Skip to main content

Stato dell’arte e nuove frontiere della neurochirurgia della regione ipotalamo-ipofisaria

Sommario

Lo scopo di questa rassegna è fornire una visione generale dell’attuale stato della chirurgia ipofisaria e delle sue prospettive future, che possa essere utile ai differenti professionisti coinvolti nella gestione dei pazienti ipofisari per orientarsi nel rapido sviluppo di questo campo, anche per effetto dello sviluppo tecnologico. Oltre alla precisazione dei vantaggi, dei limiti, ma anche delle possibili evoluzioni, del rivoluzionario approccio endoscopico, verranno presentate anche le altre opzioni attualmente a disposizione della chirurgia. Saranno considerati quegli sviluppi tecnologici di imaging sia preoperatorio sia intraoperatorio che potranno caratterizzare il futuro prossimo della chirurgia ipofisaria, aumentandone ulteriormente le potenzialità, l’efficacia e la sicurezza, come la RM avanzata, i possibili sviluppi della radiomica, le applicazioni della realtà aumentata e dell’Artificial Intelligence e il valore aggiunto di un nuovo modello organizzativo, rappresentato dalle Pituitary Units, comprendenti le differenti discipline coinvolte nella gestione delle patologie ipofisarie.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Bibliografia

  1. Couldwell WT (2004) Transsphenoidal and transcranial surgery for pituitary adenomas. J Neuro-Oncol 69:237–256

    Article  Google Scholar 

  2. Hardy J (1969) Transphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg 16:185–217

    CAS  Article  Google Scholar 

  3. Cappabianca P, Cavallo LM, de Divitiis E (2004) Endoscopic endonasal transsphenoidal surgery. Neurosurgery 55:933–940

    Article  Google Scholar 

  4. Jho HD, Carrau RL (1996) Endoscopy assisted transsphenoidal surgery for pituitary adenoma. Technical note. Acta Neurochir (Wien) 138(12):1416–1425

    CAS  Article  Google Scholar 

  5. Frank G, Pasquini E, Farneti G et al. (2006) The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinology 83(3–4):240–248

    CAS  Article  Google Scholar 

  6. Micko AS, Wohrer A, Wolfsberger S et al. (2015) Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. J Neurosurg 122:803–811

    Article  Google Scholar 

  7. Zoli M, Milanese L, Bonfatti R et al. (2016) Cavernous sinus invasion by pituitary adenomas: role of endoscopic endonasal surgery. J Neurosurg Sci 60(4):485–494

    PubMed  Google Scholar 

  8. Raverot G, Dantony E, Beauvy J et al. (2017) Risk of recurrence in pituitary neuroendocrine tumors: a prospective study using a five-tiered classification. J Clin Endocrinol Metab 102(9):3368–3374

    Article  Google Scholar 

  9. Guaraldi F, Zoli M, Righi A et al. (2020) A practical algorithm to predict postsurgical recurrence and progression of pituitary neuroendocrine tumours (PitNET)s. Clin Endocrinol (Oxf) 93(1):36–43

    CAS  Article  Google Scholar 

  10. Oldfield EH, Vortmeyer AO (2006) Development of a histological pseudocapsule and its use as a surgical capsule in the excision of pituitary tumors. J Neurosurg 104:7

    Article  Google Scholar 

  11. Cavallo LM, Frank G, Cappabianca P et al. (2014) The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients. J Neurosurg 121(1):100–113

    Article  Google Scholar 

  12. Barazi SA, Pasquini E, D’Urso PI et al. (2013) Extended endoscopic transplanum-transtuberculum approach for pituitary adenomas. Br J Neurosurg 27(3):374–382

    CAS  Article  Google Scholar 

  13. Rampinelli V, Doglietto F, Mattavelli D et al. (2017) Two-dimensional high definition versus three-dimensional endoscopy in endonasal skull base surgery: a comparative preclinical study. World Neurosurg 105:223–231

    Article  Google Scholar 

  14. Litvack ZN, Zada G, Laws ER Jr (2012) Indocyanine green fluorescence endoscopy for visual differentiation of pituitary tumor from surrounding structures. J Neurosurg 116(5):935–941

    Article  Google Scholar 

  15. Buchfelder M, Kreutzer J (2008) Transcranial surgery for pituitary adenomas. Pituitary 11(4):375–384

    Article  Google Scholar 

  16. Mazzatenta D, Zoli M, Guaraldi F et al. (2020) Outcome of endoscopic endonasal surgery in pediatric craniopharyngiomas. World Neurosurg 134:e277–e288

    Article  Google Scholar 

  17. Hardesty DA, Montaser AS, Beer-Furlan A et al. (2018) Limits of endoscopic endonasal surgery for III ventricle craniopharyngiomas. J Neurosurg Sci 62(3):310–321

    PubMed  Google Scholar 

  18. Khatri D, Wagner K, Ligas B et al. (2020) Excision of a retrochiasmatic craniopharyngioma by transcallosal, interforniceal approach with exoscope assistance: 2-dimensional operative video. Oper Neurosurg (Hagerstown) 19(4):E411

    Article  Google Scholar 

  19. Lai M, Skyrman S, Shan C et al. (2020) Fusion of augmented reality imaging with the endoscopic view for endonasal skull base surgery; a novel application for surgical navigation based on intraoperative cone beam computed tomography and optical tracking. PLoS One 15(1):e0227312

    CAS  Article  Google Scholar 

  20. Soneru CP, Riley CA, Hoffman K et al. (2019) Intra-operative MRI vs endoscopy in achieving gross total resection of pituitary adenomas: a systematic review. Acta Neurochir (Wien) 161(8):1683–1698

    Article  Google Scholar 

  21. Jacquesson T, Yeh FC, Panesar S et al (2019) Full tractography for detecting the position of cranial nerves in preoperative planning for skull base surgery: technical note. J Neurosurg, 1–11

  22. Ugga L, Cuocolo R, Solari D et al. (2019) Prediction of high proliferative index in pituitary macroadenomas using MRI-based radiomics and machine learning. Neuroradiology 61(12):1365–1373

    Article  Google Scholar 

  23. Chen X, Tong Y, Shi Z et al. (2019) Noninvasive molecular diagnosis of craniopharyngioma with MRI-based radiomics approach. BMC Neurol 19(1):6

    Article  Google Scholar 

  24. Bashari WA, Senanayake R, Koulouri O et al. (2020) PET-guided repeat transsphenoidal surgery for previously deemed unresectable lateral disease in acromegaly. Neurosurg Focus 48(6):E8

    Article  Google Scholar 

  25. Casanueva FF, Barkan AL, Buchfelder M et al. (2017) Criteria for the definition of pituitary tumor centers of excellence (PTCOE): a pituitary society statement. Pituitary 20:489–498

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marco Faustini Fustini.

Ethics declarations

Conflitto di interesse

Gli autori Diego Mazzatenta, Matteo Zoli, Alessandro Pirina, Federica Guaraldi, Ernesto Pasquini, Sofia Asioli, Caterina Tonon e Marco Faustini Fustini dichiarano di non avere conflitti di interesse.

Consenso informato

Lo studio presentato in questo articolo non ha richiesto sperimentazione umana.

Studi sugli animali

Gli autori di questo articolo non hanno eseguito studi sugli animali.

Additional information

Nota della casa editrice

Springer Nature rimane neutrale in riguardo alle rivendicazioni giurisdizionali nelle mappe pubblicate e nelle affiliazioni istituzionali.

Proposto da Alessandro Peri.

Informazioni Supplementari

I link al materiale elettronico supplementare sono elencati qui sotto.

(DOC 12 kB)

(DOC 11 kB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mazzatenta, D., Zoli, M., Pirina, A. et al. Stato dell’arte e nuove frontiere della neurochirurgia della regione ipotalamo-ipofisaria. L'Endocrinologo 22, 50–56 (2021). https://doi.org/10.1007/s40619-021-00820-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40619-021-00820-9

Parole chiave

  • Adenoma ipofisario
  • Adenomi secernenti
  • Adenomi non secernenti
  • Chirurgia ipofisaria
  • Approccio endoscopico endonasale
  • Nuove tecnologie