J Neurol Surg B
DOI: 10.1055/s-0039-1694051
Original Article
Georg Thieme Verlag KG Stuttgart · New York

A Novel Technique for Transpalatal Hypophysectomy

Ilton Guenhiti Shinzato
1  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
2  COPPE, Universidade Federal do Rio de Janeiro, Brazil
,
Felipe Bouchabki de Almeida Guardini
3  Brazilian Neurosurgery Society, São Paulo, SP, Brazil
4  Universidade Federal de São Paulo, SP, Brazil
5  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, MS, Brazil
,
Herbert de Abreu Cavalcanti
6  Hospital Santa Casa de Campo Grande, Brazil
,
Tiago Fernando Scopel
7  Brazil
,
Fernando Kobayashi
3  Brazilian Neurosurgery Society, São Paulo, SP, Brazil
5  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, MS, Brazil
,
Anselmo Costa
3  Brazilian Neurosurgery Society, São Paulo, SP, Brazil
5  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, MS, Brazil
,
Igor Issao Moreira Yamamura
5  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, MS, Brazil
,
Eurico Ribeiro Feltrin
3  Brazilian Neurosurgery Society, São Paulo, SP, Brazil
5  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, MS, Brazil
,
Bruno Martins Ferreira de Andrade
3  Brazilian Neurosurgery Society, São Paulo, SP, Brazil
5  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, MS, Brazil
,
Franklin Marques Ennes
3  Brazilian Neurosurgery Society, São Paulo, SP, Brazil
5  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, MS, Brazil
,
Anderson Alves Silva
5  Hospital Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, MS, Brazil
,
Tiago Andrade de Oliveira e Silva
8  Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, MS, Brazil
,
Antonio Martins de Freitas Junior
8  Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, MS, Brazil
,
Adalberto Santiago de Souza Junior
8  Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, MS, Brazil
,
Danilo Horta Marcato
8  Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, MS, Brazil
,
Lucas Rasi Cunha
9  Statistician. Faculdade Senai, Campo Grande, MS, Brazil
,
Neide Trindade Mendes
10  Universidade Federal de São Carlos, São Carlos, SP, Brazil
,
Kleber Soline Monteiro Vargas
3  Brazilian Neurosurgery Society, São Paulo, SP, Brazil
11  Santa Casa de Campo Grande, Universidade Federal de Mato Grosso do Sul, MS, Brazil
› Author Affiliations
Further Information

Publication History

21 November 2018

11 June 2019

Publication Date:
18 September 2019 (online)

Abstract

Objective A novel technique is described for transpalatal hypophysectomy as an option for sellar region surgery using a microscope and/or endoscope.

Technique A straight submucosal tunnel (approximately 20 mm in diameter; 40–50 mm long—half the length required by conventional transsphenoidal hypophysectomy) is dissected in favorable alignment with the main tumor axis, providing a direct view that allows the surgeon to operate on large suprasellar tumors, even in cases of extra-axial expansion.

Results In a 25-year period, over 50 patients benefited from this surgery. Macroadenomas devoid of extra-axial expansions were totally excised (76.5%), otherwise, partially (23.5%). Forty-nine patients (98%) were extubated soon after surgery. Mean surgery duration was 3 hour 32 minute, with 2 days 6 hour before free feeding was restored. Postoperative hospitalization under neurosurgical care averaged 6 days 6 hour. Currently, patients undergoing the procedure do not require nasal tampons and can eat soft foods soon after recovery from anesthesia. Although two patients (3.9%) presented with oronasal fistulae postoperatively, no episodes of severe hemorrhage occurred during surgery and there were no cases of liquoric fistulae, visual impairment, panhypopituitarism, or severe syndrome of inappropriate antidiuretic hormone secretion.

Conclusion The new surgical approach is safe, effective, and well accepted by patients, who reported low levels of discomfort. Postsurgical complications or sequela are currently rare, but further operations should be performed using more appropriate materials, instruments, and equipment to allow comparisons with other techniques.