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Vol. 27. Issue 5.
Pages 229-236 (September - October 2016)
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Vol. 27. Issue 5.
Pages 229-236 (September - October 2016)
Artículo de revisión
Cirugía endoscópica endonasal en patología selar. Análisis de nuestros primeros 200 pacientes. Qué hemos aprendido
Endoscopic endonasal surgery for sellar region pathology. An analysis of our first 200 patients. What we have learned
Luis Reyesa,
Corresponding author
, Sergio Garcíaa, Jorge Toralesa, Irene Halperínb, Isam Alobidc, Felicia Hanzub, Mireia Morab, Ricard Valerod, Joaquim Enseñata
a Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España
b Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
c Servicio de Otorrinolaringología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
d Servicio de Anestesiología y Reanimación, Hospital Clínic i Provincial de Barcelona, Barcelona, España
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Figures (1)
Tables (2)
Tabla 1. Clasificación de Knosp de los macroadenomas hipofisarios
Tabla 2. Frecuencia de cada tipo tumoral según el diagnóstico histológico
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Resumen
Introducción

Los tumores hipofisarios y de la región selar representan el 10-15% de los tumores benignos intracraneales, siendo los adenomas los más frecuentes. En el siguiente artículo exponemos la experiencia adquirida a lo largo de 9años en el tratamiento quirúrgico por vía endoscópica de lesiones selares. Explicaremos los aspectos característicos de nuestra técnica quirúrgica y los resultados en términos clínicos y hormonales.

Material y métodos

Realizamos un estudio retrospectivo de 200 pacientes con lesiones selares intervenidos por un único neurocirujano (J.E.) mediante abordaje endoscópico endonasal transesfenoidal entre febrero de 2006 y febrero 2015. No se incluyen abordajes extendidos a la base craneal, craneofaringiomas, ni lesiones inflamatorias, metastásicas o malignas.

Resultados

De 200 pacientes, 7 eran quistes de Rathke y 193 adenomas (26 microadenomas y 165 macroadenomas). Subclasificados estos, a su vez, según el grado de invasión del seno cavernoso (Knosp 0, 1 y 2: 129 casos; Knosp 3 y 4: 71 casos). Se consiguió una exéresis tumoral completa en 143 pacientes (71,5%), subtotal en 39 (19,5%) y parcial en 18 (9%). En el grupo de mayor ocupación del seno cavernoso (Knosp 3 y 4) se consiguió una resección completa en un 55,5% (40/71). Se logró una remisión hormonal en 34 pacientes (85%) con acromegalia, en 23 (76%) con prolactinomas y en 30 (86%) con enfermedad de Cushing.

Conclusión

Los resultados obtenidos en nuestra serie, fruto de la centralización y la experiencia, son equiparables a los mejores resultados conseguidos en centros de referencia de cirugía hipofisaria. La exploración quirúrgica precoz de la fístula reduce la tasa de meningitis posquirúrgicas.

Palabras clave:
Adenoma de hipófisis
Cirugía transesfenoidal
Acromegalia
Enfermedad de Cushing
Fístula de líquido cefalorraquídeo
Knosp
Abstract
Introduction

Pituitary and sellar region tumours account for 10-15% of intracranial benign tumours, with pituitary adenoma being the most common one. In this article, a review is presented on 9 years of experience in surgical treatment using an endoscopic approach of sellar region lesions. The main features of our surgical technique will be explained, as well as the results in clinical and hormonal terms.

Material and methods

A retrospective analysis was conducted on 200 patients operated on due to sellar lesions by the same neurosurgeon (J.E.) using an endoscopic endonasal transsphenoidal approach between February 2006 and February 2015. The cases excluded were, those requiring extended approaches of the skull base, as well as craniopharyngiomas, inflammatory, metastatic, or malignant lesions.

Results

Of the 200 patients treated (59.5% women, mean age of 51.7 years, range: 18-82 years old), there were: 7 Rathke cysts and 193 adenomas (26 micro-adenomas and 165 macro-adenomas). All of them sub-classified according to the degree of invasion of the cavernous sinus (Knosp 0, 1, and 2: 129 cases and Knosp 3 and 4: 71 cases). Total resection was achieved in 143 patients (71.5%), subtotal resection in 39 (19.5%), and partial resection in 18 (9%). In the group of higher occupancy of the cavernous sinus (Knosp 3 and 4) complete resection was achieved in 55.5% (40 of 71 patients). Hormonal remission was achieved in 34 patients with acromegaly (85%), 23 patients with prolactinomas (76%), and 30 patients with Cushing's disease (86%).

Conclusion

The results obtained in our series, due to the centralisation of pathology and experience, are comparable to those achieved in pituitary surgery reference centres. Early surgical exploration of cerebrospinal fluid leaks reduces the risk of post-surgical meningitis.

Keywords:
Pituitary adenoma
Transsphenoidal surgery
Acromegaly
Cushing's disease
Cerebrospinal fluid leak
Knosp

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