data were compared with the first and second postoperative ones using paired-sample t-test. Results: Without the use of decongestant drops, the total airway resistance increased significantly (p=0.016), and the nasal airflow decreased significantly (p=0.031) in the first postoperative evaluation. However, in the 3rd postoperative month, the difference was not significant. With the use of decongestant drops, the objective parameters showed no significant changes compared to preoperative data even at the first evaluation. The SNOT- 22 scores also did not differ significantly in 1st and 3rd postoperative months. The first postoperative SNOT-22 showed a strong correlation with the second minimal cross-sectional area on simultaneous evaluation, and with the preoperative total airway resistance. Conclusion: EETSA has a transient adverse effect on the nasal patency that quickly improves, making it a safe approach for the sinonasal system. Rhinomanometry is the most sensitive test for detecting these nasal functional changes objectively. [ABSTRACT FROM AUTHOR]

McCune-Albright syndrome (MAS) is an uncommon polyostotic manifestation of fibrous dysplasia in association with at least one endocrinopathy that is mostly associated with precocious puberty and hyperpigmented skin macules named café-au-lait spots. We present an atypical manifestation of McCune-Albright syndrome in a 19-year-old man with the uncommon association of polyostotic fibrous dysplasia and gigantism in the absence of café-au-lait spots and precocious puberty. He presented with a height increase to 202 cm in the previous 3 years, which had become more progressive in the fewmonths prior. Physical examination revealed only a mild facial asymmetry; however, a computed tomography (CT) scan discovered vast areas of voluminous bones with ground-glass density and thickening involving the craniofacial bones and skull base. Magnetic resonance imaging (MRI) found a right stalk shift of the pituitary with a 20 mm pituitary adenoma. We describe the diagnostic and endoscopic endonasal transsphenoidal approach for excision of the tumor. [ABSTRACT FROM AUTHOR]

Background: Proposing a strategy for sellar reconstruction in endoscopic transsphenoidal transsellar approach for pituitary adenoma. Methods: 240 patients with pituitary adenoma underwent pure endoscopic endonasal transsphenoidal surgery. Intra-operative CSF leaks were classified as grade 0, no observable leak; grade 1, CSF dripping through an arachnoid membrane defect of less than 1 mm; and grade 2, CSF flowing through an arachnoid defect of more than 1 mm. Sellar reconstruction was performed according to our staging system; in stage I, the defect was covered with oxidized cellulose and sphenoid sinus filled up with Gelfoam. In stage II, a layer of fat was applied on the defect and fascia lata placed epidurally. In stage III, one or two layers of fascia were used with adding surgical glue and/or lumbar drainage. Mucosa of sphenoid sinuses was kept intact as much as possible and approximated at the end of procedure. Result: intra-operative CSF leaks grade 0, 1 and 2 resulted in 133(55.4%), 78 (32.5%) and 29(12.1%) patients, respectively. Stage I of reconstruction was used in 126 patients (52.5%) with no intra-operative CSF leak or sever prolapse of arachnoid membrane. Stage II was performed in 80 patients (33.3%) with either leak grade 1 (73 patients) or grade 0 with severe prolapse of the suprasellar components induced in the sella (2 cases) or in whom extra-pseudocapsular dissection performed (5 cases). Stage III was performed in 34 cases (14.2%) with either CSF leak grade 2 (29 patients) or grade 1 with simultaneous severe destruction or removal of sellar floor laterally, superiorly or inferiorly (5 patients) which made it impossible to place the fascia underlay to the bone. A minimum of 18 months follow-up showed development of 2 CSF leaks (0.8%), one pneumocephalus (0.4%) and 2 meningitis (0.8%) cases. Conclusion: Given the low postoperative CSF leak rate, we demonstrated that our adopted sellar reconstruction strategy focusing mostly on the adopted intra-operative CSF leak grading system is safe and useful for overcoming devastating complications like postoperative CSF leaks. [ABSTRACT FROM AUTHOR]