Endoscopic endonasal management of rare sellar lesions: clinical and surgical experience on 78 cases and review of the literature

• Published in: World neurosurgery Vol. 100; pp. 369 - 380
• Main Authors: Somma, Teresa, MD, Solari, Domenico, MD, PhD, Beer-Furlan, Andre, MD, Guida, Lelio, MD, Otto, Bradley, MD, Prevedello, Daniel, MD, Cavallo, Luigi Maria, MD, PhD, Carrau, Ricardo, MD, Cappabianca, Paolo, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017
• Subjects: Adenoma, Oxyphilic - diagnostic imaging; Adenoma, Oxyphilic - surgery; Arachnoid Cysts - diagnostic imaging; Arachnoid Cysts - surgery; Cohort Studies; Disease Management; Endoscopic endonasal approach; Female; Glioma - diagnostic imaging; Glioma - surgery; Humans; Hypophysitis - diagnostic imaging; Hypophysitis - surgery; Male; Middle Aged; Nasal Cavity - diagnostic imaging; Nasal Cavity - surgery; Neuroendoscopy - methods; Neurosurgery; Rare tumors; Retrospective Studies; Sella Turcica - diagnostic imaging; Sella Turcica - surgery; Skull base surgery; Transsphenoidal sellar region; magnetic resonance imaging; transsphenoidal sellar region; skull base surgery; DI; diabetes insipidus; MRI; PNET; QOL; ccerebrospinal fluid; CRF; CSF; rare tumors; endoscopic endonasal approach; corticotropin releasing factor; quality of life; primitive neuroectodermal tumor; Rare tumors; Skull base surgery; Transsphenoidal sellar region; Endoscopic endonasal approach; WHO
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.11.057

Abstract Objective In the present study we aim to provide further definition of a group of rare sellar pathologies treated by the endoscopic endonasal approach. Matherial and Methods A retrospective analysis of data obtained from a series of 1729 patients who underwent endoscopic endonasal surgery at two academic institutions (Università degli Studi di Napoli Federico II, Naples, Italy - between January 1997 and December 2013, and The Wexner Medical Center at The Ohio State University – between July 2010 and September 2015). Clinical charts, operative notes and pathology reports were examined. Results A total of 346 cases were identified to have non-adenomatous pathologies. Applying the Rosner test for outliers assisted to exclude relatively frequent lesions. The final cohort of rare sellar pathologies comprised 78 patients. Arachnoid cysts were the most frequently encountered sellar lesion (12 patients, 15%), followed by metastasis (11 cases, 14%), followed by hypophysitis (8 cases, 10%), oncocytoma and glioma (6 cases, 8% each). The most frequent clinical findings were headache (28%) and visual disorders (80%). A standard endoscopic endonasal approach was performed in 44 cases (56%), whereas, an extended approach was carried out in 34 patients (44%). Tumor removal was gross-total in 53% of patients, subtotal in 19 %, and partial in 21%. Post-operative endocrinologic and visual deficit evaluation revealed improvements in endocrine function in 8 patients (10%), visual disorders in 13 (16%). Postoperative complications arose in 28% of cases, mostly represented by diabetes insipidus (10%). Conclusion Endoscopic endonasal approaches offer some specific benefits in the treatment of these patients.