OBJECTIVE Following transsphenoidal surgery (TSS), it is important to assess for and manage adrenal insufficiency (AI). The goal of this study is to assess the efficacy and safety of a glucocorticoid (GC) sparing protocol to limit GC exposure in patients undergoing TSS. METHODS Adult patients undergoing TSS (excluding Cushing disease) with adequate adrenal function prior to surgery underwent ...

The clinical course and diagnosis of a patient with Cushing's disease complicated by pregnancy is described, and the anaesthetic management of trans-sphenoidal selective adenomectomy performed during the second trimester outlined. Problems included obesity, diabetes, hypertension and a suboptimal airway. Fibreoptic awake intubation and intravenous anaesthesia were used. Insulin requirements dec...

OBJECTIVE A number of factors can influence the reported outcomes of transsphenoidal surgery (TSS) for Cushing's disease - including different remission and recurrence criteria, for which there is no consensus. Therefore, a comparative analysis of the best treatment options and patient management strategies is difficult. In this review, we investigated the clinical outcomes of initial TSS in pa...

Background and Aim: Over the past 2 decades, endoscopy has become an integral part of the surgical repertoire for pituitary procedures and over the past several decades, the endoscopic endonasal trans sphenoidal approach (EETA) has gradually become an accepted option for pituitary tumors with intra-,supra-,and para-sellar location and extension, because of its minimal invasiveness and high effi...

Granulomatous hypophysitis is rare pathology that mimics pituitary adenoma. Diagnosis is only confirmed by histopathology examination. Trans-sphenoidal surgery is considered diagnostic when descent tissue specimen is obtained and therapeutic by decompressing optic pathway and the sella. Pathological findings always reveal granulomatous areas, multinucleated giant cells, plasma cells, and lympho...

Endoscopic endonasal approaches are increasingly becoming the state of art in transsphenoidal pituitary surgery. The goal of this study is first to briefly introduce nasal and sphenoidal phases of the approach along with reconstruction phase. Then, the key points of radiologic studies of various parts of the surgery with images and movies are discussed. Difficult cases from 350 surgeries will b...

A patient sustained internal carotid artery (ICA) injury during trans-sphenoidal surgery. Bleeding from the resultant pseudo-aneurysm was not fully controlled by surgical packing. Emergency endovascular deployment over the injured ICA segment of a self-expandable covered-stent ('Symbiot' stent), initially designed for use in coronary saphenous vein-graft, was successful in securing haemostasis.

OBJECTIVE The complication rates associated with different types of functional endoscopic sinus surgery (FESS) remain to be fully examined. STUDY DESIGN Retrospective cohort study. METHODS We extracted data from the Japanese Diagnosis Procedure Combination database on 50,734 patients (aged ≥ 16 years) who underwent FESS for chronic rhinosinusitis between 2007 and 2013. We focused on specifi...

PURPOSE To delineate the relationship between the optic nerves and the posterior paranasal sinuses using CT data. METHODS Direct coronal sinus CT scans of 150 consecutive patients with chronic inflammatory sinus disease were reviewed by two radiologists. Axial oblique reconstructions along the course of the optic nerve were obtained for the first 100 patients. The direct relationship between ...

BACKGROUND Endoscopic trans-sphenoidal surgery has been increasingly replacing microscopic surgery as the state of the art trans-sphenoidal approach. OBJECTIVE OF REVIEW To assess the efficacy and safety of pure endoscopic approach in comparison with microscopic approach in pituitary surgery. TYPE OF REVIEW Literature review and meta-analysis. SEARCH STRATEGY Systematic literature searche...