Journal of Korean Neurosurgical Society

  • 제65권4호
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  • Pages.591-597
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  • 2022
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Arachnoid Remodeling by Clipping Technique Facilitates Surgical Maneuverability during Transsphenoidal Surgery for Pituitary Macroadenoma

  • Kim, Eui Hyun (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Park, Soo Jeong (Department of Neurosurgery, Ewha Woman's University College of Medicine) ;
  • Na, Minkyun (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Moon, Ju Hyung (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Kim, Sun Ho (Department of Neurosurgery, Yonsei University College of Medicine)
  • 투고 : 2021.07.05
  • 심사 : 2021.12.08
  • 발행 : 2022.07.01
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초록

Objective : Pituitary adenomas frequently extend into the suprasellar space. After a suprasellar tumor is removed, the superiorly extended arachnoid becomes redundant and sinks down into the intrasellar space which often hiders visualization and accessibility to the hidden space behind the evaginated arachnoid. We introduced arachnoid remodeling by clipping technique, and evaluated its usefulness and safety during TSS. Methods : Total 223 patients who underwent arachnoid remodeling with our new clipping technique were included. Redundant arachnoid was clipped along the dural edge with multiple 2.6-mm titanium clips until the redundant arachnoid membrane no longer blocked the surgical route. To check for possible deterioration of hormonal function by this technique, we assessed anterior pituitary function of 166 patients who underwent arachnoid remodeling by clipping and compared this with those of other 429 control patients. Results : Our technique greatly enhanced the accessibility and visualization of intrasellar and parasellar spaces, both of which are generally hindered by redundant arachnoid during transsphenoidal surgery (TSS). We found no difference in anterior pituitary function between a clip-assisted arachnoid remodeling group and the control group, implying that this technique does not result in hypopituitarism. Conclusion : During TSS for pituitary adenomas with suprasellar extension, arachnoid remodeling by clipping technique is very useful and convenient for the management of the redundant arachnoid membrane to enhance visualization and surgical accessibility.

키워드

과제정보

This work was presented at the conference of the international society of pituitary surgeons (ISPS), San Diego, CA, USA (February 18-20, 2018). This study was supported by a faculty research grant of Yonsei University College of Medicine (6-2020-0224). The authors thank MID (Medical Illustration & Design), part of the Medical Research Support Services of Yonsei University College of Medicine, for all artistic support related to this work.

참고문헌

  1. Barzaghi LR, Losa M, Giovanelli M, Mortini P : Complications of transsphenoidal surgery in patients with pituitary adenoma: experience at a single centre. Acta Neurochir (Wien) 149 : 877-885, 2007 https://doi.org/10.1007/s00701-007-1244-8
  2. Ciric I, Ragin A, Baumgartner C, Pierce D : Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40 : 225-237, 1997 https://doi.org/10.1097/00006123-199702000-00001
  3. Decker RE, Chalif DJ : Progressive coma after the transsphenoidal decompression of a pituitary adenoma with marked suprasellar extension: report of two cases. Neurosurgery 28 : 154-157, 1991 https://doi.org/10.1227/00006123-199101000-00023
  4. Kim EH, Ku CR, Lee EJ, Kim SH : Extracapsular en bloc resection in pituitary adenoma surgery. Pituitary 18 : 397-404, 2015 https://doi.org/10.1007/s11102-014-0587-4
  5. Kim EH, Moon JH, Kim SH : Clipping technique for the repair of the intraoperative cerebrospinal fluid leakage during transsphenoidal pituitary tumor surgery. Oper Neurosurg (Hagerstown) 17 : 382-388, 2019 https://doi.org/10.1093/ons/opy408
  6. Kim EH, Oh MC, Kim SH : Angiographically documented cerebral vasospasm following transsphenoidal surgery for pituitary tumors. Pituitary 16 : 260-269, 2013 https://doi.org/10.1007/s11102-012-0415-7
  7. Kim EH, Oh MC, Kim SH : Application of low-field intraoperative magnetic resonance imaging in transsphenoidal surgery for pituitary adenomas: technical points to improve the visibility of the tumor resection margin. Acta Neurochir (Wien) 155 : 485-493, 2013 https://doi.org/10.1007/s00701-012-1608-6
  8. Kitano M, Taneda M : Capsule plication as a protective measure against post-operative intracapsular haematoma formation following transsphenoidal removal of pituitary macroadenoma. Acta Neurochir (Wien) 150 : 797-802, 2008 https://doi.org/10.1007/s00701-008-1583-0
  9. Ku CR, Kim EH, Oh MC, Lee EJ, Kim SH : Surgical and endocrinological outcomes in the treatment of growth hormone-secreting pituitary adenomas according to the shift of surgical paradigm. Neurosurgery 71(2 Suppl Operative) : ons192-ons203, 2012
  10. Kurwale NS, Ahmad F, Suri A, Kale SS, Sharma BS, Mahapatra AK, et al. : Post operative pituitary apoplexy: preoperative considerations toward preventing nightmare. Br J Neurosurg 26 : 59-63, 2012 https://doi.org/10.3109/02688697.2011.591947
  11. Lee EJ, Ahn JY, Noh T, Kim SH, Kim TS, Kim SH : Tumor tissue identification in the pseudocapsule of pituitary adenoma: should the pseudocapsule be removed for total resection of pituitary adenoma? Neurosurgery 64(3 Suppl) : ONS62-ONS69, 2009
  12. Moon JH, Kim EH, Kim SH : Snare technique for the remodeling of the redundant arachnoid pouch to prevent cerebrospinal fluid rhinorrhea and hematoma collection during transsphenoidal surgery for suprasellar-extended pituitary tumors. J Neurosurg 125 : 1443-1450, 2016 https://doi.org/10.3171/2015.11.jns151328
  13. Nakane T, Kuwayama A, Watanabe M, Kageyama N : Transsphenoidal approach to pituitary adenomas with suprasellar extension. Surg Neurol 16 : 225-229, 1981 https://doi.org/10.1016/0090-3019(81)90012-4
  14. Zhang X, Fei Z, Zhang J, Fu L, Zhang Z, Liu W, et al. : Management of nonfunctioning pituitary adenomas with suprasellar extensions by transsphenoidal microsurgery. Surg Neurol 52 : 380-385, 1999 https://doi.org/10.1016/S0090-3019(99)00120-2