Geri Dön

Fonksiyonel hipofiz adenomlarında transsfenoidal rezeksiyon volümünün nazal ve sfenoid sinüs ölçümleriyle değerlendirilmesi

Evaluation of transsphenoidal resection volume in functional pituitary adenomas by nasal and sphenoid sinus measurements

PDF İndir

  1. Tez No: 910609
  2. Yazar: EYLEM YAĞMUR ÖZKELEŞ
  3. Danışmanlar: PROF. DR. HAKAN KARABAĞLI
  4. Tez Türü: Tıpta Uzmanlık
  5. Konular: Nöroşirürji, Neurosurgery
  6. Anahtar Kelimeler: Columella, pituitary adenoma, transsphenoidal approach, sphenoid sinus, nasal cavity, tumor volume, Columella, pituitary adenoma, transsphenoidal approach, sphenoid sinus, nasal cavity, tumor volum
  7. Yıl: 2023
  8. Dil: Türkçe
  9. Üniversite: Selçuk Üniversitesi
  10. Enstitü: Tıp Fakültesi
  11. Ana Bilim Dalı: Beyin ve Sinir Cerrahisi Ana Bilim Dalı
  12. Bilim Dalı: Belirtilmemiş.
  13. Sayfa Sayısı: 80

Özet

Objective: In our study, we aimed to reveal the relationship between the tumor resection volume in transsphenoidal pituitary surgery and the anatomical differences that may be encountered in the nasal and sphenoid sinus anatomy, to suggest new approaches to this surgical procedure, and to emphasize the features that need to be taken into consideration. Material and method: A total of 63 cases who were operated on by two different surgeons due to functional pituitary adenoma via transsphenoidal route at Selçuk University Faculty of Medicine Neurosurgery Clinic between 2010 and 2022 were included in the study. Microscopic method was used in 47 cases and endoscopic method was used in 16 cases. 30 of the patients are women and 33 are men. The average age is 49.5, the minimum age is 17 and the maximum age is 81. The sphenoid sinus types of these patients were grouped according to the degree of pneumatization. Volume data was provided using preoperative and early postoperative magnetic resonance images through the Syngo.via imaging program. Using the Enlil PACS program, the distances between the columella base and the sphenoid sinus and the angle measurements of this direction with the nasal cavity floor were obtained from preoperative pituitary magnetic resonance T1 sagittal sequence sections. The relationship between these parameters was evaluated statistically. Results: There were 10 (15.9%) people with pathology type PRL+ GH+ adenoma, 17 (27%) people with gonadotrope adenoma, 13 (20.6%) people with somatotrope adenoma, 11 (17.5%) people with lactotrope adenoma, 6 (9.5%) individuals with ACTH+ adenomas and 6 (9.5%) individuals with GH+ adenomas. There were 47 (74.6%) whose surgery type was microscopic and 16 (25.4%) who had endoscopic. While the mean early postoperative resection volume was 4.95±5.36 m3 , the mean late postoperative resection volume was found to be 4.29±5.32 m3 , and there was no statistically significant difference between these measurements (p>0.05). In early and late postoperative measurements, resection volume averages were statistically significantly lower in the invasive sphenoid sinus type (p0.05). There was no statistically significant difference in presellar sphenoid sinus type (p>0.05). The average resection volume rate in sellar sphenoid sinus types was found to be 61.54±18.48, and this measurement was statistically higher than other sphenoid sinus types (p0.05). There was no statistically significant difference between the mean of early postoperative resection volume and the mean of late postoperative resection volume (p>0.05). As a result, when the effect sizes were examined, resection volume showed a rapid decrease in microscopic (η2=0.437) and endoscopic (η2=0.157) measurements, respectively, across surgery types. While the average resection volume rate in those operated with the microscopic method was 57.79±19.41, the average resection volume rate in those operated with the endoscopic method was 60.24±21.55, and there was no statistically significant difference between these surgical types (p>0.05). The distance between the columella and the sphenoid sinus and preoperative resection volume measurements did not have a statistically significant effect on the resection volume rate (p>0.05). While resection volume showed a rapid decrease in gonadotrope (η2=0.327), PRL+ GH+(η2=0.240), GH+(η2=0.238) and somatotroph (η2=0.118) measurements in pathology types, respectively, no significant intra-group difference was observed in lactotrope and ACTH+ surgery types. Conclusion: In pituitary adenomas operated with the transphenoidal approach, different anatomical markers are used to determine the anatomical corridor until reaching the adenoma. These markers are a result of the surgical experience and studies achieved to date. In this study, we have conveyed our clinical experience to the literature by showing that the tumor resection volume is not affected by some measurements of the sphenoid sinus and nasal cavity. We think that there are still anatomical differences that may affect the tumor resection volume and that further studies should be continued with a larger number of patients in different centers.

Özet (Çeviri)

Objective: In our study, we aimed to reveal the relationship between the tumor resection volume in transsphenoidal pituitary surgery and the anatomical differences that may be encountered in the nasal and sphenoid sinus anatomy, to suggest new approaches to this surgical procedure, and to emphasize the features that need to be taken into consideration. Material and method: A total of 63 cases who were operated on by two different surgeons due to functional pituitary adenoma via transsphenoidal route at Selçuk University Faculty of Medicine Neurosurgery Clinic between 2010 and 2022 were included in the study. Microscopic method was used in 47 cases and endoscopic method was used in 16 cases. 30 of the patients are women and 33 are men. The average age is 49.5, the minimum age is 17 and the maximum age is 81. The sphenoid sinus types of these patients were grouped according to the degree of pneumatization. Volume data was provided using preoperative and early postoperative magnetic resonance images through the Syngo.via imaging program. Using the Enlil PACS program, the distances between the columella base and the sphenoid sinus and the angle measurements of this direction with the nasal cavity floor were obtained from preoperative pituitary magnetic resonance T1 sagittal sequence sections. The relationship between these parameters was evaluated statistically. Results: There were 10 (15.9%) people with pathology type PRL+ GH+ adenoma, 17 (27%) people with gonadotrope adenoma, 13 (20.6%) people with somatotrope adenoma, 11 (17.5%) people with lactotrope adenoma, 6 (9.5%) individuals with ACTH+ adenomas and 6 (9.5%) individuals with GH+ adenomas. There were 47 (74.6%) whose surgery type was microscopic and 16 (25.4%) who had endoscopic. While the mean early postoperative resection volume was 4.95±5.36 m3 , the mean late postoperative resection volume was found to be 4.29±5.32 m3 , and there was no statistically significant difference between these measurements (p>0.05). In early and late postoperative measurements, resection volume averages were statistically significantly lower in the invasive sphenoid sinus type (p0.05). There was no statistically significant difference in presellar sphenoid sinus type (p>0.05). The average resection volume rate in sellar sphenoid sinus types was found to be 61.54±18.48, and this measurement was statistically higher than other sphenoid sinus types (p0.05). There was no statistically significant difference between the mean of early postoperative resection volume and the mean of late postoperative resection volume (p>0.05). As a result, when the effect 73 sizes were examined, resection volume showed a rapid decrease in microscopic (η2=0.437) and endoscopic (η2=0.157) measurements, respectively, across surgery types. While the average resection volume rate in those operated with the microscopic method was 57.79±19.41, the average resection volume rate in those operated with the endoscopic method was 60.24±21.55, and there was no statistically significant difference between these surgical types (p>0.05). The distance between the columella and the sphenoid sinus and preoperative resection volume measurements did not have a statistically significant effect on the resection volume rate (p>0.05). While resection volume showed a rapid decrease in gonadotrope (η2=0.327), PRL+ GH+(η2=0.240), GH+(η2=0.238) and somatotroph (η2=0.118) measurements in pathology types, respectively, no significant intra-group difference was observed in lactotrope and ACTH+ surgery types. Conclusion: In pituitary adenomas operated with the transphenoidal approach, different anatomical markers are used to determine the anatomical corridor until reaching the adenoma. These markers are a result of the surgical experience and studies achieved to date. In this study, we have conveyed our clinical experience to the literature by showing that the tumor resection volume is not affected by some measurements of the sphenoid sinus and nasal cavity. We think that there are still anatomical differences that may affect the tumor resection volume and that further studies should be continued with a larger number of patients in different centers.

Benzer Tezler

  1. Tez No

    785476

    Hipofiz makroadenomlarında cerrahi tedavi etkinliğini öngörmede manyetik rezonans görüntüleme bulgularının değerlendirilmesi

    Evaluation of magnetic resonance imaging findings in prediction of surgical treatment effectiveness in pituitary macroadenomas

    MUHAMMED SAMED CANSIZ

    Tıpta Uzmanlık

    Türkçe

    Türkçe

    2023

    Radyoloji ve Nükleer TıpSelçuk Üniversitesi

    Radyoloji Ana Bilim Dalı

    DOÇ. DR. ALAADDİN NAYMAN

  2. Tez No

    889517

    Endoskopik transsfenoidal yolla hipofiz adenomu ameliyatı yapılan hastaların cerrahi ve klinik sonuçlarının retrospektif olarak incelenmesi

    Retrospective analysis of surgical and clinical outcomes in patients undergoing endoscopic transsphenoidal surgery for pituitary adenomas

    MUHAMMED BURAK SARIKAYA

    Tıpta Uzmanlık

    Türkçe

    Türkçe

    2024

    NöroşirürjiTrakya Üniversitesi

    Beyin ve Sinir Cerrahisi Ana Bilim Dalı

    DOÇ. DR. AHMET TOLGAY AKINCI

  3. Tez No

    608596

    Hipofiz adenomlarında mikroskobik ve endoskopik cerrahi yaklaşımların karşılaştırılması

    The comparison of endoscopic and microscopic surgery in pituitary adenomas

    DERYA ABEŞ

    Tıpta Uzmanlık

    Türkçe

    Türkçe

    2019

    Kulak Burun ve BoğazSağlık Bilimleri Üniversitesi

    Kulak Burun Boğaz Ana Bilim Dalı

    DR. ÖĞR. ÜYESİ GÖKHAN KURAN

  4. Tez No

    557488

    Hipofiz adenomlarında transsfenoidal mikrocerrahi ve sonuçlarının değerlendirilmesi

    The evaluation of transsphenoidal surgery results of pituitary adenomas

    ORKUN KOBAN

    Tıpta Uzmanlık

    İngilizce

    İngilizce

    2012

    NöroşirürjiSağlık Bakanlığı

    Beyin-Sinir ve Omurilik Cerrahisi Ana Bilim Dalı

    DOÇ. DR. KAYA KILIÇ

  5. Tez No

    266837

    Hipofiz adenomlarında endoskopik yolla transnazal-transsfenoidal cerrahi etkinliğinin klasik yöntemlerle karşılaştırılması

    The comparison of the effectivity of endoscopic transnasal-transsphenoidal surgery versus traditional tecniques in pitiutary adenomas

    HAKAN ÖZALP

    Tıpta Uzmanlık

    Türkçe

    Türkçe

    2010

    NöroşirürjiAnkara Üniversitesi

    Beyin ve Sinir Cerrahisi Ana Bilim Dalı

    DOÇ. DR. AĞAHAN ÜNLÜ

Geri Dön