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Vol. 32. Issue 4.
Pages 170-177 (July - August 2021)
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Vol. 32. Issue 4.
Pages 170-177 (July - August 2021)
Clinical Research
DOI: 10.1016/j.neucie.2020.05.002
Endoscopic endonasal lateral transellar approach for growth hormone-secreting adenomas with cavernous sinus invasion: Technical note and surgical results
Abordaje transelar lateral endonasal endoscópico para adenomas hipofisiarios productores de hormona del crecimiento con invasión al seno cavernoso: nota técnica y resultados quirúrgicos
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Juan Luis Gómez-Amadora, Jaime Jesús Martínez-Andab,
Corresponding author
dr.martinezanda@gmail.com

Corresponding author.
, Pablo David Guerrero-Suarezb, Arturo Miguel Rosales-Amayab, Julio Cesar Delgado-Arceb, David Antonio Guerrero-Lópezb
a Department of Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Insurgentes Sur Av. 3877, Barrio La Fama, Postal Code 14269 Mexico City, Mexico
b Neurosurgery Department, Toluca Medical Center of Social Security Institute of the State of Mexico and Provinces Baja Velocidad, Av. 57.5km Mexico – Toluca Highway, Postal Code 52140 Metepec, State of Mexico, Mexico
Article information
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Table 1. Clinical and epidemiological data.
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Abstract
Background

Cavernous sinus (CS) invasion is found in 15–20% of pituitary adenomas; it represents a poor prognosis factor and a surgical challenge even in experienced pituitary centers. We present our experience and technical note description for surgical management of pituitary adenomas with CS invasion in acromegaly by the transsellar lateral approach with an endoscopic endonasal transsphenoidal route.

Method

prospective case series of patients who underwent endoscopic endonasal surgery for Growing Hormone (GH) producing adenomas with CS invasion treated at the Neurosurgery departments of National Institute of Neurology and Neurosurgery in Mexico City, and of Toluca Medical Center of Social Security Institute of the State of Mexico and Provinces between January 2014 and March 2019.

Results

Thirty-two of 94 patients with diagnosis of pituitary adenoma treated at our institutions (34%) had acromegaly; thirteen of patients with acromegaly diagnosis met the inclusion criteria for CS invasion. Postoperative images reported gross total resection in 10 patients (76.9%). Mean follow-up time was 28.3 months. Remission criteria were achieved in nine patients (69.2%), with one of these patients (11.1%) having recurrence during follow up. All patients with no biochemical remission had improvement in GH and IGF profiles. Three patients without remission underwent radiosurgery (14Gy), and one patient had remission after the procedure.

Conclusions

We consider this to be a safe and efficient approach for tumors invading CS, when surgical team have good experience in endoscopy of the skull base and reconstruction techniques, appropriate instruments are available, and tumor has soft consistency.

Keywords:
Pituitary adenoma
Acromegaly
Endoscopic surgery
Cavernous sinus
Abbreviations:
CS
GH
MRI
IGF-1
ICA
CN
CSF
Resumen
Antecedentes

Se encuentra invasión al seno cavernoso en el 15-20% de los adenomas hipofisiarios, y representa un factor de mal pronóstico, así como un reto quirúrgico en algunas series. En el presente trabajo describimos y evaluamos nuestra experiencia con una técnica quirúrgica para el manejo de adenomas hipofisiarios con invasión al seno cavernoso en pacientes con acromegalia a través de un abordaje transelar lateral por la vía endonasal endoscópica.

Métodos

Serie de casos prospectiva de pacientes tratados con cirugía endonasal endoscópica para pacientes con diagnóstico de acromegalia y adenomas hipofisiarios con invasión al seno cavernoso tratados en los Departamentos de Neurocirugía del Instituto Nacional de Neurología y Neurocirugía en la Ciudad de México y en el Centro Médico Toluca del Instituto de Seguridad Social del Estado de México y Municipios entre enero del 2014 y marzo del 2019.

Resultados

Treinta y dos pacientes de 94 con diagnóstico de adenoma hipofisiario fueron tratados en nuestras instituciones, cumplieron con criterios clínicos y bioquímicos para el diagnóstico de acromegalia (34%); de estos, 13 pacientes cumplieron con criterios por imagen y quirúrgicos de invasión al seno cavernoso (40,6%). Las imágenes postoperatorias mostraron resección completa en 10 pacientes (76,9%). El tiempo medio de seguimiento fue de 28,3 meses. Se alcanzó un índice de remisión bioquímica en el 69,2% de los casos, con un paciente presentando recurrencia durante el seguimiento. Tres de los pacientes sin remisión bioquímica fueron sometidos a radiocirugía, con respuesta terapéutica en uno de ellos.

Conclusiones

Consideramos que el procedimiento descrito en el presente trabajo puede considerarse una vía segura y eficiente para el abordaje quirúrgico de pacientes con adenoma hipofisiario e invasión al seno cavernoso, cuando el equipo quirúrgico cuenta con experiencia en cirugía de base de cráneo por vía endoscópica, se cuenta con el instrumental adecuado y el tumor es de consistencia aspirable.

Palabras clave:
Adenoma hipofisiario
Acromegalia
Cirugía endoscópica
Seno cavernoso

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