2024-03-28T10:07:30Z
https://nagoya.repo.nii.ac.jp/oai
oai:nagoya.repo.nii.ac.jp:00028491
2023-01-16T04:21:24Z
499:500:501
Removal of the Medial Wall of the Cavernous Sinus for Functional Pituitary Adenomas: A Technical Report and Pathologic Significance
Nagata, Yuichi
93434
Takeuchi, Kazuhito
93435
Yamamoto, Taiki
93436
Ishikawa, Takayuki
93437
Kawabata, Teppei
93438
Shimoyama, Yoshie
93439
Wakabayashi, Toshihiko
93440
Acromegaly
Cavernous sinus
Cushing disease
Medial wall
Medial wall–plasty
Medial wall removal
Pituitary adenoma
Background: Removal of the medial wall of the cavernous sinus (MW) is challenging for neurosurgeons. We describe a practical method of endoscopic MW removal via endonasal transsphenoidal approach to minimalize intraoperative blood loss and postoperative morbidities. We also present the pathologic significance of this technique for functional pituitary adenomas (FPAs). Methods: We performed MW removal in patients with FPA with no well-defined pseudocapsule and a tumor in direct contact with the MW. The MW was judged to have tumor invasion based on the intraoperative appearance, and it was removed regardless of the appearance of MW involvement. Intraoperative findings and postoperative clinical, endocrinologic, and pathologic outcomes were retrospectively reviewed. Results: Fourteen patients underwent MW removal for FPA, including 12 patients with acromegaly and 2 with Cushing disease. Mean intraoperative blood loss was 170 mL (range, 32–400 mL), and none of the patients required blood transfusion. Among the 7 patients without intraoperative apparent MW involvement, 4 (57.1%) had pathologically confirmed tumor invasion into the MW (occult invasion). Biochemical remission by surgery alone was achieved in 13 patients (92.9%). Transient oculomotor palsy occurred in 1 patient (7.1%). Conclusions: Occult tumor invasion into the MW was often detected in patients with FPA without a well-defined pseudocapsule but in direct contact with the MW. Our technique can enhance the effectiveness of surgery with minimal postoperative morbidities.
ファイル公開:2020-06-01
journal article
Elsevier
2019-06
application/pdf
World Neurosurgery
126
53
58
1878-8750
https://nagoya.repo.nii.ac.jp/record/28491/files/WNEU_11609_edit_report_AU.pdf
eng
https://doi.org/10.1016/j.wneu.2019.02.134
© 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/