Capsule plication as a protective measure against post-operative intracapsular haematoma formation following trans-sphenoidal removal of pituitary macroadenoma.

Abstract:

BACKGROUND:Post-operative haematoma and visual deterioration are rare but serious complications after trans-sphenoidal surgery. For more reliable decompression of the optic nerve, we introduce a new technique for volume reduction of the cavity remaining after trans-sphenoidal resection of macroadenomas. TECHNIQUE:After intracapsular removal of the adenoma, the suprasellar portion of the tumour 'capsule' spontaneously prolapsed into the sella turcica. The lowest part of the prolapsed capsule was sutured and/or clipped to reduce the volume of the residual cavity remaining after tumour resection. FINDINGS:A total of 23 patients with macroadenomas extending to suprasellar area had visual symptoms and were treated by trans-sphenoidal surgery. In seven (30%) patients, computerised tomography scans on the first post-operative day demonstrated haematoma formation in the residual cavity. The magnetic resonance imagings on the seventh post-operative day, however, showed approximately 80% reduction in the tumour size. Visual disturbance improved in 20 patients (87%). No patient had post-operative deterioration of visual function. The complications in this series included transient diabetes insipidus in three patients and panhypopituitarism in one patient. CONCLUSIONS:Capsule plication is a useful measure for volume reduction of the large residual cavity after trans-sphenoidal surgery for macroadenoma. It may prevent an acute post-operative complication due to intracapsular haematoma, and improve surgical outcome in well selected cases.

journal_name

Acta Neurochir (Wien)

journal_title

Acta neurochirurgica

authors

Kitano M,Taneda M

doi

10.1007/s00701-008-1583-0

subject

Has Abstract

pub_date

2008-08-01 00:00:00

pages

797-802; discussion 802

issue

8

eissn

0001-6268

issn

0942-0940

journal_volume

150

pub_type

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