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Edward R Laws - One of the best experts on this subject based on the ideXlab platform.
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readmission and other adverse events after Transsphenoidal Surgery prevalence timing and predictive factors
Journal of The American College of Surgeons, 2017Co-Authors: David J Cote, Hasan A Zaidi, Ian F Dunn, Hormuz H Dasenbrock, Ivo S Muskens, Marike L D Broekman, Timothy R Smith, Edward R LawsAbstract:Background Transsphenoidal Surgery is a common neurosurgical procedure for accessing the pituitary and anterior skull base, yet few multicenter analyses have evaluated outcomes after this procedure. Study Design Patients undergoing Transsphenoidal Surgery from 2006 to 2015 were extracted from the American College of Surgeons NSQIP database. Logistic regression was used to identify predictors of 30-day complications. Results Of 1,240 patients included in this analysis, 6.9% experienced a major complication, and 9.4% experienced any complication within 30 days. Other adverse events included death in 0.7% and nonroutine hospital discharge in 5.3%. Most adverse events occurred within the first 2 weeks postoperatively; 82.9% of patients experienced their first complication during the initial hospital stay. Multivariable analysis demonstrated that predictors of hospital stay longer than 4 days included American Society of Anesthesiologists classification III to V (p = 0.015), insulin-dependent diabetes mellitus (p Conclusions Overall rates of adverse events in patients undergoing Transsphenoidal Surgery are relatively low, and most occur before discharge from the hospital. Post-discharge complications associated with Transsphenoidal Surgery include deep vein thrombosis, pulmonary embolism, and urinary tract infection. Delayed postoperative cerebrospinal fluid leak is the major cause of reoperation, and hyponatremia is the major cause of readmission.
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time course of symptomatic recovery after endoscopic Transsphenoidal Surgery for pituitary adenoma apoplexy in the modern era
World Neurosurgery, 2016Co-Authors: Hasan A Zaidi, David J Cote, William T Burke, Joseph P Castlen, Wenya Linda Bi, Edward R Laws, Ian F DunnAbstract:Background Pituitary tumor apoplexy can result from either hemorrhagic or infarctive expansion of pituitary adenomas, and the related mass effect can result in compression of critical neurovascular structures. The time course of recovery of visual field deficits, headaches, ophthalmoparesis, and pituitary dysfunction after endoscopic Transsphenoidal Surgery has not been well established. Methods Medical records were retrospectively reviewed for all patients who underwent endoscopic Transsphenoidal Surgery for pituitary tumor apoplexy from April 2008 to November 2014. Results Of 578 patients who underwent Transsphenoidal Surgery, pituitary tumor apoplexy was identified in 44 patients (7.6%). Two patients had prior Surgery, leaving 42 patients for final analysis. These included infarction-related apoplexy in 7 (14.4%) patients, and hemorrhagic apoplexy in 35 (85.6%) patients. Hemorrhagic adenomas had a larger axial tumor diameter than patients with infarctive adenomas (4.4 ± 4.1 cm vs. 1.8 ± 0.8 cm; P P n = 37) and/or visual disturbances ( n = 22) had complete resolution of symptoms at last follow-up, whereas 83.3% of patients who presented with ophthalmoplegia experienced resolution. Endocrinologic dysfunction remained relatively consistent after Surgery. Conclusions Endoscopic Transsphenoidal Surgery can provide durable resolution of symptoms for patients presenting with pituitary tumor apoplexy. Recovery from headaches, visual, and pituitary dysfunction may be more rapid compared with ophthalmoparesis.
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Transsphenoidal Surgery for rathke s cleft cyst can reduce headache severity and frequency
Pituitary, 2016Co-Authors: David J Cote, Timothy R Smith, Maher M Hulou, Benjamin D Besasie, Sandra C Yan, Edward R LawsAbstract:Purpose The purpose of this study was to determine the effect of Transsphenoidal Surgery for Rathke’s cleft cyst (RCC) on headache frequency, severity, and duration.
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Transsphenoidal Surgery for rathke s cleft cyst can reduce headache severity and frequency
Pituitary, 2016Co-Authors: David J Cote, Timothy R Smith, Maher M Hulou, Benjamin D Besasie, Sandra C Yan, Edward R LawsAbstract:The purpose of this study was to determine the effect of Transsphenoidal Surgery for Rathke’s cleft cyst (RCC) on headache frequency, severity, and duration. The medical records of 43 consecutive patients who underwent Transsphenoidal resection of a pathologically-proven RCC at our institution by the senior author (E.R.L.) between April 2008 and April 2014 were reviewed. Patients were called by telephone and asked to answer questions about the severity, location, type, duration, and quality of their headaches, both pre- and post-operatively. This information was joined with detailed data collected directly from each patient’s medical record regarding headaches upon presentation and at 1-week, 6-week, 3-month, and annual post-operative appointments. Twenty-three patients (53 %) responded to our telephone survey after repeated attempts at contact. Median follow-up was 64 months (range 6–83 months). Of these patients, 19 (82.6 %) reported pre-operative headaches, compared to 12 (52.2 %) who reported post-operative headaches (OR = 1.75, p = 0.02). Average headache severity on a 1–10 scale decreased from 6.4 (SD = 2.0) pre-operatively to 3.4 (SD = 1.9) post-operatively (p = 0.006), while average maximum severity decreased from 8.6 (SD = 2.2) pre-operatively to 4.0 (SD = 3.3) post-operatively (p < 0.001). The frequency of headaches also decreased, from 18.1 (SD = 12.6) per month pre-operatively to 3.7 (SD = 8.4) per month post-operatively (p < 0.001). Overall, 14 patients (60.9 %) reported improvement in their headaches, and three patients (13.0 %) reported that their headaches had completely resolved. In a carefully selected patient population, Transsphenoidal Surgery for RCC can reduce headache monthly frequency, average typical severity, and average maximum severity with minimal risk of morbidity or mortality.
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endoscopic Transsphenoidal Surgery for acromegaly remission using modern criteria complications and predictors of outcome
The Journal of Clinical Endocrinology and Metabolism, 2011Co-Authors: John A Jane, Edward R Laws, Robert M Starke, Spencer C Payne, Mohamed A Elzoghby, Davis L Reames, M O Thorner, John C Marshall, Mary Lee VanceAbstract:Context: Despite the growing application of endoscopic Transsphenoidal Surgery (ETSS), outcomes for GH adenomas are not clearly defined. Objective: We reviewed our experience with ETSS with specific interest in remission rates using the 2010 consensus criteria, predictors of remission, and associated complications. Design and Setting: This was a retrospective single institution study. Patients, Interventions, and Outcome Measures: Sixty acromegalic patients who underwent ETSS were identified. Remission was defined as a normal IGF-I and either a suppressed GH less than 0.4 ng/ml during an oral glucose tolerance test or a random GH less than 1.0 ng/ml. Results: Remission was achieved in all 14 microadenomas and 28 of 46 macroadenomas (61%). Tumor size, age, gender, and history of prior Surgery were not predictive on multivariant analysis. In hospital postoperative morning GH levels less than 2.5 ng/ml provided the best prediction of remission (P < 0.001). Preoperative variables predictive of remission inclu...
Michael Buchfelder - One of the best experts on this subject based on the ideXlab platform.
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follow up and long term outcome of nonfunctioning pituitary adenoma operated by Transsphenoidal Surgery with intraoperative high field magnetic resonance imaging
Acta Neurochirurgica, 2014Co-Authors: Sven Berkmann, Christopher Nimsky, Rudolf Fahlbusch, Sven Schlaffer, Michael BuchfelderAbstract:Background Intraoperative MRI (iMRI) increases gross total resection (GTR) rates in Transsphenoidal Surgery; however, long-term follow-up data is lacking. The objective is to assess the outcome of patients with nonfunctioning pituitary adenomas (NFA) at a mean follow-up of > 5 years.
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factors influencing the immediate and late outcome of cushing s disease treated by Transsphenoidal Surgery a retrospective study by the european cushing s disease survey group
The Journal of Clinical Endocrinology and Metabolism, 1995Co-Authors: D Bochicchio, Marco Losa, Michael BuchfelderAbstract:Hypercortisolism attributable to hypersecretion of ACTH by a pituitary adenoma is an uncommon and progressively lethal disease. Because of its rarity, it has been difficult to collect a large series of patients in order to identify the prognostic factors influencing the outcome after Transsphenoidal Surgery. We conducted a multicenter, retrospective analysis of the early and late results of surgical treatment of Cushing's disease. Files of patients with Cushing's disease who underwent Transsphenoidal Surgery between 1975 and 1990 were collected from 25 institutions throughout Europe. Data from 668 of 716 patients were suitable for statistical analyses. Surgical mortality was 1.9%, and major morbidity occurred in 97 patients (14.5%). Clinical and biochemical remission of Cushing's disease after Surgery occurred in 510 cases (76.3%). Identification of the tumor by neuroradiological imaging or at operation with histopathological corroboration was associated with remission of hypercortisolism. Recurrence of the disease occurred in 65 (12.7%) of 510 patients in remission after Surgery at a mean time of 39.3 months (range 6-104 months). The distribution of the recurrences did not show any apparent plateau or cluster throughout the follow-up period. Low postoperative steroid levels, absence of cortisol response to CRH, and the need for long-term glucocorticoid substitution therapy were all associated with a high probability of long-term remission. Our study demonstrates that Transsphenoidal Surgery is a safe and effective treatment for patients with Cushing's disease. However, after successful Surgery there is a steady increase in the percentage of recurrences, which continues with time. Patients who after operation had hypoadrenocorticism and needed long-term glucocorticoid substitution therapy had the lowest risk of relapse.
David J Cote - One of the best experts on this subject based on the ideXlab platform.
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gross total resection of pituitary adenomas after endoscopic vs microscopic Transsphenoidal Surgery a meta analysis
Acta Neurochirurgica, 2018Co-Authors: David J Cote, Ivo S Muskens, Reem Almutairi, Mark D Dijkman, Vasileios K Kavouridis, Erin Crocker, Kholoud Ghazawi, Marike L D BroekmanAbstract:Background Microscopic Transsphenoidal Surgery (mTSS) is a well-established method to address adenomas of the pituitary gland. Endoscopic Transsphenoidal Surgery (eTSS) has become a viable alternative, however. Advocates suggest that the greater illumination, panoramic visualization, and angled endoscopic views afforded by eTSS may allow for higher rates of gross total tumor resection (GTR). The aim of this meta-analysis was to determine the rate of GTR using mTSS and eTSS.
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gross total resection of pituitary adenomas after endoscopic vs microscopic Transsphenoidal Surgery a meta analysis
Acta Neurochirurgica, 2018Co-Authors: David J Cote, Ivo S Muskens, Mark D Dijkman, Vasileios K Kavouridis, Erin Crocker, Kholoud Ghazawi, Reem D Almutairi, Marike L D BroekmanAbstract:Microscopic Transsphenoidal Surgery (mTSS) is a well-established method to address adenomas of the pituitary gland. Endoscopic Transsphenoidal Surgery (eTSS) has become a viable alternative, however. Advocates suggest that the greater illumination, panoramic visualization, and angled endoscopic views afforded by eTSS may allow for higher rates of gross total tumor resection (GTR). The aim of this meta-analysis was to determine the rate of GTR using mTSS and eTSS. A meta-analysis of the literature was conducted using PubMed, EMBASE, and Cochrane databases through July 2017 in accordance with PRISMA guidelines. Seventy case series that reported GTR rate in 8257 pituitary adenoma patients were identified. For all pituitary adenomas, eTSS (GTR=74.0%; I2 = 92.1%) was associated with higher GTR as compared to mTSS (GTR=66.4%; I2 = 84.0%) in a fixed-effect model (P-interaction 0.05). No significant publication bias was identified for any of the outcomes. Among patients who were not randomly allocated to either approach, eTSS resulted in a higher rate of GTR as compared to mTSS for all patients and for NFPA patients alone, but only in a fixed-effect model. For FPA, however, eTSS did not seem to offer a significantly higher rate of GTR. These conclusions should be interpreted with caution because of the nature of the included non-comparative studies.
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readmission and other adverse events after Transsphenoidal Surgery prevalence timing and predictive factors
Journal of The American College of Surgeons, 2017Co-Authors: David J Cote, Hasan A Zaidi, Ian F Dunn, Hormuz H Dasenbrock, Ivo S Muskens, Marike L D Broekman, Timothy R Smith, Edward R LawsAbstract:Background Transsphenoidal Surgery is a common neurosurgical procedure for accessing the pituitary and anterior skull base, yet few multicenter analyses have evaluated outcomes after this procedure. Study Design Patients undergoing Transsphenoidal Surgery from 2006 to 2015 were extracted from the American College of Surgeons NSQIP database. Logistic regression was used to identify predictors of 30-day complications. Results Of 1,240 patients included in this analysis, 6.9% experienced a major complication, and 9.4% experienced any complication within 30 days. Other adverse events included death in 0.7% and nonroutine hospital discharge in 5.3%. Most adverse events occurred within the first 2 weeks postoperatively; 82.9% of patients experienced their first complication during the initial hospital stay. Multivariable analysis demonstrated that predictors of hospital stay longer than 4 days included American Society of Anesthesiologists classification III to V (p = 0.015), insulin-dependent diabetes mellitus (p Conclusions Overall rates of adverse events in patients undergoing Transsphenoidal Surgery are relatively low, and most occur before discharge from the hospital. Post-discharge complications associated with Transsphenoidal Surgery include deep vein thrombosis, pulmonary embolism, and urinary tract infection. Delayed postoperative cerebrospinal fluid leak is the major cause of reoperation, and hyponatremia is the major cause of readmission.
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time course of symptomatic recovery after endoscopic Transsphenoidal Surgery for pituitary adenoma apoplexy in the modern era
World Neurosurgery, 2016Co-Authors: Hasan A Zaidi, David J Cote, William T Burke, Joseph P Castlen, Wenya Linda Bi, Edward R Laws, Ian F DunnAbstract:Background Pituitary tumor apoplexy can result from either hemorrhagic or infarctive expansion of pituitary adenomas, and the related mass effect can result in compression of critical neurovascular structures. The time course of recovery of visual field deficits, headaches, ophthalmoparesis, and pituitary dysfunction after endoscopic Transsphenoidal Surgery has not been well established. Methods Medical records were retrospectively reviewed for all patients who underwent endoscopic Transsphenoidal Surgery for pituitary tumor apoplexy from April 2008 to November 2014. Results Of 578 patients who underwent Transsphenoidal Surgery, pituitary tumor apoplexy was identified in 44 patients (7.6%). Two patients had prior Surgery, leaving 42 patients for final analysis. These included infarction-related apoplexy in 7 (14.4%) patients, and hemorrhagic apoplexy in 35 (85.6%) patients. Hemorrhagic adenomas had a larger axial tumor diameter than patients with infarctive adenomas (4.4 ± 4.1 cm vs. 1.8 ± 0.8 cm; P P n = 37) and/or visual disturbances ( n = 22) had complete resolution of symptoms at last follow-up, whereas 83.3% of patients who presented with ophthalmoplegia experienced resolution. Endocrinologic dysfunction remained relatively consistent after Surgery. Conclusions Endoscopic Transsphenoidal Surgery can provide durable resolution of symptoms for patients presenting with pituitary tumor apoplexy. Recovery from headaches, visual, and pituitary dysfunction may be more rapid compared with ophthalmoparesis.
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predictors and rates of delayed symptomatic hyponatremia after Transsphenoidal Surgery a systemastic review
World Neurosurgery, 2016Co-Authors: David J Cote, Hasan A Zaidi, Abdulaziz Ibrahim Alzarea, Michael Acosta, Maher M Hulou, Kevin T Huang, Hamoud Almutairi, Ahmad Alharbi, Majed Algrani, Ahmad AlatawiAbstract:Background Delayed symptomatic hyponatremia (DSH) is a known complication of Transsphenoidal Surgery that can lead to prolonged hospital stay, readmission, and in rare cases, death. Many potential predictors for development of DSH have been investigated. A better understanding of DSH risk can lead to better patient outcomes. We performed a systematic review to determine the rates and predictors of DSH after both endoscopic Transsphenoidal Surgery and microscopic Transsphenoidal Surgery. Methods A systematic search of the literature was conducted using MEDLINE/PUBMED, EMBASE, and Cochrane databases. Inclusion criteria were 1) case series with at least 10 cases reported, 2) adult patients who underwent eTSS or mTSS for pituitary tumors, and 3) reported occurrence of DSH (defined as serum sodium level Results Ten case series satisfied the inclusion criteria for a total of 2947 patients. Various factors including age, gender, cerebrospinal fluid leak, and tumor size were investigated as potential predictors of DSH. DSH event rates for both mTSS and eTSS fell between around 4 and 12 percent and included a variety of proposed predictors. Conclusions Age, gender, tumor size, rate of decline of blood sodium, and Cushing disease are potential predictors of DSH. By identifying patients at high risk for DSH, preventative efforts can be implemented in the perioperative setting to reduce the incidence of potentially catastrophic hyponatremia following Transsphenoidal Surgery.
Andrew S Little - One of the best experts on this subject based on the ideXlab platform.
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pituitary gland recovery following fully endoscopic Transsphenoidal Surgery for nonfunctioning pituitary adenoma results of a prospective multicenter study
Journal of Neurosurgery, 2019Co-Authors: Andrew S Little, Daniel M Prevedello, Garni Barkhoudarian, Paul A Gardner, Juan C Fernandezmiranda, Michael R Chicoine, Kevin C J Yuen, Daniel F KellyAbstract:OBJECTIVE: Recovery from preexisting hypopituitarism after Transsphenoidal Surgery for pituitary adenoma is an important outcome to investigate. Furthermore, pituitary function has not been thoroughly evaluated after fully endoscopic Surgery, and benchmark outcomes have not been clearly established. Here, the authors characterize pituitary gland outcomes with a focus on gland recovery following endoscopic Transsphenoidal removal of clinically nonfunctioning adenomas. METHODS: This multicenter prospective study was conducted at 6 US pituitary centers among adult patients with nonfunctioning pituitary macroadenomas who had undergone endoscopic endonasal pituitary Surgery. Pituitary gland function was evaluated 6 months after Surgery. RESULTS: The 177 enrolled patients underwent fully endoscopic Transsphenoidal Surgery; 169 (95.5%) of them were available for follow-up. Ninety-five (56.2%) of the 169 patients had had a preoperative deficiency in at least one hormone axis, and 20/95 (21.1%) experienced recovery in at least one axis at the 6-month follow-up. Patients with adrenal insufficiency were more likely to recover (10/34 [29.4%]) than were those with hypothyroidism (8/72 [11.1%]) or male hypogonadism (5/50 [10.0%]). At the 6-month follow-up, 14/145 (9.7%) patients had developed at least one new deficiency. The study did not identify any predictors of gland recovery (p ≥ 0.20). Permanent diabetes insipidus was observed in 4/166 (2.4%) patients. Predictors of new gland dysfunction included a larger tumor size (p = 0.009) and Knosp grade 3 and 4 (p = 0.051). CONCLUSIONS: Fully endoscopic pituitary Surgery resulted in improvement of pituitary gland function in a substantial minority of patients. The deficiency from which patients were most likely to recover was adrenal insufficiency. Overall rates of postoperative permanent diabetes insipidus were low. This study provides multicenter benchmark neuroendocrine clinical outcome data for the endoscopic technique.
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delayed hyponatremia is the most common cause of 30 day unplanned readmission after Transsphenoidal Surgery for pituitary tumors
Neurosurgery, 2016Co-Authors: Michael A Bohl, William L. White, Shah Ahmad, Heidi Jahnke, Deborah Shepherd, Laura Knecht, Andrew S LittleAbstract:Background Unplanned readmission after surgical procedures is an important quality metric. Yet, readmission rates and causes have not been evaluated for patients after Transsphenoidal Surgery for pituitary tumors. Objective To analyze unplanned 30-day readmissions at a pituitary center and to encourage the development of effective clinical pathways to prevent readmission. Methods A retrospective review of adult patients who underwent Transsphenoidal Surgery for pituitary lesions at Barrow Neurological Institute (January 2011-March 2014) was performed to identify causes of unplanned readmission within 30 days of Surgery. Patient demographics, tumor details, surgical complications, and endocrine function were documented. Results Of 303 patients who had Transsphenoidal Surgery, 27 (8.9%) were readmitted within 30 days. Most of the 27 (15 [55.6%]) had delayed hyponatremia. Other causes were diabetes insipidus (4 [14.8%]), adrenal insufficiency (2 [7.4%]), and cerebrospinal fluid leak, epistaxis, cardiac arrhythmia, pneumonia, urinary tract infection, and hypoglycemia (1 each [3.7%]). Outpatient sodium screening was performed as needed. In cases of hyponatremia, the mean postoperative day of readmission was day 8 (range, 6-12 days) and the mean serum sodium was 119 mmol/L (range, 111-129 mmol/L). Numerous patient and surgical factors were examined, and no specific predictors of readmission were identified. We developed an outpatient care pathway for managing hyponatremia with the goal of improving readmission rates. Conclusion This study establishes a quality benchmark for readmission rates after Transsphenoidal Surgery for pituitary lesions and identifies delayed hyponatremia as the primary cause. Implementation of an outpatient care pathway for managing hyponatremia may improve readmission rates.
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comparison of sinonasal quality of life and health status in patients undergoing microscopic and endoscopic Transsphenoidal Surgery for pituitary lesions a prospective cohort study
Journal of Neurosurgery, 2015Co-Authors: Andrew S Little, Daniel M Prevedello, Heidi Jahnke, Daniel F Kelly, John Milligan, Chester F Griffiths, Ricardo L Carrau, Gail Rosseau, Garni Barkhoudarian, Charlene ChalonerAbstract:OBJECT Despite the widespread adoption of endoscopic Transsphenoidal Surgery for pituitary adenomas, the sinonasal quality of life (QOL) and health status in patients who have undergone this technique have not been compared with these findings in patients who have undergone the traditional direct uninostril microsurgical technique. In this study, the authors compared the sinonasal QOL and patient-reported health status after use of these 2 surgical techniques. METHODS The study design was a nonblinded prospective cohort study. Adult patients with sellar pathology and planned Transsphenoidal Surgery were screened at 4 pituitary centers in the US between October 2011 and August 2013. The primary end point of the study was postoperative patient-reported sinonasal QOL as measured by the Anterior Skull Base Nasal Inventory–12 (ASK Nasal-12). Supplementary end points included patient-reported health status estimated by the 8-Item Short Form Health Survey (SF-8) and EuroQol (EQ)-5D-5L instruments, and sinonasal ...
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predictors of sinonasal quality of life and nasal morbidity after fully endoscopic Transsphenoidal Surgery
Journal of Neurosurgery, 2015Co-Authors: Andrew S Little, Daniel M Prevedello, Daniel F Kelly, John Milligan, Chester F Griffiths, Ricardo L Carrau, Gail Rosseau, Garni Barkhoudarian, Bradley A Otto, Heidi JahnkeAbstract:OBJECT Despite the increasing application of endoscopic Transsphenoidal Surgery for pituitary lesions, the prognostic factors that are associated with sinonasal quality of life (QOL) and nasal morbidity are not well understood. The authors examine the predictors of sinonasal QOL and nasal morbidity in patients undergoing fully endoscopic Transsphenoidal Surgery. METHODS An exploratory post hoc analysis was conducted of patients who underwent endoscopic pituitary Surgery and were enrolled in a prospective multicenter QOL study. End points of the study included patient-reported sinonasal QOL and objective nasal endoscopy findings. Multivariate models were developed to determine the patient and surgical factors that correlated with QOL at 2 weeks through 6 months after Surgery. RESULTS This study is a retrospective review of a subgroup of patients studied in the clinical trial “Rhinological Outcomes in Endonasal Pituitary Surgery” (clinical trial no. NCT01504399, clinicaltrials.gov). Data from 100 patients w...
Daniel M Prevedello - One of the best experts on this subject based on the ideXlab platform.
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pituitary gland recovery following fully endoscopic Transsphenoidal Surgery for nonfunctioning pituitary adenoma results of a prospective multicenter study
Journal of Neurosurgery, 2019Co-Authors: Andrew S Little, Daniel M Prevedello, Garni Barkhoudarian, Paul A Gardner, Juan C Fernandezmiranda, Michael R Chicoine, Kevin C J Yuen, Daniel F KellyAbstract:OBJECTIVE: Recovery from preexisting hypopituitarism after Transsphenoidal Surgery for pituitary adenoma is an important outcome to investigate. Furthermore, pituitary function has not been thoroughly evaluated after fully endoscopic Surgery, and benchmark outcomes have not been clearly established. Here, the authors characterize pituitary gland outcomes with a focus on gland recovery following endoscopic Transsphenoidal removal of clinically nonfunctioning adenomas. METHODS: This multicenter prospective study was conducted at 6 US pituitary centers among adult patients with nonfunctioning pituitary macroadenomas who had undergone endoscopic endonasal pituitary Surgery. Pituitary gland function was evaluated 6 months after Surgery. RESULTS: The 177 enrolled patients underwent fully endoscopic Transsphenoidal Surgery; 169 (95.5%) of them were available for follow-up. Ninety-five (56.2%) of the 169 patients had had a preoperative deficiency in at least one hormone axis, and 20/95 (21.1%) experienced recovery in at least one axis at the 6-month follow-up. Patients with adrenal insufficiency were more likely to recover (10/34 [29.4%]) than were those with hypothyroidism (8/72 [11.1%]) or male hypogonadism (5/50 [10.0%]). At the 6-month follow-up, 14/145 (9.7%) patients had developed at least one new deficiency. The study did not identify any predictors of gland recovery (p ≥ 0.20). Permanent diabetes insipidus was observed in 4/166 (2.4%) patients. Predictors of new gland dysfunction included a larger tumor size (p = 0.009) and Knosp grade 3 and 4 (p = 0.051). CONCLUSIONS: Fully endoscopic pituitary Surgery resulted in improvement of pituitary gland function in a substantial minority of patients. The deficiency from which patients were most likely to recover was adrenal insufficiency. Overall rates of postoperative permanent diabetes insipidus were low. This study provides multicenter benchmark neuroendocrine clinical outcome data for the endoscopic technique.
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comparison of sinonasal quality of life and health status in patients undergoing microscopic and endoscopic Transsphenoidal Surgery for pituitary lesions a prospective cohort study
Journal of Neurosurgery, 2015Co-Authors: Andrew S Little, Daniel M Prevedello, Heidi Jahnke, Daniel F Kelly, John Milligan, Chester F Griffiths, Ricardo L Carrau, Gail Rosseau, Garni Barkhoudarian, Charlene ChalonerAbstract:OBJECT Despite the widespread adoption of endoscopic Transsphenoidal Surgery for pituitary adenomas, the sinonasal quality of life (QOL) and health status in patients who have undergone this technique have not been compared with these findings in patients who have undergone the traditional direct uninostril microsurgical technique. In this study, the authors compared the sinonasal QOL and patient-reported health status after use of these 2 surgical techniques. METHODS The study design was a nonblinded prospective cohort study. Adult patients with sellar pathology and planned Transsphenoidal Surgery were screened at 4 pituitary centers in the US between October 2011 and August 2013. The primary end point of the study was postoperative patient-reported sinonasal QOL as measured by the Anterior Skull Base Nasal Inventory–12 (ASK Nasal-12). Supplementary end points included patient-reported health status estimated by the 8-Item Short Form Health Survey (SF-8) and EuroQol (EQ)-5D-5L instruments, and sinonasal ...
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predictors of sinonasal quality of life and nasal morbidity after fully endoscopic Transsphenoidal Surgery
Journal of Neurosurgery, 2015Co-Authors: Andrew S Little, Daniel M Prevedello, Daniel F Kelly, John Milligan, Chester F Griffiths, Ricardo L Carrau, Gail Rosseau, Garni Barkhoudarian, Bradley A Otto, Heidi JahnkeAbstract:OBJECT Despite the increasing application of endoscopic Transsphenoidal Surgery for pituitary lesions, the prognostic factors that are associated with sinonasal quality of life (QOL) and nasal morbidity are not well understood. The authors examine the predictors of sinonasal QOL and nasal morbidity in patients undergoing fully endoscopic Transsphenoidal Surgery. METHODS An exploratory post hoc analysis was conducted of patients who underwent endoscopic pituitary Surgery and were enrolled in a prospective multicenter QOL study. End points of the study included patient-reported sinonasal QOL and objective nasal endoscopy findings. Multivariate models were developed to determine the patient and surgical factors that correlated with QOL at 2 weeks through 6 months after Surgery. RESULTS This study is a retrospective review of a subgroup of patients studied in the clinical trial “Rhinological Outcomes in Endonasal Pituitary Surgery” (clinical trial no. NCT01504399, clinicaltrials.gov). Data from 100 patients w...
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late recurrences of cushing s disease after initial successful Transsphenoidal Surgery
The Journal of Clinical Endocrinology and Metabolism, 2008Co-Authors: Chirag G Patil, Laurence Katznelson, Daniel M Prevedello, Shivanand P Lad, Mary Lee Vance, Michael O Thorner, Edward R LawsAbstract:Context: Few studies have systematically analyzed the long-term recurrence rates of Cushing’s disease after initial successful Transsphenoidal Surgery. Setting: This was a retrospective review of patients treated at the University of Virginia Medical Center. Patients: A total of 215 subjects with Cushing’s disease who underwent initial Transsphenoidal Surgery for resection of a presumed pituitary microadenoma from 1992–2006 were included. Main Outcome Measures: Remission and recurrence rates of Cushing’s disease were examined. Recurrence was defined as an elevated 24-h urine free cortisol with clinical symptoms consistent with Cushing’s disease. Results: Of the 215 patients who underwent Transsphenoidal Surgery for Cushing’s disease, surgical remission was achieved in 184 (85.6%). The mean length of follow-up was 45 months. Actuarial recurrence rates of Cushing’s disease after initially successful Transsphenoidal Surgery at 1, 2, 3, and 5 yr were 0.5, 6.7, 10.8, and 25.5%, respectively. Among the 184 pati...
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a brief history of endoscopic Transsphenoidal Surgery from philipp bozzini to the first world congress of endoscopic skull base Surgery
Neurosurgical Focus, 2005Co-Authors: Francesco Doglietto, John A Jane, Daniel M Prevedello, Joseph K Han, Edward R LawsAbstract:Since its inception, one of the major issues in Transsphenoidal Surgery has been the adequate visualization of anatomical structures. As Transsphenoidal Surgery evolved, technical advancements improved the surgical view of the operative field and the orientation. The operating microscope replaced Cushing's headlight and Dott's lighted speculum retractor, and fluoroscopy provided intraoperative imaging. These advances led to the modern concept of micro-surgical Transsphenoidal procedures in the early 1970s. For the past 30 years the endoscope has been used for the treatment of diseases of the sinus and, more recently, in the surgical treatment of pituitary tumors. The collaboration between neurological and otorhinolaryngological surgeons has led to the development of novel surgical procedures for the treatment of various pathological conditions in the skull base. In this paper the authors review the history of the endoscope—its technical development and its application—from the first endoscope described by...