This book, which reviews the current state of transsphenoidal surgery, is dedicated to those individuals who had the courage to remain true to what had become an unpopular surgical concept, and to revive what has ultimately become one of the major advances of 21st century neurosurgery. After performing some 440 transsphenoidal operations for pituitary lesions, Harvey Cushing abandoned the procedure in favor of craniotomy towards the end of his surgical career, and most of the rest of the neurosurgical world followed suit.
In Europe, Oskar Hirsch in Vienna continued enthusiastically with his endonasal transsphenoidal approach and ultimately brought it to the United States. In the British Isles, Norman Dott, after a year with Cushing in 1925, became an exponent of the sublabial transssphenoidal approach, and taught it to Gerard Guiot of France. Guiot trained Jules Hardy of Montreal Canada, and with the concepts of excellent lighted transsphenoidal retractors, the operating microscope, intraoperative fluoroscopy, and the idea of selective removal of microadenomas, a new era of pituitary surgery had begun.
In the United States, early pioneers of the method included Nicholas Zervas, John Van Gilder, George Tindall, Charles Wilson, Martin Weiss, Ivan Ciric, George Udvarhelyi, Kalmon Post, and others who have inspired and influenced all of us who follow.
These individuals had the courage to learn and develop a novel technique, to work collaboratively with Otorhinolaryngologists and Endocrinologists, and to persist in publishing and presenting their work despite resistance and even ridicule from their more traditional colleagues. It is exciting to consider how the evolution of these concepts has changed much of what we do in Neurosurgery, and how much this has benefitted our patients.
Key Features
- Refine your skills through discissions of intraoperative imaging, new techniques in transsphenoidal surgery, new microsurgical procedures, radiosurgical techniques, and more.
- Get balanced and comprehensive perspectives on pituitary surgery from well-recognized international, multidisciplinary contributors.
- Make better-informed decisions with case presentations, drawn from Dr. Laws's 40-plus years as a leader in pituitary surgery, that include a summary of the clinical history, preoperative radiographs, and postoperative clinical information and radiographs.
- Tap into exceptional visual guidance and reduce the risk of error through abundant clinical photographs and line drawings.
- Find the information you need quickly via a consistent chapter-to-chapter organization.
Website Features
- Consult the book from any computer at home, in your office, or at any practice location.
- Instantly locate the answers to your clinical questions via a simple search query.
- Quickly find out more about any bibliographical citation by linking to its MEDLINE abstract.
- Images: Browse a Library of all book images. Easily select, organize, and download your images into a presentation.
Contents
Chapter 1 - Reflections on the Evolution of Pituitary Tumor Surgery with Emphasis on the Transsphenoidal Approach
Chapter 2 - History of Transsphenoidal Surgery for Pituitary Tumors
- The Origins
Chapter 3 - Principles and Pitfalls of Anesthesia for Transsphenoidal Surgery
- Introduction
- Presentation
- General Preoperative Concerns
- Preoperative Concerns Related to Endocrine Disease
- Intraoperative Management
- Postoperative Considerations
Chapter 4 - The Perioperative Care of the Pituitary Patient
- Introduction
- Preoperative Evaluation: Establishing an Anatomical and Endocrinological Diagnosis and Managing Endocrinopathy
- Preoperative Management
- Intraoperative Management
- Postoperative Management
- Postoperative Management After Extended Transsphenoidal Surgery
Chapter 5 - The Neuro-Ophthalmology of Pituitary Tumors
- Introduction
- Neuro-Anatomical Considerations
Chapter 6 - Rhinological Evaluation
- Introduction
- Nasal Anatomy
- Physiology of Nasal Airflow
- Preoperative Considerations
- Approaches to the Sphenoid
- Complications
Chapter 7 - Imaging of the Sella and Parasellar Region
- Introduction
- Normal Anatomy of the Sellar-Parasellar Region
- Diagnostic Modalities
- Specific Lesions
- Supplementary Imaging Modalities
Chapter 8 - Intraoperative Imaging: Current Trends, Technology, and Future Directions
- Introduction
- Current Trends and Technology
- Types of Magnets
- iMRI in Neurosurgery
- iMRI in Transsphenoidal Surgery
- Intraoperative MRI of the Sellar Region
- Potential of iMRI-Guided Transsphenoidal Surgery
- Limitations of Current iMRI-Guided Transsphenoidal Approaches
Chapter 9 - Classification, Pathobiology, Molecular Markers, and Intraoperative Pathology
- Introduction
- The Normal Pituitary Gland
- Intraoperative Pathology and Handling of the Specimens
- Specimen Handling
- Pituitary Adenomas
- Inflammatory Hypophysitis
- Lymphocytic Hypophysitis
- Giant-Cell Granulomatous Hypophysitis
- Miscellaneous Lesions and Tumors
Chapter 10 - Surgical Anatomy of the Sellar Region
- The Sellar Region
- Suprasellar and Third Ventricular Region
Chapter 11 - Microsurgical Approaches for Transsphenoidal Surgery
- Introduction
- Concepts of the Approach
- Surgical Technique
- Reconstruction / Closure
Chapter 12 - Endoscopic Transsphenoidal Surgery: Anatomy, Instrumentation, Techniques
- Anatomy
- Instrumentation
- Techniques
Chapter 13 - Endoscopic Transsphenoidal Pituitary Surgery: Results and Complications
- Introduction
- Indications
- Surgical Technique
- Surgical Standard Technique
- Quality of Nasal Functionality
- Discussion
- Final Remarks
Chapter 14 - The Role of Transsphenoidal Surgery in the Management of Complex Lesions Involving the Skull Base
- Introduction
- Anatomical Limitations of Variations on the Transsphenoidal Approach
- Surgical Indications for Variations of the Transsphenoidal Approach
- Operative Techniques
- Complications
- Use of the Transsphenoidal Approach in Combination with Other Skull Base Approaches
- Use of the Endoscope for Skull Base Lesions
Chapter 15 - Closure Methods
- Introduction
- Rate of Intraoperative and Postoperative CSF Leaks After Transsphenoidal Surgery
- Principles of Transsphenoidal Sellar Defects and Their Repair
- Summary of Currently Used Closure Materials
- Closure Technique: Graded Repair of Intraoperative CSF Leaks
Chapter 16 - Complications: Avoidance and Management
- Introduction
- Nasal Complications
- Intranasal Complications
- Dental Complications
- Intraorbital Complications
- Intracranial
- Meningitis / Abscess
- Cavernous Sinus
- Cranial Nerves
- Hypopituitarism
- Hypothalamic
- Visual Loss / Chiasmatic Injury
- Hemorrhage
- Empty Sella
- Reoperation
Chapter 17 - Transsphenoidal Surgery for Recurrent Disease
- Introduction
- General Considerations
- Diagnosing the Recurrence of Pituitary Adenomas
- GH Adenomas
- Corticotroph Adenomas: Cushing's Disease and Nelson's Syndrome
- TSH Adenomas
- Therapy for Recurrent Pituitary Tumors
- Sphenoid Sinus Access and Exposure
- Sphenoidotomy
- Outcomes
Chapter 18 - Transsphenoidal Resection of Craniopharyngiomas
- Introduction
- Epidemiology and Controversy
- History
- Surgical Anatomy and Embryology
- Rationale for the Transsphenoidal Approach
- Extended Transsphenoidal Surgery
- Additional Indications
- Endoscopic Techniques
- Redo Transsphenoidal Surgery
- Pediatric Craniopharyngiomas
- Complications
Chapter 19 - Transsphenoidal Surgery for Cushing's Disease: Pitfalls, Results, and Long-Term Follow-up
- Introduction
- Pitfalls in the Treatment of Cushing's Disease
- Radiological Pitfalls
- Pitfalls in Transsphenoidal Surgery
- Complications
- Results and Long-Term Follow-up
- Postoperative Endocrine Function
- Treatment of Failed Surgery and Recurrent Disease
Chapter 20 - Transsphenoidal Surgery for Acromegaly
- Introduction
- Clinical Evaluation
- Indications for Surgery
- Results and Complications of Surgery
Chapter 21 - Transsphenoidal Surgery for Prolactinomas
- Introduction
- Radiological Assessment
- Clinical Presentation
- Options for Patients with Prolactinomas
Chapter 22 - Transsphenoidal Surgery for Nonfunctioning Adenomas
- History
- Epidemiology and Histopathology
- Classification
- Natural History
- Surgery for Nonfunctioning Adenomas
- Complications
- Outcomes
- Adjuvant Therapy
Chapter 23 - Pituitary Carcinoma
- Introduction
- Pathogenesis of Pituitary Carcinomas
- Histological Analysis
- Proliferative Markers
- Molecular Analysis and Cytogenetics
- Prognosis and Predictors of Outcome
Chapter 24 - Pituitary Metastases
- Introduction
- Primary Neoplasm
- Metastases Located Within the Pituitary Gland
- Differentiation between Metastasis and Other Intrasellar Lesions
Chapter 25 - Pituitary Tumors in Infancy and Childhood
- Introduction
- Epidemiology
- Clinical Signs and Presentation
- Diagnostics
- Surgical Management and Outcomes
- Complications of Transsphenoidal Surgery
- Long-term Management
Chapter 26 - Anatomical Approach to Giant Pituitary Tumors
- Introduction
- Grade I Pituitary Tumors
- Grade II Giant Pituitary Tumors
- Grade III Pituitary Tumors
- Grade IV Pituitary Tumors
- Author's Experience
- Results
Chapter 27 - Radiotherapy for Pituitary Tumors
- Introduction
- History
- Basic Principles
- Normal Tissue Tolerance
- Results
- Acromegaly
- Cushing's Disease
- Prolactinoma
- Complications of Radiotherapy
Chapter 28 - Stereotactic Radiosurgery for Pituitary Adenomas
- Introduction
- Radiosurgical Techniques
- Radiosurgical Goals and Expectations Based upon the Literature
- Control of Pituitary Adenoma Growth
- Cushing's Disease
- Acromegaly
- Prolactinoma
- Nelson's Syndrome
- Endocrine Improvement and Late Recurrence
- Complications of Radiosurgery for Pituitary Adenomas
- The Experience at the University of Virginia
About the Authors
- Edward R. Laws, MD, FACS, Professor, Department of Neurosurgery, Harvard University; Director, Pituitary / Neuroendocrine Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachussetts.
- Giuseppe Lanzino, MD, Professor of Neurosurgery, Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
Product Details
- Hardcover: 336 pages
- Publisher: Saunders; 1 Har/Psc edition (2011)
- Language: English
- ISBN-10: 1416002928
- ISBN-13: 978-1416002925
- Product Dimensions: 11.1 x 8.7 x 0.6 inches
List Price: $248.00