World Neurosurg
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To report our clinical experience with an advanced navigation protocol that provides seamless integration into the operating workflow of endoscopic transsphenoidal surgery. ⋯ The advanced navigation protocol permits continuous suction-tracked navigation guidance during endoscopic transsphenoidal surgery and optimal visualization of solid bone, fine paranasal sinus structures, soft-tissue and vascular structures. This may add to the safety of the procedure especially in cases of anatomical variations and in cases of recurrent adenomas with distorted anatomy.
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To describe surgical management with complete resection of patients with recurrent benign or malignant lesions involving the cavernous sinus after standard therapy with an emphasis on surgical indications and surgical technique. ⋯ Complete cavernous sinus resection is an option for patients with progressive or recurrent tumors after standard therapy. Extended survival can occur in some patients. The risks of surgery are considerable, and the underlying disease, age of the patient, and associated comorbidities should be considered when making the decision to operate. Surgery should be considered for oncologic resection of malignant tumors with limited extracranial disease or in patients with recurrent or progressive benign tumors. A key decision involves whether revascularization should be used with resection. Revascularization has been used in patients with inadequate vascular reserve as measured by balloon occlusion testing and patients with benign tumors and longer life expectancy.
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Iliac crest autograft is the historic gold standard for bone grafting, but is associated with a significant patient morbidity. Fusion rates of C1-C2 up to 88.9% using allograft and 96.7% using autologous iliac crest bone graft can be achieved when combined with rigid screw fixation. We sought to determine our fusion rate when combining allograft with recombinant human bone morphogenetic protein-2 (rh-BMP2) and rigid screw fixation. ⋯ The use of small doses of rh-BMP2 added to allograft in addition to rigid screw fixation is a safe and highly effective means of promoting a solid fusion of the atlantoaxial complex and spares the patient the morbidity of iliac crest harvest.
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To describe our designed protocol for the reconstruction of three-dimensional (3D) models applied to various endoscopic endonasal approaches that allows performing a 3D virtual dissection of the desired approach and analyzing and quantifying critical surgical landmarks. ⋯ The methodology for surgical training in the anatomic laboratory described in this article has proven to be very effective, producing a depiction of anatomic landmarks as well as 3D visual feedback that improves the study, design, and execution in various neurosurgical approaches. The Dextroscope as a virtual surgery simulation system can be used as a preoperative planning tool that can allow the neurosurgeon to perceive, practice reasoning, and manipulate 3D representations using the transsphenoidal perspective acquiring specifically visual information for endoscopic endonasal approaches to the skull base. The Dextroscope also can be used as an advanced tool for analytic purposes to perform different types of measurements between surgical landmarks before, during, and after dissection.
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Thyroid-stimulating hormone (TSH)-expressing pituitary adenomas are a rare but important entity with a spectrum of clinical manifestations. There are currently no data to indicate whether a difference exists in the natural progression of active and silent TSH-expressing pituitary adenomas (defined by the presence or absence of clinical hyperthyroidism, respectively). Here we report our experience (including presenting symptoms, treatment, and outcome) with managing both groups over 11 years in the largest single-center study published to date. ⋯ TSH-expressing pituitary adenomas present with a wide clinical spectrum. Visual disturbances are common. Despite radiologic evidence of clearance after surgery and extended follow-up, they may still recur whether clinically "active" or "silent." Our data support the need for close, long-term follow-up of these patients.