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Contributors
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- By Lenard A. Adler, Pinky Agarwal, Rehan Ahmed, Jagga Rao Alluri, Fawaz Al-Mufti, Samuel Alperin, Michael Amoashiy, Michael Andary, David J. Anschel, Padmaja Aradhya, Vandana Aspen, Esther Baldinger, Jee Bang, George D. Baquis, John J. Barry, Jason J. S. Barton, Julius Bazan, Amanda R. Bedford, Marlene Behrmann, Lourdes Bello-Espinosa, Ajay Berdia, Alan R. Berger, Mark Beyer, Don C. Bienfang, Kevin M. Biglan, Thomas M. Boes, Paul W. Brazis, Jonathan L. Brisman, Jeffrey A. Brown, Scott E. Brown, Ryan R. Byrne, Rina Caprarella, Casey A. Chamberlain, Wan-Tsu W. Chang, Grace M. Charles, Jasvinder Chawla, David Clark, Todd J. Cohen, Joe Colombo, Howard Crystal, Vladimir Dadashev, Sarita B. Dave, Jean Robert Desrouleaux, Richard L. Doty, Robert Duarte, Jeffrey S. Durmer, Christyn M. Edmundson, Eric R. Eggenberger, Steven Ender, Noam Epstein, Alberto J. Espay, Alan B. Ettinger, Niloofar (Nelly) Faghani, Amtul Farheen, Edward Firouztale, Rod Foroozan, Anne L. Foundas, David Elliot Friedman, Deborah I. Friedman, Steven J. Frucht, Oded Gerber, Tal Gilboa, Martin Gizzi, Teneille G. Gofton, Louis J. Goodrich, Malcolm H. Gottesman, Varda Gross-Tsur, Deepak Grover, David A. Gudis, John J. Halperin, Maxim D. Hammer, Andrew R. Harrison, L. Anne Hayman, Galen V. Henderson, Steven Herskovitz, Caitlin Hoffman, Laryssa A. Huryn, Andres M. Kanner, Gary P. Kaplan, Bashar Katirji, Kenneth R. Kaufman, Annie Killoran, Nina Kirz, Gad E. Klein, Danielle G. Koby, Christopher P. Kogut, W. Curt LaFrance, Patrick J.M. Lavin, Susan W. Law, James L. Levenson, Richard B. Lipton, Glenn Lopate, Daniel J. Luciano, Reema Maindiratta, Robert M. Mallery, Georgios Manousakis, Alan Mazurek, Luis J. Mejico, Dragana Micic, Ali Mokhtarzadeh, Walter J. Molofsky, Heather E. Moss, Mark L. Moster, Manpreet Multani, Siddhartha Nadkarni, George C. Newman, Rolla Nuoman, Paul A. Nyquist, Gaia Donata Oggioni, Odi Oguh, Denis Ostrovskiy, Kristina Y. Pao, Juwen Park, Anastas F. Pass, Victoria S. Pelak, Jeffrey Peterson, John Pile-Spellman, Misha L. Pless, Gregory M. Pontone, Aparna M. Prabhu, Michael T. Pulley, Philip Ragone, Prajwal Rajappa, Venkat Ramani, Sindhu Ramchandren, Ritesh A. Ramdhani, Ramses Ribot, Heidi D. Riney, Diana Rojas-Soto, Michael Ronthal, Daniel M. Rosenbaum, David B. Rosenfield, Durga Roy, Michael J. Ruckenstein, Max C. Rudansky, Eva Sahay, Friedhelm Sandbrink, Jade S. Schiffman, Angela Scicutella, Maroun T. Semaan, Robert C. Sergott, Aashit K. Shah, David M. Shaw, Amit M. Shelat, Claire A. Sheldon, Anant M. Shenoy, Yelizaveta Sher, Jessica A. Shields, Tanya Simuni, Rajpaul Singh, Eric E. Smouha, David Solomon, Mehri Songhorian, Steven A. Sparr, Egilius L. H. Spierings, Eve G. Spratt, Beth Stein, S.H. Subramony, Rosa Ana Tang, Cara Tannenbaum, Hakan Tekeli, Amanda J. Thompson, Michael J. Thorpy, Matthew J. Thurtell, Pedro J. Torrico, Ira M. Turner, Scott Uretsky, Ruth H. Walker, Deborah M. Weisbrot, Michael A. Williams, Jacques Winter, Randall J. Wright, Jay Elliot Yasen, Shicong Ye, G. Bryan Young, Huiying Yu, Ryan J. Zehnder
- Edited by Alan B. Ettinger, Albert Einstein College of Medicine, New York, Deborah M. Weisbrot, State University of New York, Stony Brook
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- Book:
- Neurologic Differential Diagnosis
- Published online:
- 05 June 2014
- Print publication:
- 17 April 2014, pp xi-xx
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87 - Cavernous sinus syndrome
- from Section 2 - Differential Diagnosis within Specific Localizations
- Edited by Alan B. Ettinger, Albert Einstein College of Medicine, New York, Deborah M. Weisbrot, State University of New York, Stony Brook
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- Book:
- Neurologic Differential Diagnosis
- Published online:
- 05 June 2014
- Print publication:
- 17 April 2014, pp 547-548
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Chapter 106 - Transsphenoidal surgery
- from Section 22 - Neurologic Surgery
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
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- Book:
- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 683-685
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Summary
Transsphenoidal surgery is the surgical approach of choice in treatment of sellar and parasellar tumors. The pathologies include pituitary adenomas, craniopharyngiomas, meningiomas, Rathke's cysts, chordomas, or, rarely, infectious etiologies and autoimmune disorders. The most common indication for transsphenoidal surgery is a pituitary adenoma that originates from the anterior lobe of a pituitary gland. The anterior lobe secretes prolactin (PRL), adrenocorticotropic hormone (ACTH), growth hormone (GH), thyroid-stimulating hormone (thyrotropin) (TSH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Pituitary adenomas can be divided by size into microadenomas (< 1 cm) and macroadenomas (> 1 cm). Pituitary adenomas are also classified as clinically functioning (hyper-secreting, endocrine active) or as non-functioning (no hormone secretion, inactive). Patients can present with symptoms due to mass effect: headaches, visual deficits, cranial nerve neuropathies, and hydrocephalus or endocrine disturbance from hormone hypersecretion or hypopituitarism. The hypersecretory symptoms include amenorrhea-galactorrhea and infertility (hyperprolactinemia); Cushing's disease and hypercortisolism (ACTH); gigantism or acromegaly (GH); and thyrotoxicosis (TSH). Less common presentations of pituitary adenomas occur in association with certain endocrine syndromes (e.g., multiple endocrine neoplasia). In addition to recording the patient history and conducting a physical exam, the diagnostic evaluation for the majority of patients should include obtaining endocrine laboratory and MRI results (especially dynamic pituitary sequences). The main indication for treatment of these tumors is to reestablish normal hormonal secretion and to address the mass effect. The current treatment modalities include transsphenoidal surgical resection, medical management, and radiotherapy.
As our understanding of the physiology and pathophysiology of the hypothalamic-pituitary-end organs (e.g., thyroid, adrenal, gonads) has evolved, medical options have emerged for treatment alternatives for some of the functioning pituitary adenomas, the most common of which are prolactinomas. Currently, prolactinomas are primarily managed medically. The hypothalamic release of dopamine inhibits hypophyseal prolactin secretion, so dopaminergic-agonists have been developed (i.e., bromocriptine, cabergoline) to suppress prolactin secretion. Approximately 80% of patients with prolactinomas are controlled by medical therapy alone with a resultant normalization of prolactin and significant tumor shrinkage. The treatment is lifelong as agents are tumorstatic; withdrawal of the therapy will lead to tumor re-growth. Another drawback of the dopamine agonist treatment is that it causes tumor scarring and fibrosis, which can make any possible surgery much more difficult. Tumor fibrosis usually occurs in about one year after initiating treatment; therefore, early surgical intervention is preferred if the patient elects to proceed with surgery because of personal preference, management failure, or drug side-effects (headache, dizziness, nausea, postural hypotension).