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At least 919 records · Page 51Linked to original sources
PubMed2005

[Endoscope-assisted microsurgery for invasive endo- and suprasellar pituitary macroadenomas: a consecutive retrospective study with 13 patients].

BACKGROUND AND PURPOSE: Surgery of invasive endo- and suprasellar pituitary macroadenomas remains difficult. The records of 13 consecutive patients who underwent transsphenoidal surgery were analyzed in order to evaluate advantages and limitations of endoscopy for surgery of invasive pituitary macroadenomas. METHODS: A transseptal transsphenoidal intersepto-columellar approach was performed with a nasal 0-degree endoscope. Removal of the macroadenoma was performed under the control of a microscope. When the tumor seemed to be completely removed with microscope, a rigid 30-degree endoscope was inserted in the intrasellar and suprasellar regions in order to detect residual adenoma tissue. These residues were removed when technically possible. RESULTS: No rhinologic complication was noted. In 7 patients, the intra- and suprasellar endoscopic view detected a tumor residue which could be removed in each case. Two cases of cerebrospinal fluid leakage occurred during the complementary tumor resection. Two cases of diabetes insipidus and two of rhinorrhea were reported postoperatively. The analysis of the postoperative MRIs showed a complete removal in 23% of the patients (3/13), 75 to 100% removal in 54% of the patients (7/13), 50 to 75% removal in 8% of the patients (1/13) and 50% removal in 15% of the patients (2/13). More than 75% removal was thus achieved in 77% of the patients (10/13). The mean follow-up was 27.2 months. CONCLUSIONS: Rhinologic morbidity was reduced with the endoscopic endonasal approach. Endoscopy complemented with a microscope offered an optimal view of the intra- and suprasellar regions. Endoscopy also improved tumor resection of the invasive endo- and suprasellar pituitary macroadenomas by visualizing hidden suprasellar tumor residues. However, endoscopy was associated with a higher rate of postoperative rhinorrhea.

Adenoma↗
PubMed1997

Transanal endoscopic microsurgery.

Traditional methods of excising adenomas and selected carcinomas of the distal rectum provide adequate exposure and acceptable cure rates. Recurrence rates after locally excising adenomas, however, are 12% to 25%, possibly because the limited exposure has led to less than adequate resection margins. Whether or not TEM can yield lower recurrence rates remains to be seen, but this perhaps is not the main reason one should include TEM in his or her armamentarium. Rather, it is the improved exposure, the superior optics, and the opportunity to address lesions in the upper rectum that set TEM apart from conventional instrumentation. One should also keep in mind that these "inaccessible" lesions have been treated heretofore with either a transsacral or transabdominal approach, both of which are accompanied by a lengthy hospital stay and potential morbidity. When considering TEM excision of rectal cancers, proper patient selection cannot be overemphasized. Endorectal ultrasonography can help to determine depth of penetration preoperatively, and TEM can be used with curative intent for those lesions with minimal involvement of the rectal wall. TEM can also be used as a means to palliate the primary tumor of those patients with incurable, disseminated disease. Minimal-access surgery is here to stay. TEM may gain acceptance in this arena, marking a new technology for the treatment of a number of rectal conditions. The considerable skill necessary to perform this operation, combined with the relatively infrequent nature of the pathology addressed, however, will make TEM the domain of only a few surgeons.

Adenoma↗
PubMed1984

Microsurgery for vasectomy reversal and vasoepididymostomy.

Accurate microsurgical techniques developed by us have allowed a considerable improvement in success rate for vasectomy reversal, and a better understanding of the pathophysiology of obstruction. This has permitted us also to treat pathologic obstructive azoospermia more effectively.

Biopsy↗
PubMed2005

[Microsurgery of canalicular stenosis].

The microsurgical treatment of canalicular stenosis is indicated in localized stenosis. The goal is to restore lacrymal mucosa continuity in order to re-establish spontaneous lacrymal drainage. Stenosis located close to the puncti can be reached by the direct approach, those close to the lacrymal sac require an approach via the common canaliculus. The surgical indications and techniques are developed, with particular attention given to common canaliculus repair and the new surgical approach to reach it.

Dacryocystorhinostomy↗
PubMed1990

Studies of traumatic neuralgia in the maxillofacial region: symptom complexes and response to microsurgery.

Patients with chronic pain following trigeminal nerve injuries were studied before and after microsurgical repairs using the McGill Pain Language Inventory, sensory reflex testing, and assessment of pain relief from nerve blocks. This protocol differentiated four syndrome types that appeared singly or in combination: anesthesia dolorosa (AD), sympathetic mediated pain (SMP), hyperalgesia, and hyperpathia. Trigeminal nerve blocks proved to be good predictors of pain relief from microsurgical treatments. Surgical pain reduction was poor for AD and SMP (14.6% and 20.7%) as compared with hyperalgesia and hyperpathia (60.5% and 56.3%).

Adolescent↗
PubMed1998

Microsurgery for intra-abdominal testicular retention.

OBJECTIVES: In cases of high intra-abdominal retention of the testis a standard technique of cryptorchidy treatment will not be able to bring down the testis into the scrotum. In this study we wanted to evaluate the feasibility and reliability of the technical aspects of testicular autotransplantations in children under the age of 5 years. STUDY DESIGN: A series of 25 microsurgical autotranslantations of testes performed on 17 boys since July 1984 are reviewed. Emphasis was placed on the microvascular transplantation technique, the age of the patient and the long term viability of the autotransplants. An end-to-end microvascular anastomosis between the deep inferior epigastric artery and the testicular artery was performed in an end-to-end way using mattress stitches to accommodate the difference in diameter between the donor and recipient vessels. Also the testicular veins were anastomosed to the deep inferior epigastric veins. RESULTS: Of the 25 transplantations (96%) were successful after a mean follow up of 24 months, the one failure was ascribed arterial thrombosis. CONCLUSION: Our results show a 96% survival of the transplanted testes using the end-to-end vascular anastomosis as described here.

Abdomen↗
PubMed1988

Pituitary pathology in Cushing's disease. Histology and morphometry of pituitary tissues removed through microsurgery.

58 cases of Cushing's disease were studied after selective transsphenoidal surgery, by means of histology, immunocytochemistry and morphometry. The qualitative and quantitative results, related to the clinical follow-up of the patients indicated that: 1) when a well-defined tumor was found (62% of the patients), successful outcomes occurred in 88% of the cases, 2) when a tumor could not be found, successful outcomes amounted to only 33% of the cases, a rate that might be related to a surgical exploration of the basophil cell zone "invading" the neural lobe, thus questioning a role of this zone, at least in some Cushing's diseases.

Adenoma↗