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Perioperative Challenges During Pituitary Surgery

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Essentials of Neurosurgical Anesthesia & Critical Care
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Abstract

The pituitary gland is located in the sella turcica at the base of the brain, in close proximity to the sphenoid sinus, hypothalamus, optic chiasm, and vessels. Anesthesia for pituitary surgery involves problems related to surgical intervention and preexisting dysfunction/changes in the endocrine system of patients. Removal of pituitary adenomas in patients with Cushing’s disease or acromegaly is best done by endoscopic transnasal and transsphenoidal microsurgery while preserving anterior pituitary function in most patients. Serious complications may occur with respect to the airway, hormonal dysfunction (diabetes insipidus), serum electrolyte disturbances, CSF leakage, and visual fields, just to name a few, during/after anesthesia and surgery.

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Suggested Reading

  • Ali Z, Prabhakar H, Bithal PK, Dash HH. Bispectral index-guided administration of anesthesia for transsphenoidal resection of pituitary tumors: a comparison of 3 anesthetic techniques. J Neurosurg Anesthesiol. 2009;21:10–5.

    Article  Google Scholar 

  • Ammirati M, Wei L, Ciric I. Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2013;84:843–9.

    Article  Google Scholar 

  • Atkinson JL, Young WF Jr, Meyer FB, Davis DH, Nippoldt TB, Erickson D, et al. Sublabial transseptal vs transnasal combined endoscopic microsurgery in patients with Cushing disease and MRI-depicted microadenomas. Mayo Clin Proc. 2008;83:550–3.

    Article  Google Scholar 

  • Burkhardt T, Rotermund R, Schmidt NO, Kiefmann R, Flitsch J. Dexamethasone PONV prophylaxis alters the hypothalamic-pituitary-adrenal axis after transsphenoidal pituitary surgery. J Neurosurg Anesthesiol. 2014;26:216–9.

    Article  Google Scholar 

  • Dinsmore J. Anaesthesia for elective neurosurgery. Br J Anaesth. 2007;99:68–74.

    Article  CAS  Google Scholar 

  • Dunn LK, Nemergut EC. Anesthesia for transsphenoidal pituitary surgery. Curr Opin Anaesthesiol. 2013;26:549–54.

    Article  CAS  Google Scholar 

  • Gondim JA, Almeida JP, de Albuquerque LA, Gomes E, Schops M, Mota JI. Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas. J Neurosurg. 2015;123:31–8.

    Article  Google Scholar 

  • Nemergut EC, Zuo Z. Airway management in patients with pituitary disease: a review of 746 patients. J Neurosurg Anesthesiol. 2006;18:73–7.

    Article  Google Scholar 

  • Ovassapian A, Doka JC, Romsa DE. Acromegaly-uses of fiberoptic laryngoscopy to avoid tracheostomy. Anesthesiology. 1981;54:429–30.

    Article  CAS  Google Scholar 

  • Schmitt H, Buchfelder M, Radespiel-Tröger M, Fahlbusch R. Difficult intubation in acromegalic patients: incidence and predictability. Anesthesiology. 2000;93:110–4.

    Article  CAS  Google Scholar 

  • The Committee of Brain Tumor Registry of Japan. Report of brain tumor registry of Japan (1969–1993) 10th edition. Neurol Med Chir. 2000;40:1–102.

    Article  Google Scholar 

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Correspondence to Shuji Dohi .

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Dohi, S. (2020). Perioperative Challenges During Pituitary Surgery. In: Brambrink, A., Kirsch, J. (eds) Essentials of Neurosurgical Anesthesia & Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-17410-1_33

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  • DOI: https://doi.org/10.1007/978-3-030-17410-1_33

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-17408-8

  • Online ISBN: 978-3-030-17410-1

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