Dataset Information

Endoscopic transsphenoidal resection of a recurrent petrous apex cholesterol granuloma: Operative video.

ABSTRACT: Background:Cholesterol granulomas (GC) of the petrous apex are benign cystic lesions that occur due to a foreign body reaction to blood by-products and cholesterol crystals. They cause erosion and expansion of the petrous apex and lead to cranial nerve deficits. Case Description:We present an operative video of a 28-year-old male whose work-up for horizontal diplopia revealed a right petrous apex GC. He originally underwent a subtemporal and later a transmastoid approach at outside institutions before he presented to us with diplopia due to recurrence. An endoscopic transsphenoidal transclival approach was done for drainage and resection of the GC. The patient did well and his diplopia resolved. A follow-up MRI showed no recurrence of the granuloma. Conclusion:This case illustrates an endoscopic transsphenoidal transclival approach for a recurrent petrous apex CG, which may lead to symptom resolution if done in a timely fashion.

SUBMITTER: Saiegh FA

PROVIDER: S-EPMC7193459 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Endoscopic transsphenoidal resection of a recurrent petrous apex cholesterol granuloma: Operative video.

Saiegh Fadi Al FA Lavergne Pascal P Mahtabfar Aria A Garzon-Muvdi Tomas T Rosen Marc M Evans James J JJ

Surgical neurology international 20200425

<h4>Background</h4>Cholesterol granulomas (GC) of the petrous apex are benign cystic lesions that occur due to a foreign body reaction to blood by-products and cholesterol crystals. They cause erosion and expansion of the petrous apex and lead to cranial nerve deficits.<h4>Case description</h4>We present an operative video of a 28-year-old male whose work-up for horizontal diplopia revealed a right petrous apex GC. He originally underwent a subtemporal and later a transmastoid approach at outsid ...[more]

PMID: 32844048

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Project description:PurposeCurrently, endoscopic transsphenoidal surgery is the main treatment for pituitary neuroendocrine tumors (PitNETs). Excision of the tumor may have positive or negative effects on pituitary endocrine function, and the pituitary function of somatotroph tumors is a point of particular concern after the operation. This study aimed to conduct a meta-analysis on the effect of endoscopic transsphenoidal somatotroph tumor resection on pituitary function.MethodsA systematic literature search was conducted for articles that included the evaluation of pituitary target gland before and after endoscopic transsphenoidal pituitary tumor resection and were published between 1992 and 2022 in PubMed, Cochrane, and Ovid MEDLINE.ResultsSixty-eight studies that included biochemical remission rates in 4524 somatotroph tumors were concluded. According to the 2000 consensus, the biochemical remission rate after transsphenoidal endoscopic surgery was 66.4% (95% CI, 0.622-0.703; P = 0.000), the biochemical remission rate was 56.2% according to the 2010 consensus (95% CI, 0.503-0.620; P = 0.041), and with the rate of biochemical remission ranging from 30.0 to 91.7% with investigator's definition. After endoscopic resection, adrenal axis dysfunction was slightly higher than that before surgery, but the difference was not statistically significant. Hypothyroidism was 0.712 times higher risk than that before surgery (OR = 0.712; 95% CI, 0.527-0.961; P = 0.027). Hypogonadism was 0.541 times higher risk than that before surgery (OR = 0.541; 95% CI, 0.393-0.746; P = 0.000). Hyperprolactinemia was 0.131 times higher risk than that before surgery (OR = 0.131; 95% CI, 0.022-0.783; P = 0.026). The incidence of pituitary insufficiency was 1.344 times the risk before surgery after endoscopic resection of somatotroph tumors, but the difference was not statistically significant.ConclusionsIn patients with somatotroph tumors after undergoing endoscopic surgery, the risk of dysfunction and pituitary insufficiency tend to increase, while preoperative thyroid insufficiency, gonadal insufficiency, and hyperprolactinemia will be partially relieved.

Dataset Information

Endoscopic transsphenoidal resection of a recurrent petrous apex cholesterol granuloma: Operative video.

Publications

Endoscopic transsphenoidal resection of a recurrent petrous apex cholesterol granuloma: Operative video.

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