Integration of an enhanced recovery after surgery program for patients undergoing pituitary surgery

Evidence-based enhanced recovery after surgery(ERAS)programs aim to improve patient outcomes and shorten hospital stays.The objective of this study is to describe the development,implementation,and evolution of an ERAS protocol to optimize the perioperative management for patients undergoing endoscopic skull base surgery for pituitary tumors.A systematic review of the literature was performed,best practices were discussed with stakeholders,and institutional guidelines were established and implemented.Key performance indicators(KPI)were measured and patient-reported outcome surveys were collected.The ERAS protocol was introduced successfully at our institution.We describe the process of initiation of the program and the perioperative management of our patients.We demonstrated the feasibility of integration of ERAS protocols for pituitary tumors with multidisciplinary engagement,with a particular emphasis on the use of data informatics and metrics to monitor outcomes.We expect that this approach will translate to improved quality of care for these often-complex patients.

Perioperative management of endoscopic transsphenoidal pituitary surgery

The contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary surgery.Utility of a multi-disciplinary unit in management decisions facilitates the delivery of optimal care.Evolution of technology and surgical expertise in pituitary surgery mandates ongoing review of all components of the care central to these patients.The many areas of potential variability in the pre,intra and post-operative timeline of pituitary surgery are readily identifiable.Core undertakings and contemporary controversies in the peri-operative management of patients undergoing endoscopic transsphenoidal pituitary surgery are assessed against the available literature with a view to providing guidance for the best evidence-based practice.

The causes and prevention and treatment of cerebrospinal fluid leak during transsphenoidal pituitary adenomas surgery

Objective To analyze the causes and prevention and treatment of cerebrospinal fluid leak during transsphenoidal pituitary adenoma surgery. Methods Retrospective study of 260 cases of microscopic transsphenoidal surgery and 274 cases of endoscopic surgery for resection of the pituitary adenomas was performed. CSF leak occurred

Analysis of complications of transsphenoidal surgery for pituitary adenomas

Objective To analyze the complications of transsphenoidal operation for pituitary adenomas. Methods Postoperative complications of 323 patients underwent transphenoidal surgery for pituitary adenoma between January 2001 and December 2009 in our department were retrospectively reviewed. Results Insipidus was the most common complication after

Complications's prophylaxis in neuroendoscopic endonasal transsphenoidal surgery for pituitary adenomas

Objective To discuss the complicatiaons’s prophylaxis of removing pituitary adenomas by neuroendoscopy in tranasphenoidal surgery. Methods Clinical data of 253 cases treated by endoscopic endanasal transsphenoidal surgery were analysed. Results The total tumor removal was done in 216 (85.38%) cases,subtotal in

Sudden Sensorineural Hearing Loss after Pituitary Adenoma Resection-A Case Series with Literature Review

Objective Complications after transsphenoidal surgery for pituitary adenoma have been well documented in the literatures,but the occurrence of delved sudden sensorineural hearing loss(SNHL)after pituitary adenoma resection is extremely rare.In this study three cases who developed sudden SNHL 3 to 7 days after pituitary adenoma surgery without experiencing cerebrospinal fluid leak or meningitis were presented,and the possible causes of SNHL were discussed.Methods Three cases with sudden hearing loss after transsphenoidal surgery for pituitary adenoma were reviewed.The past medical history,onset of sudden hearing loss,accompanying symptoms such as headache,tinnitus,dizziness and aural fullness,and the post-operative MRI images,therapy and hearing results were reported.Results Three cases developed profound sudden SNHL on the 3rd to 7th post-operative day,all accompanied by prior headache,tinnitus and dizziness.One patient developed episodic vertigo,ear fullness accompanying with fluctuating hearing loss in the first post-operative month.Two patients had past medical history of arteriosclerosis and coronary heart disease or cerebral infarction.Two of three demonstrated obstructive hydrocephalus on MRI on the first post-operative day.Under treatment with prednisone orally,dexamethasone intratympanic mjection,neurotrophic and vasodilatation drugs for 3 to 8 months,hearing of all three improved partially.Obstructive hydrocephalus and ischemia might be responsible for the hearing loss.Conclusion Post-operative obstructive hydrocephalus and ischemia of labyrinthine arteries might lead to the delayed SNHL after transsphenoidal surgery for pituitary adenoma.