{"title":"Transoral Robotic Surgery Applied to the Skull Base","authors":"D. Chauvet, S. Hans","doi":"10.5772/INTECHOPEN.81048","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.81048","url":null,"abstract":"Skull base surgery has been developed with transsphenoidal approaches to reach the sella and especially the pituitary tumors. Transnasal endoscopic technique has become the gold standard for many years. Indeed, the intraoperative view with specific endo - scope is very good, and thus the gross total of pituitary adenomas removal rates have been increased. Nevertheless, why has not this technique been challenged, especially given the potential rhinologic side effects and 2D vision? Robotic surgery with the da Vinci system is now well known all over the world. Transoral robotic surgery (TORS) is also commonly used in head and neck cancer with satisfying results. In this ENT approach, the da Vinci videoendoscope looks downward; we had the idea to place it behind the hard palate in order to look upward. Therefore, from cadaveric studies to clinical “première mondiale,” we developed an innovative TORS to reach the sella and to remove pituitary tumors.","PeriodicalId":447316,"journal":{"name":"Pituitary Diseases","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134338364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Huge Pituitary Adenomas: Dedicated Surgical Technique and Indications for Extent of Tumour Removal in the Modern Era","authors":"M. Fraioli, Andrea Pagano, B. Fraioli, P. Lunardi","doi":"10.5772/INTECHOPEN.77269","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.77269","url":null,"abstract":"Transsphenoidal surgery is the most indicated approach not only for small and large pituitary adenomas but also for huge ones. A modified transsphenoidal technique to remove huge pituitary adenomas with marked suprasellar extension (4–8 cm of maxi- mum diameter) resulted very useful in authors’ experience. The technique allowed avoiding the occurrence of a precocious descent of the suprasellar cisternal plane into the sellar plane during tumor removal and its related dangerous consequences. Technique was performed opening at the beginning only the lateral parts of peritumoral dura mater, and after removal of lateral parts of the tumor, the central part of peritumoral dura mater was opened and the central intrasellar and suprasellar parts of the tumor were removed. Comparing the results to similar patients operated by the same authors with standard surgical technique, we observed that total removal was accomplished in 64% of patients treated with modified technique than 45% of patients treated with standard transsphenoi dal surgery. Moreover, better results were achieved concerning intraoperative CSF leak, postoperative CSF fistula, and average time of postoperative stay in hospital. For invasive dumbbell-shaped pituitary adenomas, particular therapeutic plans are necessary.","PeriodicalId":447316,"journal":{"name":"Pituitary Diseases","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125289890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Jemel, W. Alaya, Fedia Boubaker, O. Berrich, B. Zantour
{"title":"Pituitary Apoplexy","authors":"M. Jemel, W. Alaya, Fedia Boubaker, O. Berrich, B. Zantour","doi":"10.5772/intechopen.77270","DOIUrl":"https://doi.org/10.5772/intechopen.77270","url":null,"abstract":"Pituitary apoplexy is a rare clinical emergency due to acute ischemic infarction or hemorrhage of the pituitary gland. As this disorder most often involves a pituitary adenoma, especially nonfunctioning tumors, the syndrome should be referred to as pituitary tumor apoplexy. The precise physiopathology is not completely clear. Although in most cases it occurs spontaneously, pituitary apoplexy can be precipi- tated by many risk factors. The main symptom is headache of sudden onset associated with visual disturbances, signs of meningeal irritation, and/or endocrine dysfunction. Corticotropic deficiency is a potentially life-threatening disorder. Magnetic resonance imaging is the most sensitive to confirm the diagnosis by revealing a pituitary tumor with hemorrhagic and/or necrotic components. Earlier studies used to consider urgent decompression of the lesion surgically, but nowadays, more recent studies favor conser- vative management in selected patients (those without important visual acuity or field defects and with normal consciousness). This wait-and-see approach gives evidence of excellent outcomes in terms of oculomotor palsy, pituitary function, and subsequent tumor growth. Surgical decompression may be necessary in some cases. Once the acute phase is over, the patient should be reevaluated for hormonal deficiencies. Moreover, spontaneous remission of syndromes, such as acromegaly, may be caused by pituitary adenoma apoplexy.","PeriodicalId":447316,"journal":{"name":"Pituitary Diseases","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128744164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bozzola Mauro, M. Chiara, B. Elena, StamatiAndreina Filomena, Larizza Daniela, F. Pietro, VillaniAlberto
{"title":"Management of Celiac Patients with Growth Failure","authors":"Bozzola Mauro, M. Chiara, B. Elena, StamatiAndreina Filomena, Larizza Daniela, F. Pietro, VillaniAlberto","doi":"10.5772/INTECHOPEN.77129","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.77129","url":null,"abstract":"","PeriodicalId":447316,"journal":{"name":"Pituitary Diseases","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116271819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hormone Secretion in Pituitary Adenomas: Immunohistochemical Studies","authors":"Raydeh Al Khani","doi":"10.5772/INTECHOPEN.81590","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.81590","url":null,"abstract":"Classification of pituitary adenomas is still changing and not completely satisfying. Various types of hormones, prehormonal substances, and transcription factors are detected in pituitary adenomas. Monohormonal secretion in pituitary adenomas is frequent, notably prolactin secretion. Secretion of more than one hormone normally originating from the same adenohypophyseal cell lineage is well known, classically GH-PRL and FSH-LH. Other combinations of hormonal secretion are reported; they are sometimes underestimated. Plurihormonal secretion in pituitary adenomas, which is secretion of hormones that are normally originating from different adenohypophyseal cell lineages, is usually underestimated and in most cases remains subclinical. An immunohistochemical study of all pituitary hormones and prehormonal substances, as demonstrating transcription factors, is not always available; it is frequently not performed. This chapter aims to show the underestimated and vague areas of pituitary adenomas and to emphasize the importance of immunohistochemical studies in the diagnosis and prediction of clinical outcomes of these adenomas.","PeriodicalId":447316,"journal":{"name":"Pituitary Diseases","volume":"189 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132604979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neuro-Ophthalmology Findings in Pituitary Disease (Review of Literature)","authors":"Arwa Azmeh","doi":"10.5772/INTECHOPEN.77065","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.77065","url":null,"abstract":"Visual symptoms often accompany pituitary diseases. Pituitary tumors may compress surrounding structures such as optic chiasm leading to visual field defects including bitemporal hemianopia and visual disturbance. They also may compress cranial nerves III, IV, and VI, leading to ocular motility abnormalities. Pituitary adenomas are the most common cause of chiasmal compression. Patients with nonsecreting tumors present initially with vision loss, and these tumors can reach large size without causing other symptoms; however, hormonally active tumors are detected before vision loss because of systemic symptoms. Acute hemorrhage or infarction of the pituitary tumor known as pituitary apoplexy causes diplopia, loss of vision, and visual field. Thus, the ophthal - mologist’s role is crucial in diagnosis and treatment of pituitary tumors. As visual loss may be the first sign of recurrence after treatment, it is essential to repeat visual field and visual acuity testing every 6–12 months. of non-paretic diplopia. The most common presenting sign in sellar/suprasellar meningiomas is visual disturbance, followed by headaches, diplopia, and ptosis. Parasellar meningiomas manifest with ocular motility abnormalities, abnormal pupillary reaction, as well as abnormal facial sensation; these complaints result from injury to cranial nerves III, IV, V1, V2, or VI and ocular sympathetic nerves in the parasellar region.","PeriodicalId":447316,"journal":{"name":"Pituitary Diseases","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132310897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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