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Showkat Mirza - One of the best experts on this subject based on the ideXlab platform.
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Radiological features for the approach in trans-sphenoidal Pituitary Surgery
Pituitary, 2017Co-Authors: Victoria Twigg, Simon D. Carr, R. Balakumar, Saurabh Sinha, Showkat MirzaAbstract:Introduction In order to perform trans-sphenoidal endoscopic Pituitary Surgery safely and efficiently it is important to identify anatomical and Pituitary disease features on the pre-operative CT and MRI scans; thereby minimising the risk to surrounding structures and optimising outcomes. We aim to create a checklist to streamline pre-operative planning. Methods We retrospectively reviewed pre-operative CT and MRI scans of 100 adults undergoing trans-sphenoidal endoscopic Pituitary Surgery. Results Radiological findings and their incidence included deviated nasal septum (62%), concha bullosa (32%), bony dehiscence of the carotid arteries (18%), sphenoid septation overlying the internal carotid artery (24% at the sella) and low lying CSF (32%). The mean distance of the sphenoid ostium to the skull base was 10 mm (range 2.7–17.6 mm). We also describe the ‘teddy bear’ sign which when present on an axial CT indicates the carotid arteries will be identifiable intra-operatively. Conclusions There are significant variations in the anatomical and Pituitary disease features between patients. We describe a number of features on pre-operative scans and have devised a checklist including a new ‘teddy bear’ sign to aid the surgeon in the anatomical assessment of patients undergoing trans-sphenoidal Pituitary Surgery.
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Radiological features for the approach in trans-sphenoidal Pituitary Surgery.
Pituitary, 2017Co-Authors: Victoria Twigg, Simon D. Carr, R. Balakumar, Saurabh Sinha, Showkat MirzaAbstract:In order to perform trans-sphenoidal endoscopic Pituitary Surgery safely and efficiently it is important to identify anatomical and Pituitary disease features on the pre-operative CT and MRI scans; thereby minimising the risk to surrounding structures and optimising outcomes. We aim to create a checklist to streamline pre-operative planning. We retrospectively reviewed pre-operative CT and MRI scans of 100 adults undergoing trans-sphenoidal endoscopic Pituitary Surgery. Radiological findings and their incidence included deviated nasal septum (62%), concha bullosa (32%), bony dehiscence of the carotid arteries (18%), sphenoid septation overlying the internal carotid artery (24% at the sella) and low lying CSF (32%). The mean distance of the sphenoid ostium to the skull base was 10 mm (range 2.7–17.6 mm). We also describe the ‘teddy bear’ sign which when present on an axial CT indicates the carotid arteries will be identifiable intra-operatively. There are significant variations in the anatomical and Pituitary disease features between patients. We describe a number of features on pre-operative scans and have devised a checklist including a new ‘teddy bear’ sign to aid the surgeon in the anatomical assessment of patients undergoing trans-sphenoidal Pituitary Surgery.
Jean Anderson Eloy - One of the best experts on this subject based on the ideXlab platform.
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Examining the "July effect" on patients undergoing Pituitary Surgery.
International forum of allergy & rhinology, 2018Co-Authors: Bassel Bashjawish, Shreya Patel, Suat Kılıç, Wayne D. Hsueh, James K. Liu, Soly Baredes, Jean Anderson EloyAbstract:BACKGROUND Our aim in this study was to assess the impact of the turnover of residents in July on patients undergoing Pituitary Surgery. METHODS This work was a retrospective cohort study of cases from the National Inpatient Sample (NIS). Patients who underwent Pituitary Surgery from 2005 to 2012 were selected in the NIS. Patients undergoing Surgery in July and in non-July months were compared to determine differences in demographics, comorbidities, and complications. RESULTS Of the 12,939 patients, 1098 (8.5%) underwent Pituitary Surgery in July. Patients receiving Surgery in July had similar demographics and Agency for Healthcare Research and Quality comorbidity values compared with patients receiving Surgery in other months. There were no significant differences in mortality, cerebral edema, cerebrospinal fluid leakage, iatrogenic Pituitary complications, iatrogenic cerebrovascular accidents, urinary tract infections, pulmonary edema, pulmonary complications, or acute cardiac complications. There were no differences in the rate of postoperative fistulas, hematomas, perforations, or infections. The use of meningeal suturing, pedicled or free-flap reconstruction, and skin reconstruction was more frequent in July. Finally, hospitalization costs in July were similar to costs in other months. CONCLUSION The turnover of new residents in July showed no change in complication rates for patients undergoing Pituitary Surgery. Patient care in July is similar to care during other months, demonstrating that hospitals are adequately supervising surgical residents during this transition.
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Impact of postoperative pneumonia following Pituitary Surgery
The Laryngoscope, 2015Co-Authors: Stuti V. Desai, James K. Liu, Soly Baredes, Christina H. Fang, Milap D. Raikundalia, Jean Anderson EloyAbstract:Objectives/Hypothesis Postoperative pneumonia (PNA) has been identified as a preventable never event by the Centers for Medicare and Medicaid Services (CMS). The CMS has discussed possibly discontinuing reimbursement for this postoperative complication. In this study, risk factors, patient outcomes, and hospital charges of care associated with postoperative PNA in patients undergoing Pituitary Surgery were evaluated. Methods Discharge data of patients who underwent Pituitary Surgery between 2002 and 2010 were obtained from the National Inpatient Sample database. Demographics, preexisting comorbidities, postoperative complications, morbidity, length of hospital stay, and hospital charges were analyzed. Results A total of 15,317 patients were included in this analysis. Ninety-eight patients (0.6%) were diagnosed with PNA postoperatively. There was a significant association between postoperative PNA and older age (P
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Impact and cost of care of venous thromboembolism following Pituitary Surgery
The Laryngoscope, 2015Co-Authors: Eleonora F. Spinazzi, James K. Liu, Soly Baredes, Christina H. Fang, Milap D. Raikundalia, Morgan J. Pines, Jean Anderson EloyAbstract:Objectives/Hypothesis In 2008, the Centers for Medicare and Medicaid Services discontinued reimbursement for postoperative venous thromboembolism (VTE) events such as deep venous thrombosis and pulmonary embolism, citing them as preventable postoperative complications. We examined the impact of postoperative VTE on patients undergoing Pituitary Surgery. Methods The Nationwide Inpatient Sample (NIS) was evaluated for patients undergoing Pituitary resection from 2002 to 2010. Patient demographics, comorbidities, length of stay, hospital charges, and postoperative complications were analyzed. Results Eighty-seven patients who underwent Pituitary Surgery developed a VTE. Patients who underwent Pituitary Surgery that developed VTE were older (55.9 ± 15.2 years) than those who did not develop VTE (50.1 ± 17.2 years) (P = 0.002). VTE occurred at a significantly higher rate in patients with coagulopathy, peripheral vascular disorder, and weight loss (P
Edward R. Laws - One of the best experts on this subject based on the ideXlab platform.
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Image Guidance and Visualization in Pituitary Surgery
Image-Guided Neurosurgery, 2015Co-Authors: Ian F. Dunn, Edward R. LawsAbstract:The evolution of Pituitary Surgery parallels advances in cranial imaging. Access to deep-seated Pituitary lesions and avoidance of closely approximated neurovascular structures adjacent to the sella mandates precision. Subsequent generations of technologies, including fluoroscopy, CT, MRI, ultrasound, and metabolic nuclear imaging, provide complementary strategies for accurate diagnosis and localization. Importantly, the operating microscope and the endoscope have resulted in paradigm shifts in the surgical approach to Pituitary lesions. The management of large and complex Pituitary tumors may also be abetted by the increasing availability of intraoperative MRI suites. Further integration of biologic imaging strategies and maneuverable endoscopes will continue to enhance the safety and success of Pituitary Surgery for both functioning and nonfunctioning tumors.
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Image guidance in Pituitary Surgery.
Frontiers of hormone research, 2006Co-Authors: Ashok R. Asthagiri, Edward R. Laws, John A. JaneAbstract:Image guidance in Pituitary Surgery has evolved since diagnostic imaging of the sellar region was first introduced at the turn of the 20th century. These advances have played a key role in the decre
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Postoperative care following Pituitary Surgery
Journal of intensive care medicine, 2005Co-Authors: Aaron S. Dumont, Edward C. Nemergut, John A. Jane, Edward R. LawsAbstract:Patients undergoing Surgery for Pituitary tumors represent a heterogeneous population each with unique clinical, biochemical, radiologic, pathologic, neurologic, and/or ophthalmologic considerations. The postoperative management of patients following Pituitary Surgery often occurs in the context of a dynamic state of the hypothalamic-Pituitary-end organ axis. Consequently, a significant component of the postoperative care of these patients focuses on vigilant screening and observation for neuroendocrinologic perturbations such as varying degrees of hypopituitarism and disorders of water balance (diabetes insipidus and the syndrome of inappropriate antidiuretic hormone). Additionally, one must be cognizant of other potential complications specific to the transsphenoidal approach for tumor removal including cerebrospinal fluid leakage and meningitis. This review addresses the postoperative management of patients undergoing Pituitary Surgery with an emphasis on careful screening and recognition of complications.
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use of floseal hemostatic sealant in transsphenoidal Pituitary Surgery technical note
Neurosurgery, 2002Co-Authors: Dilantha B Ellegala, Nicholas Maartens, Edward R. LawsAbstract:OBJECTIVE Bleeding during transsphenoidal Pituitary Surgery can lead to a variety of operative difficulties. When the endonasal transsphenoidal approach is used, even mild intraoperative hemorrhage can lessen visibility in the confined operative field of view. This technical note describes the use o
Victoria Twigg - One of the best experts on this subject based on the ideXlab platform.
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Radiological features for the approach in trans-sphenoidal Pituitary Surgery
Pituitary, 2017Co-Authors: Victoria Twigg, Simon D. Carr, R. Balakumar, Saurabh Sinha, Showkat MirzaAbstract:Introduction In order to perform trans-sphenoidal endoscopic Pituitary Surgery safely and efficiently it is important to identify anatomical and Pituitary disease features on the pre-operative CT and MRI scans; thereby minimising the risk to surrounding structures and optimising outcomes. We aim to create a checklist to streamline pre-operative planning. Methods We retrospectively reviewed pre-operative CT and MRI scans of 100 adults undergoing trans-sphenoidal endoscopic Pituitary Surgery. Results Radiological findings and their incidence included deviated nasal septum (62%), concha bullosa (32%), bony dehiscence of the carotid arteries (18%), sphenoid septation overlying the internal carotid artery (24% at the sella) and low lying CSF (32%). The mean distance of the sphenoid ostium to the skull base was 10 mm (range 2.7–17.6 mm). We also describe the ‘teddy bear’ sign which when present on an axial CT indicates the carotid arteries will be identifiable intra-operatively. Conclusions There are significant variations in the anatomical and Pituitary disease features between patients. We describe a number of features on pre-operative scans and have devised a checklist including a new ‘teddy bear’ sign to aid the surgeon in the anatomical assessment of patients undergoing trans-sphenoidal Pituitary Surgery.
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Radiological features for the approach in trans-sphenoidal Pituitary Surgery.
Pituitary, 2017Co-Authors: Victoria Twigg, Simon D. Carr, R. Balakumar, Saurabh Sinha, Showkat MirzaAbstract:In order to perform trans-sphenoidal endoscopic Pituitary Surgery safely and efficiently it is important to identify anatomical and Pituitary disease features on the pre-operative CT and MRI scans; thereby minimising the risk to surrounding structures and optimising outcomes. We aim to create a checklist to streamline pre-operative planning. We retrospectively reviewed pre-operative CT and MRI scans of 100 adults undergoing trans-sphenoidal endoscopic Pituitary Surgery. Radiological findings and their incidence included deviated nasal septum (62%), concha bullosa (32%), bony dehiscence of the carotid arteries (18%), sphenoid septation overlying the internal carotid artery (24% at the sella) and low lying CSF (32%). The mean distance of the sphenoid ostium to the skull base was 10 mm (range 2.7–17.6 mm). We also describe the ‘teddy bear’ sign which when present on an axial CT indicates the carotid arteries will be identifiable intra-operatively. There are significant variations in the anatomical and Pituitary disease features between patients. We describe a number of features on pre-operative scans and have devised a checklist including a new ‘teddy bear’ sign to aid the surgeon in the anatomical assessment of patients undergoing trans-sphenoidal Pituitary Surgery.
Edward H. Oldfield - One of the best experts on this subject based on the ideXlab platform.
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effect of primary empty sella syndrome on Pituitary Surgery for cushing s disease
Journal of Neurosurgery, 2014Co-Authors: Edward H. Oldfield, Gautam U. Mehta, Kamran D BakhtianAbstract:Object Primary empty sella syndrome (ESS) results from herniation of arachnoid mater into the Pituitary fossa. It has been suggested to have a negative effect on Pituitary Surgery; however, outcomes in this cohort have not been defined. This study was performed to determine the effect of ESS on immediate and long-term biochemical outcome after Pituitary Surgery for Cushing's disease (CD). Methods Using a matched cohort study design, the authors followed patients treated with Pituitary Surgery for CD with and without ESS. Complete ESS was defined as Pituitary gland height ≤ 2 mm, whereas partial ESS was defined as Pituitary gland height > 2 mm but less than three-quarters of the total sellar depth. The primary end points were immediate and long-term biochemical outcome. Cerebrospinal fluid leaks were recorded as a secondary end point. Results Seventy-eight patients with CD and primary ESS were identified and matched with 78 patients with CD without ESS. After surgical management, immediate biochemical remi...
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Endoscopic versus microscopic Pituitary Surgery
Journal of neurology neurosurgery and psychiatry, 2013Co-Authors: Edward H. Oldfield, John A. JaneAbstract:In recent years, endoscopic approaches to the Pituitary and skull base are being used with increasing frequency for Pituitary tumours and other tumours originating in the anterior skull base. Ammirati and colleagues report the results of their meta-analysis comparing the results of the short-term outcome of Pituitary Surgery performed using a purely endoscopic approach versus a microscopic approach.1 They included comparison of mortality, extent of tumour removal and complications (cerebrospinal fluid leak, meningitis, vascular complications, visual complications, diabetes insipidus, hypopituitarism and cranial nerve injury) in their analysis. They conclude that the only significant difference with these two approaches is that the incidence of vascular injury was increased with endoscopic Surgery. The …
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The history of Pituitary Surgery for Cushing disease: Historical vignette
Journal of neurosurgery, 2011Co-Authors: Gautam U. Mehta, Russell R. Lonser, Edward H. OldfieldAbstract:Although he never performed a Pituitary operation for the disease, Harvey Cushing was the first to describe and treat patients with Cushing disease (CD). Other surgeons at the time were reluctant to operate on the Pituitary due to the normal sella on skull radiographs in CD and the unclear etiology of the disorder. To better define and understand factors influencing the history of Pituitary Surgery for CD, the authors analyzed historical texts related to CD biology, diagnosis, and treatment. Cushing's monograph on basophilic Pituitary adenomas and cortisol excess appeared in 1932. One year later in 1933, Alfred Pattison performed the first successful Pituitary operation for CD by implanting radon seeds in the sella. Resection of a Pituitary adenoma for CD was attempted 1 month later in 1933 by Howard Naffziger, resulting in only transient improvement that corresponded to the lack of tumor in the resected tissue. Soon thereafter, Susman in 1935 and Costello in 1936 described Pituitary basophilic adenomas at autopsy in patients without premorbid endocrinopathy. They concluded that the adrenal gland was the cause of CD, which resulted in a 3-decade abandonment of Pituitary Surgery for CD. Jules Hardy in 1963 used the operating microscope to perform the first selective removal of an adrenocorticotropic hormone (ACTH)-secreting microadenoma, which established a Pituitary cause and defined the modern treatment of CD. Subsequent reports by Hardy, Laws, and Wilson resulted in widespread acceptance of Pituitary Surgery for CD. Initial reluctance to operate on the Pituitary for CD was multifaceted and included general uncertainty surrounding the etiology of Cushing syndrome as well as a lack of early surgical success, both due to the small size of ACTH-secreting adenomas. Selective removal of ACTH-secreting adenomas identified the source of CD and ended the delay in acceptance of Pituitary Surgery for CD.
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Pathophysiology of hyponatremia after transsphenoidal Pituitary Surgery
Journal of neurosurgery, 1997Co-Authors: Beatriz R. Olson, Julie Gumowski, Domenica Rubino, Edward H. OldfieldAbstract:✓ Hyponatremia after Pituitary Surgery is presumed to be due to antidiuresis; however, detailed prospective investigations of water balance that would define its pathophysiology and true incidence have not been established. In this prospective study, the authors documented water balance in patients for 10 days after Surgery, monitored any sodium dysregulation, further characterized the pathophysiology of hyponatremia, and correlated the degree of intraoperative stalk and posterior Pituitary damage with water balance dysfunction. Ninety-two patients who underwent transsphenoidal Pituitary Surgery were studied. To evaluate posterior Pituitary damage, a questionnaire was completed immediately after Surgery in 61 patients. To examine the osmotic regulation of vasopressin secretion in normonatremic patients, water loads were administered 7 days after Surgery. Patients were categorized on the basis of postoperative plasma sodium patterns. After Pituitary Surgery, 25% of the patients developed spontaneous isolat...