HİPOFİZ ADENOMUNA ENDOSKOPİK ENDONAZAL TRANSSFENOİDAL CERRAHİ YAKLAŞIM

Giriş ve Amaç: Bu çalışmanın amacı; endoskopik endonazal transsfenoidal yaklaşımla hipofiz adenomu cerrahisi yapılan hasta sonuçlarımızı literatür eşliğinde tartışmaktır. Gereç ve Yöntem: Adana Şehir Eğitim ve Araştırma Hastanesi'nde 2017-2018 tarihleri arasında hipofiz adenomu nedeniyle cerrahi planlanan ve KBB kliniğimizin beyin ve sinir cerrahisi kliniği ile birlikte endoskopik endonazal transsfenoidal cerrahi yaptığı 30 hasta retrospektif olarak incelendi. Hastaların dosyaları incelenerek yaş, cinsiyet, başvuru şikayetleri, preoperatif laboratuvar ve görüntüleme bulguları, patoloji raporları, hastanede yatış süreleri, postoperatif komplikasyonlar, postoperatif laboratuvar ve görüntüleme bulguları değerlendirildi. Bulgular: Çalışmaya alınan 30 hastanın 19'u kadın, 11'i erkekti. Hastaların ortalama yaşı 43,86± 15,24 idi. Adenomların 24(%80) tanesi makroadenom, 6 (%20)'sı mikroadenomdu. Hastaların 26(%86,7)'sında total rezeksiyon saptanırken, 4 (%13,3) tanesinde rezidü doku saptandı. Fonksiyonel adenomların 15 (%78,9) tanesinde postoperatif hormonal remisyon sağlandığı, 4 (%21) tanesinde hormonal remisyon sağlanamadığı görüldü. Hastaların postoperatif geç dönemde çekilen MRG'lerinde 2 (%6,7) hastada nüks görüldü. Sonuç: Hipofiz adenomlarının cerrahi tedavisinde endoskopik endonazal transsfenoidal cerrahinin en etkili, çevre dokulara en az zarar veren ve ameliyat sırasında en iyi görüş sağlayan yöntem olduğu düşünülmektedir.

ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL SURGICAL APPROACH TO PITUITARY ADENOMA

Introduction: The aim of this study was to report the results of endoscopic endonasal transsphenoidal surgery of pituitary adenoma accompanied by literatures. Material and Methods: Thirty patients who underwent endoscopic endonasal transsphenoidal surgery due to pituitary adenoma at Adana City Training and Research Hospital between the years 2017-2018 were evaluated retrospectively. The age, gender, presenting symptoms, preoperative laboratory and imaging findings, pathology reports, length of hospital stay, postoperative complications, postoperative laboratory and imaging findings were evaluated. Results: Thirty patients were included in the study; 19 (63,3%) of patients were female and 11 (36,7%) were male. The mean age of the patients was 43.86±15.24 years. Twentyfour (80%) of the adenomas were macroadenomas and 6 (20%) were microadenomas. Total resection was found in 26 (86,7%) patients and subtotal resection was found in 4 (13,3%) of all patients. Postoperative hormonal remission was achieved in 15 (78,9%) of the functional adenomas. Recurrent tumour growth was observed in 2 (6,7%) of patients. Conclusion: Endoscopic endonasal transsphenoidal surgery is considered to be the most effective technique, the least damaging to the surrounding tissues and providing the best vision during the surgical treatment of pituitary adenomas.

Kaynakça

1. Tascıoğlu B, Basar R. Sellar Bolgenin ve Hipofiz Bezinin Anatomisi. 1. Baskı. Editor: Ziyal Erbas T. Hipofiz Adenomları, Hacettepe Universitesi Yayınları, Ankara, 2008; pp12-21.

2. Central Brain Tumor Registry of the United States (CBTRUS). Statistical Report:Primary Brain and Central Nervous System Tumors Diagnosed in the United States, 2008-2012.

3. Jagaan-than J, Dumant AS, Jane JA Jr. Diagnosis and management of pediatrik sellar lesion. Front-Horm Res. 2006; 34: 83-104.

4. Wilson CB. Extensive personal experience "surgical management of pituitary tumors'. Journal of Clin Endocrinol and Metab, May 1997; Vol: 82, No:8.

5. Jho HD, Carrau RL, Ko Y, et al. Endoscopic pituitary surgery: An early experience. Surg Neurol 1997; 47: 213-222.

6. Jain A K, Gupta AK, Pathak A, Bhansali A, Bapuraj J R. Excision of pituitary adenomas: randomized comparison of surgical modalities. British Journal of Neurosurgery 2007; 21: 4; 328- 331.

7. Fries G, Perneczky A. Intracranial endoscopy. Adv Tech Stand Neurosurg 1999; 25:21-60.

8. Cappabianca P, Alfieri A, de Divitiis E. Endoscopic endonasal transsphenoidal approach to the sella: Towards functional endoscopic pituitary surgery (FEPS). Minim Invasive Neurosurg 1998; 41:66-73.

9. Dusick Jr, Esposito F, Kelly DF, Cohan P, DeSalles A, Becker DP, et al. The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors. J Neurosurg 2005; 102: 832-41.

10 . Higgins TS, Courtemanche C, Karakla D, Strasnick B, Singh RV, Koen Jl, et al. Analysis of transsphenoidal endoscopic versus transsphenoidal microscopic approach for excision of pituitary tumors. Am J Rhinol 2008; 22(6): 649-52.

11. O'Malley BW Jr, Grady MS, Gabel BC, Cohen MA, Heuer GG, Pisapia J, et al. Comparison of endoscopic and microscopic removal of pituitary adenomas: Single-surgeon experience and the learning curve. Neurosurg Focus 2008; 25(6):E10.

12. Gondim JA, Schops M, de Almeida JP, de Albuquerque LA, Gomes E, Ferraz T, Barroso FA. Endoscopic endonasal transsphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center. Pituitary 2010; 13(1): 68-77.

13. Cappabianca P, Cavallo LM, de Divitiis E. Endoscopic endonasal transsphenoidal surgery. Neurosurgery 2004 Oct; 55(4): 933-40.

14. Tabaee A, Anand VK, Baron Y, Hiltzik DH, Brown SM, Kacker A, et al. Endoscopic pituitary surgery: A systematic review and meta-analysis. J Neurosurg 2009; 111: 545-54.

15. Jho HD. Endoscopic pituitary surgery. Pituitary 1999; 2:139-54.

16. Kabil MS, Eby JB, Shahinian HK. Fully endoscopic endonasal vs. transseptal transsphenoidal pituitary surgery. Minim Invasive Neurosurg 2005; 48: 348-54.

17. Kiraz M, Günaldı Ö, Tanrıverdi O, Kına H. Endoskopik endonasal transsfenoidal cerrahi yüz olgunun retrospektif değerlendirilmesi. Journal of Nervous System Surgery 5 (1), 1-7

18. Zervas NT. Surgical result for pituitary adenomas: Result of international survey. In Black PM, Zervas NT, Ridgeway EC, Martin J (eds): Secretory Tumors of the Pituitary Gland. New York, Raven Press 1984; pp 377-385.

19. Gao Y, Zhong C, Wang Y, Xu S, Guo Y, Dai C, Zheng Y, Wang Y, Luo Q, Jiang J. Endoscopic versus microscopic transsphenoidal pituitary adenoma surgery: a meta-analysis.World Journal of Surgical Oncology 2014; 12: 94.

20. Agam MS, Wedemeyer MA, Wrobel B, Weiss MH, Carmichael JD, Zada G. Complications associated with microscopic and endoscopic transsphenoidal pituitary surgery: experience of 1153 consecutive cases treated at a single tertiary care pituitary center. Journal of neurosurgery 2018; 130(5):1576-1583.

21. Ciric I, Ragin A, Baumgartner C, Pierce D. Complications of transsphenoidal surgery: Results of a national survey, review of the literature, and personal experience. Neurosurgery 1997; 40:225- 236.

22. Goudakos JK, Markou KD, Georgalas C. Endoscopic versus microscopic trans-sphenoidal pituitary surgery: a systematic review and meta-analysis. Clinical Otolaryngology 2011; 36(3): 212-220.

23. Wang F, Zhou T, Wei S, Meng X, Zhang J, Hou Y, Sun G. Endoscopic endonasal transsphenoidal surgery of 1166 pituitary adenomas. Surg Endosc 2015; 29:1270-1280.

24. Guo-Dong H, Tao J, Ji-Hu Y, Wen-Jian Z, Xie-Jun Z, Jian G, ... & Wenlan, L. Endoscopic versus microscopic transsphenoidal surgery for pituitary tumors. Journal of Craniofacial Surgery 2016; 27(7):e648-e655.

25. Guvenc G, Kizmazoglu C, Pinar E, Imre A, Kaya I, Bezircioglu H, Yuceer N. Outcomes and complications of endoscopic versus microscopic transsphenoidal surgery in pituitary adenoma. Journal of Craniofacial Surgery 2016; 27(4):1015-1020.

26. Cappabianca P, Cavallo LM, Colao A, et al. Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 2002; 97:293-298.

27. Cappabianca P, Cavallo LM, Colao A, et al. Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg 2002; 45:193-200.

28. Wilson CB. A decade of pituitary microsurgery the Herbert olivecrona lecture. J Neurosurg1984; 61: 814-833.

29. DeKlotz TR, Chia SH, Lu W, Makambi KH, Aulisi E, Deeb Z. Meta-Analysis of endoscopic versus sublabial pituitary surgery. Laryngoscope 2012 Mar; 122(3):511-8.

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