Fonksiyonel hipofiz adenomlarında transsfenoidal rezeksiyon volümünün nazal ve sfenoid sinüs ölçümleriyle değerlendirilmesi
| dc.contributor.advisor | Karabağlı, Hakan | |
| dc.contributor.author | Özkeleş, Eylem Yağmur | |
| dc.date.accessioned | 2025-03-18T06:39:26Z | |
| dc.date.available | 2025-03-18T06:39:26Z | |
| dc.date.issued | 2023 | |
| dc.department | Enstitüler, Tıp Fakültesi Uzmanlık Tezleri, Beyin ve Sinir Cerrahisi Ana Bilim Dalı | |
| dc.description.abstract | Objective: In our study, we aimed to reveal the relationship between the tumor resection volume in transsphenoidal pituitary surgery and the anatomical differences that may be encountered in the nasal and sphenoid sinus anatomy, to suggest new approaches to this surgical procedure, and to emphasize the features that need to be taken into consideration. Material and method: A total of 63 cases who were operated on by two different surgeons due to functional pituitary adenoma via transsphenoidal route at Selçuk University Faculty of Medicine Neurosurgery Clinic between 2010 and 2022 were included in the study. Microscopic method was used in 47 cases and endoscopic method was used in 16 cases. 30 of the patients are women and 33 are men. The average age is 49.5, the minimum age is 17 and the maximum age is 81. The sphenoid sinus types of these patients were grouped according to the degree of pneumatization. Volume data was provided using preoperative and early postoperative magnetic resonance images through the Syngo.via imaging program. Using the Enlil PACS program, the distances between the columella base and the sphenoid sinus and the angle measurements of this direction with the nasal cavity floor were obtained from preoperative pituitary magnetic resonance T1 sagittal sequence sections. The relationship between these parameters was evaluated statistically. Results: There were 10 (15.9%) people with pathology type PRL+ GH+ adenoma, 17 (27%) people with gonadotrope adenoma, 13 (20.6%) people with somatotrope adenoma, 11 (17.5%) people with lactotrope adenoma, 6 (9.5%) individuals with ACTH+ adenomas and 6 (9.5%) individuals with GH+ adenomas. There were 47 (74.6%) whose surgery type was microscopic and 16 (25.4%) who had endoscopic. While the mean early postoperative resection volume was 4.95±5.36 m3 , the mean late postoperative resection volume was found to be 4.29±5.32 m3 , and there was no statistically significant difference between these measurements (p>0.05). In early and late postoperative measurements, resection volume averages were statistically significantly lower in the invasive sphenoid sinus type (p<0.05). In invasive and sellar sphenoid sinus types, the first measurement resection volume average was statistically higher than the other measurements (p<0.05). There was no statistically significant difference between the mean of early postoperative resection volume and the mean of late postoperative resection volume (p>0.05). There was no statistically significant difference in presellar sphenoid sinus type (p>0.05). The average resection volume rate in sellar sphenoid sinus types was found to be 61.54±18.48, and this measurement was statistically higher than other sphenoid sinus types (p<0.05). While the average resection volume ratio in the presellar sphenoid sinus type was 46.07±18.14, the average resection volume ratio in the invasive sphenoid sinus type was found to be 44.17±24.52, and there was no statistically significant difference between these types (p>0.05). There was no statistically significant difference between the mean of early postoperative resection volume and the mean of late postoperative resection volume (p>0.05). As a result, when the effect sizes were examined, resection volume showed a rapid decrease in microscopic (η2=0.437) and endoscopic (η2=0.157) measurements, respectively, across surgery types. While the average resection volume rate in those operated with the microscopic method was 57.79±19.41, the average resection volume rate in those operated with the endoscopic method was 60.24±21.55, and there was no statistically significant difference between these surgical types (p>0.05). The distance between the columella and the sphenoid sinus and preoperative resection volume measurements did not have a statistically significant effect on the resection volume rate (p>0.05). While resection volume showed a rapid decrease in gonadotrope (η2=0.327), PRL+ GH+(η2=0.240), GH+(η2=0.238) and somatotroph (η2=0.118) measurements in pathology types, respectively, no significant intra-group difference was observed in lactotrope and ACTH+ surgery types. Conclusion: In pituitary adenomas operated with the transphenoidal approach, different anatomical markers are used to determine the anatomical corridor until reaching the adenoma. These markers are a result of the surgical experience and studies achieved to date. In this study, we have conveyed our clinical experience to the literature by showing that the tumor resection volume is not affected by some measurements of the sphenoid sinus and nasal cavity. We think that there are still anatomical differences that may affect the tumor resection volume and that further studies should be continued with a larger number of patients in different centers. | |
| dc.description.abstract | Objective: In our study, we aimed to reveal the relationship between the tumor resection volume in transsphenoidal pituitary surgery and the anatomical differences that may be encountered in the nasal and sphenoid sinus anatomy, to suggest new approaches to this surgical procedure, and to emphasize the features that need to be taken into consideration. Material and method: A total of 63 cases who were operated on by two different surgeons due to functional pituitary adenoma via transsphenoidal route at Selçuk University Faculty of Medicine Neurosurgery Clinic between 2010 and 2022 were included in the study. Microscopic method was used in 47 cases and endoscopic method was used in 16 cases. 30 of the patients are women and 33 are men. The average age is 49.5, the minimum age is 17 and the maximum age is 81. The sphenoid sinus types of these patients were grouped according to the degree of pneumatization. Volume data was provided using preoperative and early postoperative magnetic resonance images through the Syngo.via imaging program. Using the Enlil PACS program, the distances between the columella base and the sphenoid sinus and the angle measurements of this direction with the nasal cavity floor were obtained from preoperative pituitary magnetic resonance T1 sagittal sequence sections. The relationship between these parameters was evaluated statistically. Results: There were 10 (15.9%) people with pathology type PRL+ GH+ adenoma, 17 (27%) people with gonadotrope adenoma, 13 (20.6%) people with somatotrope adenoma, 11 (17.5%) people with lactotrope adenoma, 6 (9.5%) individuals with ACTH+ adenomas and 6 (9.5%) individuals with GH+ adenomas. There were 47 (74.6%) whose surgery type was microscopic and 16 (25.4%) who had endoscopic. While the mean early postoperative resection volume was 4.95±5.36 m3 , the mean late postoperative resection volume was found to be 4.29±5.32 m3 , and there was no statistically significant difference between these measurements (p>0.05). In early and late postoperative measurements, resection volume averages were statistically significantly lower in the invasive sphenoid sinus type (p<0.05). In invasive and sellar sphenoid sinus types, the first measurement resection volume average was statistically higher than the other measurements (p<0.05). There was no statistically significant difference between the mean of early postoperative resection volume and the mean of late postoperative resection volume (p>0.05). There was no statistically significant difference in presellar sphenoid sinus type (p>0.05). The average resection volume rate in sellar sphenoid sinus types was found to be 61.54±18.48, and this measurement was statistically higher than other sphenoid sinus types (p<0.05). While the average resection volume ratio in the presellar sphenoid sinus type was 46.07±18.14, the average resection volume ratio in the invasive sphenoid sinus type was found to be 44.17±24.52, and there was no statistically significant difference between these types (p>0.05). There was no statistically significant difference between the mean of early postoperative resection volume and the mean of late postoperative resection volume (p>0.05). As a result, when the effect 73 sizes were examined, resection volume showed a rapid decrease in microscopic (η2=0.437) and endoscopic (η2=0.157) measurements, respectively, across surgery types. While the average resection volume rate in those operated with the microscopic method was 57.79±19.41, the average resection volume rate in those operated with the endoscopic method was 60.24±21.55, and there was no statistically significant difference between these surgical types (p>0.05). The distance between the columella and the sphenoid sinus and preoperative resection volume measurements did not have a statistically significant effect on the resection volume rate (p>0.05). While resection volume showed a rapid decrease in gonadotrope (η2=0.327), PRL+ GH+(η2=0.240), GH+(η2=0.238) and somatotroph (η2=0.118) measurements in pathology types, respectively, no significant intra-group difference was observed in lactotrope and ACTH+ surgery types. Conclusion: In pituitary adenomas operated with the transphenoidal approach, different anatomical markers are used to determine the anatomical corridor until reaching the adenoma. These markers are a result of the surgical experience and studies achieved to date. In this study, we have conveyed our clinical experience to the literature by showing that the tumor resection volume is not affected by some measurements of the sphenoid sinus and nasal cavity. We think that there are still anatomical differences that may affect the tumor resection volume and that further studies should be continued with a larger number of patients in different centers. | |
| dc.identifier.citation | Özkeleş, E. Y. (2023). Fonksiyonel hipofiz adenomlarında transsfenoidal rezeksiyon volümünün nazal ve sfenoid sinüs ölçümleriyle değerlendirilmesi. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya. | |
| dc.identifier.uri | https://hdl.handle.net/20.500.12395/54645 | |
| dc.identifier.yoktezid | 910609 | |
| dc.institutionauthor | Özkeleş, Eylem Yağmur | |
| dc.language.iso | tr | |
| dc.publisher | Selçuk Üniversitesi, Tıp Fakültesi | |
| dc.relation.publicationcategory | Tez | |
| dc.rights | info:eu-repo/semantics/openAccess | |
| dc.subject | Columella | |
| dc.subject | Pitüiter Adenom | |
| dc.subject | Transsfenoidal Yaklaşım | |
| dc.subject | Sfenoid Sinüs | |
| dc.subject | Nazal Kavite | |
| dc.subject | Tümör Volümü | |
| dc.subject | Pituitary Adenoma | |
| dc.subject | Transsphenoidal Approach | |
| dc.subject | Sphenoid Sinus | |
| dc.subject | Nasal Cavity | |
| dc.subject | Tumor Volume | |
| dc.title | Fonksiyonel hipofiz adenomlarında transsfenoidal rezeksiyon volümünün nazal ve sfenoid sinüs ölçümleriyle değerlendirilmesi | |
| dc.title.alternative | Evaluation of transsphenoidal resection volume in functional pituitary adenomas by nasal and sphenoid sinus measurements | |
| dc.type | Specialist Thesis |
