Cirurgia da hipófise por via trans-esfenoidal sob controle radiofluoroscópico e microdissecção novo tratamento da retinopatia diabética, tumores selares e neoplasias endocrinodependentes

Hardy, Jules; Marino Jr., Raul

doi:10.1590/S0004-282X1968000100002

Resumos

É apresentada nova técnica para a ablação total ou seletiva da hipófise utilizando via de acesso trans-esfenoidal, controle radiofluoroscópico e microdissecção, com traumatismo desprezível às estruturas circunvizinhas. Os autores comentam as aplicações do método à prática neurocirúrgica, relatando parte de uma série de mais 140 casos já operados. São discutidos os resultados obtidos no tratamento de 17 casos de retinopatia diabética, em 11 dos quais apenas o lobo anterior da hipófise foi removido, assim como aqueles obtidos na exérese de 20 casos de tumores selares. As indicações da hipofisectomia por via trans-esfenoidal no controle da sintomatologia das neoplasias endòcrinodependentes é estudada à luz dos resultados obtidos em 17 casos, sendo os resultados comparados com casos nos quais foi feita a implantação selar de ítrio90. As complicações operatorias em relação às três entidades nosológicas acima estudadas são também analisadas. Os autores salientam que a técnica descrita constitui, no presente estado das técnicas neurocirúrgicas utilizadas para a produção de uma insuficiência hipofisária duradoura, a intervenção de escolha.

A new neurosurgical technique for the partial or total exéresis of the pituitary gland, using a transphenoidal approach under radiofluoroscopic control and microdisection is described. Part of a series of more than 140 cases operated upon by this method is reported. Results obtained in the treatment of diabetic retinopathy in 17 cases, 11 of which had only the pars anterior removed, are discussed. The applications of the transphenoidal route in 20 cases of pituitary fossa tumors are analysed. The indications of this type of operation in the management of endocrinodependent cancer is studied in 17 cases and compared with the results of 36 cases submitted to implant of Yttrium90 in the sella turcica. The operative complications following transphenoidal exéresis of the pituitary gland in the treatment of diabetic retinopathy, sellar tumors and endocrinodependent growths are presented. The authors emphazise the fact that the described technique constitutes the procedure of choice for the production of a long lasting pituitary insufficiency, in comparison to the other techniques presently in use.

Cirurgia da hipófise por via trans-esfenoidal sob controle radiofluoroscópico e microdissecção novo tratamento da retinopatia diabética, tumores selares e neoplasias endocrinodependentes

The surgery of the pituitary gland using a transphenoidal approach under radiofluoroscopic control and microdisection: a new treatment for diabetic retinopathy, pituitary tumors and endocrinodependent growths

Jules Hardy; Raul Marino Jr.

Departamento de Neurocirurgia do Hôpital Notre Dame e Université de Montreal, Montreal (Canadá)

RESUMO

É apresentada nova técnica para a ablação total ou seletiva da hipófise utilizando via de acesso trans-esfenoidal, controle radiofluoroscópico e microdissecção, com traumatismo desprezível às estruturas circunvizinhas. Os autores comentam as aplicações do método à prática neurocirúrgica, relatando parte de uma série de mais 140 casos já operados. São discutidos os resultados obtidos no tratamento de 17 casos de retinopatia diabética, em 11 dos quais apenas o lobo anterior da hipófise foi removido, assim como aqueles obtidos na exérese de 20 casos de tumores selares. As indicações da hipofisectomia por via trans-esfenoidal no controle da sintomatologia das neoplasias endòcrinodependentes é estudada à luz dos resultados obtidos em 17 casos, sendo os resultados comparados com casos nos quais foi feita a implantação selar de ítrio⁹⁰. As complicações operatorias em relação às três entidades nosológicas acima estudadas são também analisadas.

Os autores salientam que a técnica descrita constitui, no presente estado das técnicas neurocirúrgicas utilizadas para a produção de uma insuficiência hipofisária duradoura, a intervenção de escolha.

SUMMARY

A new neurosurgical technique for the partial or total exéresis of the pituitary gland, using a transphenoidal approach under radiofluoroscopic control and microdisection is described. Part of a series of more than 140 cases operated upon by this method is reported. Results obtained in the treatment of diabetic retinopathy in 17 cases, 11 of which had only the pars anterior removed, are discussed. The applications of the transphenoidal route in 20 cases of pituitary fossa tumors are analysed. The indications of this type of operation in the management of endocrinodependent cancer is studied in 17 cases and compared with the results of 36 cases submitted to implant of Yttrium⁹⁰ in the sella turcica. The operative complications following transphenoidal exéresis of the pituitary gland in the treatment of diabetic retinopathy, sellar tumors and endocrinodependent growths are presented. The authors emphazise the fact that the described technique constitutes the procedure of choice for the production of a long lasting pituitary insufficiency, in comparison to the other techniques presently in use.

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Full text available only in PDF format.

Departament of Neurosurgery Hôpital Notre Dame Montreal Canada.

1. ADAMS, J. H.; DANIEL, D. M. & PRICHARD, M. M. L. Transection of the pituitary stalk in man: anatomical changes in the pituitary glands of 21 patients. J. Neurol. Neurosurg. Psychiat. 29:545-555, 1966.
2. CUSHING, H. Partial hypophysectomy for acromegaly. With remarks on the function of the hypophysis. Ann. Surg. 50:1002-1017, 1909.
3. CUSHING, H. The Pituitary Body and its Disorders: Clinical States Produced by Disorders of the Hypophysis Cerebri. J. B. Lippincott Co., Philadelphia, 1912.
4. DOTT, N. M. & BAILEY, P. A consideration of the hypophysial adenomata. Brit. J. Surg. 13:314-366, 1925.
5. FAGER, C. A.; REES, S. B.. & BRADLEY, R. F. Surgical ablation of the pituitary in the treatment of diabetic retinopathy. J. Neurosurg. 24:727-733, 1966.
6. FRAZIER, C. H. An approach to the hypophysis through the anterior cranial fossa. Ann. Surg. 57:145-150, 1913.
7. GUIOT, G. & THIBAUT, B. L'extirpation des adenomes hypophysaires par voie trans-esphenoidale. Neurochirurgie 1:133-150, 1959.
8. HALSTEAD, A. E. Remarks of the operative treatment of tumors of hypophysis. With the report of two cases operated on by an oronasal method. Tr. Am. S. A. 28:73-93, 1910.
9. HAMBURGER, C. A.; HAMMER, G.; NORLÉN, G. & SPOGREN, B. Transphenoidal hypophysectomy. Arch. Oto-laryngol. 74:2-8, 1961.
10. HARDY, J. Hypophysectomie trans-esphenoidale par deux modalités técniques (destruction par implantation d'Yttrium⁹⁰ et ablation extra-capsulaire). Colloque International de Lyon, France (Mai, 1966), pgs. 1-7.
11. HARDY, J. & WIGSER, S. M. Trans-sphenoidal surgery of pituitary fossa tumors with televized radiofluoroscopic control. J. Neurosurg. 23:612-619, 1965.
12. HERDERSON, W. R. The pituitary adenomata. A follow-up study of the surgical results in 338 cases (Harvey Cushing's series). Brit. J. Surg. 26: 811-921, 1939.
13. HOCHENEGG, J. Zur Therapie von Hypophysentumoren. Deutsche Ztsch. f. Chir. 100:317-326, 1909.
14. HORSLEY, V. Diseases of the pituitary gland. Brit. M. J. 1:323, 1906.
15. HORSLEY, V. On the technique of operations on the central nervous system. Brit. M. J. 2:513-517, 1906.
16. HOUSSAY, B. A. & BIASSOTI, A. The hypophysis, carbohydrate metabolism and diabetes. Endocrinology 15:511-523, 1931.
17. IKKOS, D.; LUFT, R. & OLIVECRONA, H. Hypophysectomy in man: effect on water secretion during the two first postoperative months. J. Clin. Endocrin. Metabolism 15:553, 1955.
18. KANAVEL, A. B. The removal of tumors of the pituitary body by an infra -nasal route. J.A.M.A. 52:1704-1707, 1909.
19. KJELLBERG, R. N.; KOEHLER, A. M.; PRESTON, W. M. & SWEET, W. H. Stereotaxic instrument for the use with the Bragg peak of a proton beam. Confin. Neurol. 22:183-189, 1962.
20. KOCHER, T. Ein Fall von Hypophysentumor mit operatives Keilung. Deutsche Ztschr. f. Chir. 100:13-17, 1909.
21. KRAUSE, F. Hirnchirurgie. Die Deutsche Klinik am Eingange des Zwan-zigsten Jahrhunderts in akademischen Vorlesungen. 8:953-1024, 1905.
22. MIXTER, S. J. & QUACKENBASS, A. Tumor of the hypophysis with infantilism. Ann. Surg. 52:15-22, 1910.
23. RAY, B. S. The neurosurgeon's new interest in pituitary. J. Neurosurg. 17:1-21, 1960.
24. SCHLOFFER, H. Erfolgreiche operation eines Hypophysentumors auf nasalem Wege. Wien. Klin. Wchnschr. 20:621-624, 1907.
25. VON EISELBBERG, A. F. My experience about operation upon the hypophysis. Tr. Am. S. A. 28:55-72, 1910.

Datas de Publicação

Publicação nesta coleção
14 Maio 2013
Data do Fascículo
Mar 1968

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ADAMS, J. H.; DANIEL, D. M. & PRICHARD, M. M. L. Transection of the pituitary stalk in man: anatomical changes in the pituitary glands of 21 patients. J. Neurol. Neurosurg. Psychiat. 29:545-555, 1966.

[2] 2. CUSHING, H. Partial hypophysectomy for acromegaly. With remarks on the function of the hypophysis. Ann. Surg. 50:1002-1017, 1909.

[3] 3. CUSHING, H. The Pituitary Body and its Disorders: Clinical States Produced by Disorders of the Hypophysis Cerebri. J. B. Lippincott Co., Philadelphia, 1912.

[4] 4. DOTT, N. M. & BAILEY, P. A consideration of the hypophysial adenomata. Brit. J. Surg. 13:314-366, 1925.

[5] 5. FAGER, C. A.; REES, S. B.. & BRADLEY, R. F. Surgical ablation of the pituitary in the treatment of diabetic retinopathy. J. Neurosurg. 24:727-733, 1966.

[6] 6. FRAZIER, C. H. An approach to the hypophysis through the anterior cranial fossa. Ann. Surg. 57:145-150, 1913.

[7] 7. GUIOT, G. & THIBAUT, B. L'extirpation des adenomes hypophysaires par voie trans-esphenoidale. Neurochirurgie 1:133-150, 1959.

[8] 8. HALSTEAD, A. E. Remarks of the operative treatment of tumors of hypophysis. With the report of two cases operated on by an oronasal method. Tr. Am. S. A. 28:73-93, 1910.

[9] 9. HAMBURGER, C. A.; HAMMER, G.; NORLÉN, G. & SPOGREN, B. Transphenoidal hypophysectomy. Arch. Oto-laryngol. 74:2-8, 1961.

[10] 10. HARDY, J. Hypophysectomie trans-esphenoidale par deux modalités técniques (destruction par implantation d'Yttrium⁹⁰ et ablation extra-capsulaire). Colloque International de Lyon, France (Mai, 1966), pgs. 1-7.

[11] 11. HARDY, J. & WIGSER, S. M. Trans-sphenoidal surgery of pituitary fossa tumors with televized radiofluoroscopic control. J. Neurosurg. 23:612-619, 1965.

[12] 12. HERDERSON, W. R. The pituitary adenomata. A follow-up study of the surgical results in 338 cases (Harvey Cushing's series). Brit. J. Surg. 26: 811-921, 1939.

[13] 13. HOCHENEGG, J. Zur Therapie von Hypophysentumoren. Deutsche Ztsch. f. Chir. 100:317-326, 1909.

[14] 14. HORSLEY, V. Diseases of the pituitary gland. Brit. M. J. 1:323, 1906.

[15] 15. HORSLEY, V. On the technique of operations on the central nervous system. Brit. M. J. 2:513-517, 1906.

[16] 16. HOUSSAY, B. A. & BIASSOTI, A. The hypophysis, carbohydrate metabolism and diabetes. Endocrinology 15:511-523, 1931.

[17] 17. IKKOS, D.; LUFT, R. & OLIVECRONA, H. Hypophysectomy in man: effect on water secretion during the two first postoperative months. J. Clin. Endocrin. Metabolism 15:553, 1955.

[18] 18. KANAVEL, A. B. The removal of tumors of the pituitary body by an infra -nasal route. J.A.M.A. 52:1704-1707, 1909.

[19] 19. KJELLBERG, R. N.; KOEHLER, A. M.; PRESTON, W. M. & SWEET, W. H. Stereotaxic instrument for the use with the Bragg peak of a proton beam. Confin. Neurol. 22:183-189, 1962.

[20] 20. KOCHER, T. Ein Fall von Hypophysentumor mit operatives Keilung. Deutsche Ztschr. f. Chir. 100:13-17, 1909.

[21] 21. KRAUSE, F. Hirnchirurgie. Die Deutsche Klinik am Eingange des Zwan-zigsten Jahrhunderts in akademischen Vorlesungen. 8:953-1024, 1905.

[22] 22. MIXTER, S. J. & QUACKENBASS, A. Tumor of the hypophysis with infantilism. Ann. Surg. 52:15-22, 1910.

[23] 23. RAY, B. S. The neurosurgeon's new interest in pituitary. J. Neurosurg. 17:1-21, 1960.

[24] 24. SCHLOFFER, H. Erfolgreiche operation eines Hypophysentumors auf nasalem Wege. Wien. Klin. Wchnschr. 20:621-624, 1907.

[25] 25. VON EISELBBERG, A. F. My experience about operation upon the hypophysis. Tr. Am. S. A. 28:55-72, 1910.

Brasil

Brasil

Cirurgia da hipófise por via trans-esfenoidal sob controle radiofluoroscópico e microdissecção novo tratamento da retinopatia diabética, tumores selares e neoplasias endocrinodependentes

The surgery of the pituitary gland using a transphenoidal approach under radiofluoroscopic control and microdisection: a new treatment for diabetic retinopathy, pituitary tumors and endocrinodependent growths

Resumos

Datas de Publicação