Endoscopic Endonasal Surgery for Recurrent Pituitary Tumors: Technical Challenges to the Surgical Approach

Objective To review our experience in a series of patients who underwent revision endoscopic pituitary surgery. Methods Retrospective chart review. Results A total of 27 patients were included in the study. Of the 21 patients who required nasoseptal flap reconstruction, a left-sided nasoseptal flap was successfully used in 13 patients. Gross total or near-total resection of tumor was achieved in 74.1%. Cavernous sinus invasion and presentation with residual disease were identified as factors limiting extent of resection (p = 0.002 and 0.009, respectively). A statistically significant difference (p = 0.027) was noted between mean largest tumor dimension in patients with gross total resection and those with near-total or subtotal resection. Complications occurred in 22% and included postoperative temporary diabetes insipidus (n = 2), postoperative hypotension (n = 2), new anterior pituitary insufficiency (n = 1), and right-sided abducens palsy (n = 1). Conclusions Revision endoscopic pituitary surgery is advantageous but technically challenging. Cavernous sinus invasion and presentation with residual disease were significant factors limiting extent of resection. Suprasellar extension was not a factor limiting extent of resection and may prove to be an advantage over microscopic speculum-based approaches. Because of the right-sided scarring from prior surgery, a left-sided nasoseptal flap is reliable and advantageous

Endoscopic Endonasal Surgery for Recurrent Pituitary Tumors: Technical Challenges to the Surgical Approach

Objective To review our experience in a series of patients who underwent revision endoscopic pituitary surgery. Methods Retrospective chart review. Results A total of 27 patients were included in the study. Of the 21 patients who required nasoseptal flap reconstruction, a left-sided nasoseptal flap was successfully used in 13 patients. Gross total or near-total resection of tumor was achieved in 74.1%. Cavernous sinus invasion and presentation with residual disease were identified as factors limiting extent of resection (p = 0.002 and 0.009, respectively). A statistically significant difference (p = 0.027) was noted between mean largest tumor dimension in patients with gross total resection and those with near-total or subtotal resection. Complications occurred in 22% and included postoperative temporary diabetes insipidus (n = 2), postoperative hypotension (n = 2), new anterior pituitary insufficiency (n = 1), and right-sided abducens palsy (n = 1). Conclusions Revision endoscopic pituitary surgery is advantageous but technically challenging. Cavernous sinus invasion and presentation with residual disease were significant factors limiting extent of resection. Suprasellar extension was not a factor limiting extent of resection and may prove to be an advantage over microscopic speculum-based approaches. Because of the right-sided scarring from prior surgery, a left-sided nasoseptal flap is reliable and advantageous

Higher risk of superficial injection during injection laryngoplasty in women

PURPOSE: To review our clinical experience with percutaneous injection laryngoplasty at a single institution over a three-year period, and to specifically assess the rate of unintentional injection into the superficial lamina propria (SLP) and compare with results found in the literature. MATERIALS AND METHODS: Medical records were retrospectively reviewed to identify patients who underwent office-based injection laryngoplasty (OBIL) over a three-year period. Video documentation and the written notes of the procedures were reviewed to determine the rate of inadvertent placement of injectate into the SLP. A literature review was performed to identify other reports of this complication and contributing factors. RESULTS: 113 consecutive patients were identified who underwent OBIL in the study period. Of these, 100 patients had adequate records and follow-up available for this review. All patients underwent injection augmentation with bovine collagen using a percutaneous trans-membrane or trans-cartilaginous technique. 96 had improvement in their vocal quality and/or effort. Four patients, who were all women, had unintentional injection into the SLP with resultant no change in voice or worsened voice. All superficially placed injectates were managed conservatively. CONCLUSIONS: Injection into the SLP is a well-recognized possible complication of OBIL. Our results suggest that this complication occurs more often in women than in men, perhaps due to differing laryngeal anatomy and size