2016-2019 yılları arasında endoskopik endonazal transsfenoidal yolla opere edilen hipofiz adenomu olgularının retrospektif değerlendirilmesi
Küçük Resim Yok
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç:
Endoskopik endonazal transsfenoidal yaklaşım, hipofiz adenomlarının ve diğer sellar veya
parasellar tümörlerin rezeksiyonu için yaygın olarak kullanılmaktadır. Bu çalışmada 4 yıllık
sürede Ege Üniversitesi Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı’nda hipofiz
adenomu ön-tanısıyla endonazal transsfenoidal yaklaşım ile opere edilen 124 erişkin hasta ele
alındı ve endonazal transsfenoidal yöntemin etkinliği ve sonuçları incelendi.
Gereç ve Yöntem:
Bu retrospektif klinik çalışmada Ocak 2016-Aralık 2019 arasında Ege Üniversitesi Tıp
Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı’nda hipofiz adenomu ön- tanısıyla ameliyat
edilen 124 hastanın klinik, laboratuvar, radyolojik ve cerrahi verileri değerlendirildi. Hastaların
yaşı, cinsiyeti, başvuru şikayetleri; baş ağrısı, görme bozukluğu, adet düzensizliği, halsizlik, kıl
dökülmesi, kilo artışı, kilo kaybı, hirsutizm, ekstremitelerde veya yüzde büyüme, galaktore,
erektil disfonksiyon olarak not edildi. Tüm hastaların pre-operatif dönemde çekilmiş paranazal
sinüs tomografisi, beyin anjiyo tomografisi ve dinamik hipofiz MRG görüntüleri değerlendirildi
ve tümör boyutu, kavernöz sinüs invazyonu, optik kiazmaya bası etkisi, stalk deviasyonu, 3.
ventriküle bası etkisi veya 3. ventrikülün infiltrasyonu, sella tabanın erozyonu ve destrüksiyonu
incelendi. Hastaların ameliyat süreleri, hastanede kalış süreleri ve post-operatif gelişen
komplikasyonlar değerlendirildi. Tüm hastaların patoloji sonuçları incelendi. Post-operatif
dönemde takipleri 1. günde, 3. ve 6. aylarda çekilen kontrastlı hipofiz MRG ile yapıldı ve tümör
rekürrens, regresyon veya progresyon durumları değerlendirildi.
Bulgular:
Bu çalışmaya alınan 124 olgunun 57’si kadın ve 67’si erkek idi. Hastalarımızın yaşları 20 ve
79 arasında değişmekteydi. Yaş ortalaması 49 olarak hesaplandı. En sık görülen şikayet görme
bozukluğuydu. Hipofiz MRG’larına göre 120’sinde makroadenom (adenom 1 cm’den büyük)
ve 4’ünde mikroadenom (adenom 1cm’den küçük) mevcuttu. 11-30 mm arasındaki büyüklükte
olanlar en sık gözlemlenen makroadenomlardı. 39 hastada immünreaktivitesi göstermeyen ve
85 hastada immünreaktivitesi gösteren hipofiz adenom saptandı. İmmünreaktivitesi gösterenler
arasında en sık görülen FSH, LH salgılayan adenomlarıydı. Erken post-operatif dönemde en sık
karşılaşılan komplikasyon geçici diabetes insipidus idi.
Sonuç:
Hipofiz adenomu tanısıyla endoskopik endonazal transsfenoidal yaklaşım uygulanan hastaların
perioperatif bakılarında detaylara dikkat edilmesi, komplikasyonları en aza indirmeye ve terapötik sonuçları en üst düzeye çıkarmaya katkı sağlamaktadır. Hipofiz adenomlarında
endoskopik endonazal transsfenoidal cerrahi oldukça başarılı bir yaklaşımdır.
Introduction and Objective: Endoscopic endonasal transsphenoidal approach has been widely used for resection of pituitary adenomas and other sellar or parasellar tumors. In this study, 124 adult patients with a prediagnosis of pituitary adenoma who underwent endonasal transsphenoidal approach at Department of Neurosurgery, Ege University Faculty of Medicine for a period of four years were included, and the efficiency of the endonasal transsphenoidal approach was evaluated. Material and Method: In this retrospective study, clinical, laboratory, radiological and surgical data of 124 patients pre-diagnosed with pituitary adenoma who underwent surgery at Department of Neurosurgery, Ege University Faculty of Medicine between January 2016 and December 2019 were evaluated. Patients’ age, gender and symptoms were evaluated; headache, visual disturbance, menstrual irregularity, weakness, hair loss, weight gain, weight loss, hirsutism, increased size of extremities, galactorrhea, erectile dysfunction. Pre-operative paranasal sinus tomography, computed tomography angiography and dynamic MRI scans of all patients were evaluated, and tumor size, cavernous sinus invasion, compression effect on the optic chiasm, stalk deviation, compression effect on the third ventricle or infiltration of the third ventricle, erosion and destruction of the sella floor were analyzed. The duration of surgery, the duration of patients’ hospitalization and postoperative complications were evaluated. Pathology results of all patients were analyzed. Post-operative follow-up of the patients was performed by using contrast-enhanced MRI on the 1st day, 3rd and 6th month after the surgery, and tumor recurrence, regression or progression status were evaluated. Results: 57 of 124 patients included in this study were female and 67 were male. The age of our patients ranged between 20 and 79 years. The average age was 49 years. The most common complaint was visual impairment. With contrast-enhanced MRI, the size of the tumor was analyzed and found to be larger than 1 cm (macroadenomas) in 120 patients and less than 1 cm (microadenomas) in 4 patients. Pituitary macroadenomas between 11-30 mm were most commonly observed in our study. In 39 patients non-immunoreactive adenoma and in 85 patients immunoreactive pituitary adenoma were determined. Among the adenomas demonstrating immunoreactivity, the most commonly seen were gonadotroph adenomas. Transient diabetes insipidus was the most frequently encountered early postoperative complication. Conclusion: Accurate perioperative care of patients undergoing endoscopic endonasal transsphenoidal approach due to pituitary adenoma contributes to minimizing postoperative complications and maximizing therapeutic results. Endoscopic endonasal transsphenoidal surgery is a very successful approach in the treatment of pituitary adenomas.
Introduction and Objective: Endoscopic endonasal transsphenoidal approach has been widely used for resection of pituitary adenomas and other sellar or parasellar tumors. In this study, 124 adult patients with a prediagnosis of pituitary adenoma who underwent endonasal transsphenoidal approach at Department of Neurosurgery, Ege University Faculty of Medicine for a period of four years were included, and the efficiency of the endonasal transsphenoidal approach was evaluated. Material and Method: In this retrospective study, clinical, laboratory, radiological and surgical data of 124 patients pre-diagnosed with pituitary adenoma who underwent surgery at Department of Neurosurgery, Ege University Faculty of Medicine between January 2016 and December 2019 were evaluated. Patients’ age, gender and symptoms were evaluated; headache, visual disturbance, menstrual irregularity, weakness, hair loss, weight gain, weight loss, hirsutism, increased size of extremities, galactorrhea, erectile dysfunction. Pre-operative paranasal sinus tomography, computed tomography angiography and dynamic MRI scans of all patients were evaluated, and tumor size, cavernous sinus invasion, compression effect on the optic chiasm, stalk deviation, compression effect on the third ventricle or infiltration of the third ventricle, erosion and destruction of the sella floor were analyzed. The duration of surgery, the duration of patients’ hospitalization and postoperative complications were evaluated. Pathology results of all patients were analyzed. Post-operative follow-up of the patients was performed by using contrast-enhanced MRI on the 1st day, 3rd and 6th month after the surgery, and tumor recurrence, regression or progression status were evaluated. Results: 57 of 124 patients included in this study were female and 67 were male. The age of our patients ranged between 20 and 79 years. The average age was 49 years. The most common complaint was visual impairment. With contrast-enhanced MRI, the size of the tumor was analyzed and found to be larger than 1 cm (macroadenomas) in 120 patients and less than 1 cm (microadenomas) in 4 patients. Pituitary macroadenomas between 11-30 mm were most commonly observed in our study. In 39 patients non-immunoreactive adenoma and in 85 patients immunoreactive pituitary adenoma were determined. Among the adenomas demonstrating immunoreactivity, the most commonly seen were gonadotroph adenomas. Transient diabetes insipidus was the most frequently encountered early postoperative complication. Conclusion: Accurate perioperative care of patients undergoing endoscopic endonasal transsphenoidal approach due to pituitary adenoma contributes to minimizing postoperative complications and maximizing therapeutic results. Endoscopic endonasal transsphenoidal surgery is a very successful approach in the treatment of pituitary adenomas.
Açıklama
Anahtar Kelimeler
Hipofiz Bezi, Hipofiz Adenomu, Transsfenoidal Yaklaşım, Endonazal Endoskopik Yaklaşım, Komplikasyon, Pituitary Gland, Pituitary Adenoma, Transsphenoidal Approach, Endonasal Endoscopic Approach, Complication
