Hipófisis/Pituitary

Manejo perioperatorio de los pacientes para cirugía pituitaria transesfenoidal


Perioperative management of patients undergoing transsphenoidal pituitary surgery.
Zada G, Woodmansee WW, Iuliano S, Laws ER
Asian J Neurosurg [serial online] 2010 [cited 2013 Jun 9];5:1-6.
Abstract
Background: The sellar and parasellar region is a confluence of several critical anatomical structures from various physiological systems located in close proximity to one another. Patients with pathology in this critical region of the central nervous system therefore make up a unique subset of neurosurgical patients that require careful preoperative and postoperative attention to numerous management details involving neurological, visual, and neuroendocrine function. A thorough understanding of the underlying anatomical and physiological principles of each of these systems, as well as the medical and surgical nuances involved in each case, is required to provide optimized management for patients with pituitary pathology. In this review, we discuss the major preoperative and postoperative considerations in patients undergoing resection for pituitary lesions in the modern era of transsphenoidal surgery.
Keywords: Transsphenoidal surgery, pituitary adenoma, endoscopy, sella turcica
http://www.asianjns.org/text.asp?2010/5/1/1/84790

Evolución endocrinológica de la cirugía endoscópica transesfenoidal:Experiencia en un centro de referencia en Croacia

Endocrinological outcomes of pure endoscopic transsphenoidal surgery: a Croatian Referral Pituitary Center experience.
Maric A, Kruljac I, Čerina V, Pecina HI, Sulentic P, Vrkljan M.
Referral Center for Clinical Neuroendocrinology and Pituitary Diseases, Sestre Milosrdnice University Hospital, Zagreb, Croatia.
Croat Med J. 2012 Jun;53(3):224-33.
Abstract
AIM: To analyze early remission, complications, and pituitary function recovery after pure endoscopic endonasal transsphenoidal surgery (PEETS), a novel method in pituitary adenoma treatment. METHODS: Testing of all basal hormone values and magnetic resonance imaging (MRI) were performed preoperatively and postoperatively (postoperative MRI only in nonfunctioning adenomas) in 117 consecutive patients who underwent PEETS in the period between 2007 and 2010. The series consisted of 21 somatotroph adenomas, 61 prolactinomas, and 4 corticotroph and 31 nonfunctioning adenomas. Sixty-three were macroadenomas and 54 were microadenomas. Remission was defined as hormonal excess normalization on the seventh postoperative day in functioning adenomas and as normal MRI findings approximately four months postoperatively in nonfunctioning adenomas. The presence of hypogonadism, growth hormone deficiency, and hypothyroidism was assessed on the seventh postoperative day. Hypocortisolism was assessed through necessity for replacement therapy within 18 months postoperatively. RESULTS: Remission was achieved in 84% of patients: in 100% of microadenoma and 70% of macroadenoma patients (P<0.001, odds ratio [OR], 28.16, 95% confidence interval [CI], 1.61-491.36), respectively. Endocrinological complications occurred in 17.1% of patients: in 9% of microadenoma and 24% of macroadenoma patients (P=0.049, OR, 3.06; 95% CI, 1.03-9.08). Duration of empirical hydrocortisone replacement therapy was significantly shorter in microadenoma patients (P<0.001). Thirty-five percent of preoperatively present hormonal deficiencies improved after the surgery. Between tumor types there were no significant differences in remission, complications, and normal pituitary function recovery.
CONCLUSION: Patients with microadenomas had higher remission and lower complication rates following PEETS, emphasizing the necessity for early detection and treatment of pituitary adenomas. PEETS is a discussion-worthy method for microprolactinoma treatment.
http://www.cmj.hr/2012/53/3/22661135.htm



Comparación de propofol vs sevoflurano sobre la termorregulación en pacientes bajo cirugía hipofisaria transesfenoidal: estudio preliminar


Comparison of propofol versus sevoflurane on thermoregulation in patients undergoing transsphenoidal pituitary surgery: A preliminary study.
Chowdhury T, Prabhakar H, Bharati SJ, Goyal K, Dube SK, Singh GP.
Department of Neuroanesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
Saudi J Anaesth. 2012 Jan;6(1):12-5. doi: 10.4103/1658-354X.93046.
Abstract
PURPOSE: General anesthesia causes inhibition of thermoregulatory mechanisms. Propofol has been reported to cause more temperature fall, but in case of deliberate mild hypothermia, both sevoflurane and propofol were comparable. Thermoregulation is found to be disturbed in cases of pituitary tumors. We aimed to investigate which of the two agents, sevoflurane or propofol, results in better preservation of thermoregulation in patients undergoing transsphenoidal excision of pituitary tumors. METHODS: Twenty-six patients scheduled to undergo transsphenoidal removal of pituitary adenomas were randomly allocated to receive propofol or sevoflurane anesthesia. Baseline esophageal temperature was noted. Times for temperature to fall by 1°C or 35°C and to return to baseline were also comparable (P>0.05). After that warmer was started at 43°C and time to rise to baseline was noted. Duration of surgery, total blood loss, and total fluid intake were also noted. If any, side effects such as delayed arousal and recovery from muscle relaxant were noted. RESULTS: The demographics of the patients were comparable. Duration of surgery and total blood loss were comparable in the two groups. The time for temperature to fall by 1°C or 35°C and time to return to baseline was also comparable (P>0.05). No side effects related to body temperature were noted. CONCLUSION: Both propofol and sevoflurane show similar effects in maintaining thermal homeostasis in patients undergoing transsphenoidal pituitary surgery
http://www.saudija.org/temp/SaudiJAnaesh6112-7795748_213917.pdf




http://www.saudija.org/article.asp?issn=1658-354X;year=2012;volume=6;issue=1;spage=12;epage=15;aulast=

Chowdhury



Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org