Webinar: Endoscopic Endonasal Surgery for the Treatment of Cushing’s Disease

Posted on June 6, 2016 by MaryO

Mon, Jun 13, 2016 11:00 AM – 12:00 PM EDT

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Presented by:
Dr. Maria Koutourousiou
Webinar DescriptionAn update on the diagnosis and treatment options of Cushing’s disease. Description of the endoscopic endonasal approach for the management of CD. Surgical videos demonstration and comparison with the microscopic transsphenoidal approach. Surgical outcomes and adjuvant treatment.

Presenter Bio

Dr. Mary Koutourousiou is an attending Neurosurgeon and Assistant Professor at the University of Louisville. She is the Director of the Pituitary and Skull Base Program. Dr. Koutourousiou received her M.D. from the Aristotle University of Thessaloniki, Greece and completed her neurosurgical residency at the General Hospital of Athens “G. Gennimatas”, in Greece. She underwent subspecialty fellowship training in Endoscopic Pituitary Surgery and Minimally Invasive Neurosurgery at the UMC St. Radboud, Nijmegen, in the Netherlands. She moved to the United States in 2010 and completed four years of research and a clinical fellowship in Endoscopic and Open Skull Base Surgery at UPMC Presbyterian in Pittsburgh, Pennsylvania.

Dr. Koutourousiou has published extensively in the field of endoscopic skull base surgery. Her studies have been presented in national and international neurosurgical meetings. Dr. Koutourousiou’s work in skull base surgery has been recognized by the European Skull Base Society and the World Federation of Skull Base Societies.

Register here: https://attendee.gotowebinar.com/register/4982773766837282305?utm_source=newsletter_199&utm_medium=email&utm_campaign=webinar-announcement-endoscopic-endonasal-surgery-for-the-treatment-of-cushing-s-disease

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Primary versus revision transsphenoidal resection for nonfunctioning pituitary macroadenomas: matched cohort study

Posted on May 22, 2016 by MaryO

 

Departments of 1Neurosurgery and 2Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia; and 3Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts

ABBREVIATIONS DI = diabetes insipidus; GTR = gross-total resection; NFPMA = nonfunctioning pituitary macroadenoma; PFS = progression-free survival;SIADH = syndrome of inappropriate antidiuretic hormone; SRS = stereotactic radiosurgery; STR = subtotal resection; TSR = transsphenoidal resection.

INCLUDE WHEN CITING Published online May 20, 2016; DOI: 10.3171/2016.3.JNS152735.

Correspondence John A. Jane Jr., Department of Neurological Surgery, University of Virginia, Box 800212, Charlottesville, VA 22908. email:.

Abstract

OBJECTIVE

The object of this study was to compare the outcomes of primary and revision transsphenoidal resection (TSR) of nonfunctioning pituitary macroadenomas (NFPMAs) using endoscopic methods.

METHODS

The authors retrospectively reviewed the records of 287 consecutive patients who had undergone endoscopic endonasal TSR for NFPMAs at their institution in the period from 2005 to 2011. Fifty patients who had undergone revision TSR were retrospectively matched for age, sex, and duration of follow-up to 46 patients who had undergone primary TSR. Medical and surgical complications were documented, and Kaplan-Meier analysis was performed to assess rates of radiological progression-free survival (PFS).

RESULTS

The median follow-up periods were 45 and 46 months for the primary and revision TSR groups, respectively. There were no significant differences between the primary and revision groups in rates of new neurological deficit (0 in each), vascular injury (2% vs 0), postoperative CSF leak (6% vs 2%), transient diabetes insipidus (DI; 15% vs 12%), chronic DI (2% vs 2%), chronic sinusitis (4% vs 6%), meningitis (2% vs 2%), epistaxis (7% vs 0), or suprasellar hematoma formation (0 vs 2%). However, patients who underwent primary TSR had significantly higher rates of syndrome of inappropriate antidiuretic hormone (SIADH; 17% vs 4%, p = 0.04). Patients who underwent primary operations also had significantly higher rates of gross-total resection (GTR; 63% vs 28%, p < 0.01) and significantly lower rates of adjuvant radiotherapy (13% vs 42%, p < 0.01). Radiological PFS rates were similar at 2 years (98% vs 96%) and 5 years (87% vs 80%, p = 0.668, log-rank test).

CONCLUSIONS

Patients who underwent primary TSR of NFPMAs experienced higher rates of SIADH than those who underwent revision TSR. Patients who underwent revision TSR were less likely to have GTR of their tumor, although they still had a PFS rate similar to that in patients who underwent primary TSR. This finding may be attributable to an increased rate of adjuvant radiation treatment to subtotally resected tumors in the revision TSR group.

From http://thejns.org/doi/abs/10.3171/2016.3.JNS152735?journalCode=jns

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A Team Effort to Treat a Pea-Sized Gland

Posted on May 12, 2016 by MaryO

HYANNIS – Endoscopic surgery for pituitary tumors involves the use of small instruments, but neurosurgeon Nicholas Coppa, MD, FAANS, is quick to say it takes a big team to make the surgeries a success.

“It’s very much a collaborative effort among endocrinology, neurosurgery and otolaryngology specialties,” he said.

Dr. Coppa frequently works with endocrinologist Catalina Norman, MD, PhD, and ear, nose and throat surgeon Ross Johnston, MD.

The pituitary gland sits at the base of the brain. It makes important hormones that control several different systems in the body and help maintain normal body function.

“The overwhelming majority of patients with big tumors present with visual problems,” said Dr. Coppa. “They get tunnel vision from a tumor putting pressure on the vision nerves.

Many patients’ pituitary problems are detected incidentally while the physician is trying to diagnose a set of symptoms, most commonly headaches, he added. A variety of asymptomatic tumors are detected this way.

A subset of pituitary tumors secrete excess hormones, which create syndromes characterized by whatever hormone is being secreted in excess, Dr. Coppa added. Oftentimes these problems are diagnosed by an endocrinologist.

Before coming to Neurosurgeons of Cape Cod – now known as Cape Cod Healthcare Neurosurgery – in 2013, Dr. Coppa was professor of skull base surgery at Oregon Health and Science University’s Northwest Pituitary Center. He has performed more than 200 endoscopic surgeries for pituitary tumors, sinonasal malignancies and anterior skull base encephaloceles. The procedure is fairly new on Cape Cod, he said.

The pituitary gland is about the size of a pea, so operating on it is a tricky and delicate procedure.

The surgeon commonly works with an endoscope inserted through one nostril, and microsurgical instruments through the other nostril. This allows him to maneuver to the surgical area.

According to the Northwest Pituitary Center’s web site, “The tube is connected to a TV monitor that helps your doctor see the surgical area even more clearly than with a microscope. Your doctor can also use intraoperative neuro-navigation to perform image-guided surgery, based on a pre-operative CT scan or MRI. This helps the doctor see exactly where the tumor is and avoid damaging healthy brain tissue that is nearby.”

Nasal endoscopy for the neurosurgeon has really taken off in the last 10 years, according to Dr. Coppa. The main reason for the increase is because the technique allows better visualization of the anatomy, he said.

“We find that it allows, at least in my experience, more maneuverability of your micro-surgical instruments. That’s been very satisfying for patients. The nasal morbidity [adverse effects] is lower compared to historic ways of doing it.”

Ear, nose and throat doctors use trans-nasal surgery to treat many sinus conditions, said Dr. Coppa. But the procedure is predominantly used by neurosurgeons for pituitary tumors, other tumors of the skull base and malignancies of the sinus cavity that often invade the brain.

After endoscopic pituitary surgery, patients are typically in the hospital for several days and resume day-to-day activities within that first week.

By BILL O’NEILL, OneCape Health News

 

From http://www.capecod.com/newscenter/a-team-effort-to-treat-a-pea-sized-gland/

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Webinar on Management Options for Pituitary Tumors March 22

Posted on March 19, 2016 by MaryO

Dr. Andaluz will cover the full breadth of treatment options from managing endocrine function, surgical procedures (transsphenoidal, endoscopic, and keyhole approaches), radiotherapy / radiosurgery, and the importance of getting care at a multidisciplinary center.

Dr. Norberto Andaluz is a neurosurgeon with the Mayfield Clinic and University of Cincinnati Brain Tumor Center. He is also Associate Professor of Neurosurgery at the University of Cincinnati, Surgical Director of the Neuroscience Intensive Care Unit, and Director of Neurotrauma at the University of Cincinnati Neuroscience Institute. He specializes in the treatment of all disorders and diseases of the brain and spine, but in particular, traumatic brain injury, aneurysms, arteriovenous malformations (AVMs), intracerebral hemorrhage, stroke, carotid artery disease, moyamoya disease and brain tumors (with special training in skull base tumors like pituitary adenoma). Dr. Andaluz received his medical degree from Unversidad Nacional de Rosario in Argentina. He completed his residency in neurosurgery at Instituto de Neurología y Neurocirugía at Sanatorio Parque in Rosario, Argentina and earned a fellowship in cerebrovascular surgery from the University of Cincinnati. Professional memberships include the American Heart Association, Congress of Neurological Surgeons, National Neurotrauma Society, Neurocritical Care Society and North American Skull Base Society.

Register at http://pituitary.org/events/webinar-management-options-for-pituitary-tumors

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Tiruchi surgeons treat Pakistan national for pituitary tumour

Posted on February 15, 2016 by MaryO

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The patient had discovered his condition by chance in Quetta last year.

A team of city-based surgeons has performed a sophisticated surgery on a young Pakistani national to remove a pituitary tumour.

Bakhtiyar Khan, a 30-year-old Pakistani national from the Talli village in Sibi, Balochistan, underwent the surgery here a few days ago.

The surgery was performed by Dr. T.N. Janakiraman, skull base surgeon and managing director, Royal Pearl Hospital and Research Institute, Dr. Uday Chanukya, Dr. Prayatna Kumar, skull base surgeons, and Dr. Balamurugan, anaesthesiologist.

The tumour, in the cavernous sinus — a large collection of thin-walled veins creating a cavity bordered by the temporal bone of the skull and the sphenoid bone in the head, was removed through endoscopic surgery.

“Normally surgeons go through the skull and brain to excise the tumour with the help of surgical microscopic glasses. But this doesn’t ensure the removal of the entire tumour, which is why radiation is recommended after the operation,” Dr. Janakiraman told The Hindu .

“In Bakhtiyar’s case, the tumour had gone into the cavernous sinus. We used his nasal cavity as the entry point, and brought the tumour out through the nose as well. This is a scar-less keyhole surgery that ensures complete excision and doesn’t require us to make a new opening in the skull,” he added.

Dr. Janakiraman, who was trained in the procedure by internationally renowned neurosurgeon Dr. Amin Kassam in the U.S. 10 years ago, has been doing the procedure for the past nine years in Tiruchi.

For the patient’s elder brother, Sardar Khan, the experience has been both exhausting yet exhilarating. A file clerk at the local health centre in Sibi, the Khan brothers had taken their father, who is paralysed, to a doctor in Quetta last year, when the physician there suggested that it was Mr. Bakhtiyar who needed medical attention urgently. “None of us knew that he was unwell,” recounted Mr. Sardar. “We were advised by neurosurgeon Dr. Asghar Khan to seek help in India immediately. I couldn’t believe that I, who had never left my village to see even Lahore or Karachi, had to go to India.”

In a process that took three to six months, Mr. Sardar convinced Mr. Bakhtiyar and his other siblings (they are eight brothers and two sisters) to get ready to meet Dr. Janakiraman, besides applying for passports and organising visas.

The brothers took the Samjhauta Express from Wagah to Delhi on January 31. The Tamil Nadu Sampark Kranti Express brought them to Tiruchi after a 46-hour journey. As a humanitarian gesture, the hospital has waived all fees (in the range of Rs. 1 to 3 lakhs), except the cost of medicines.

“I’m feeling much better now, and my eyesight has improved,” said Mr. Bakhtiyar Khan. After a few days of observation and a final MRI scan, he will be free to travel back home with his brother.

Said a gratified Mr. Sardar: “I haven’t seen much of India, or even of Tiruchi, but to me, Dr. Janakiraman and his team are India. I’d like to thank all my new friends in India for taking such good care of me and my brother.”

From http://www.thehindu.com/news/national/tamil-nadu/tiruchi-surgeons-treat-pakistan-national-for-pituitary-tumour/article8231567.ece

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