Delayed puberty surgery: Difference between revisions
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{{Delayed puberty}} | {{Delayed puberty}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} | ||
==Overview== | ==Overview== | ||
The mainstay of treatment for delayed [[puberty]] is medical therapy. [[Surgery]] is usually reserved for patients with either [[pituitary tumors]], [[hypothalamus]] [[hamartomas]], and [[Turner syndrome]]. There are two procedures for excision of pituitary tumors, including endoscopic transsphenoidal surgery and [[craniotomy]]. In presence of [[Y chromosome]] the chance of becoming malignant is higher in [[Turner syndrome]], [[oophorectomy]] (even [[salpingo-oophorectomy]]) has to be done urgently. | |||
==Surgery== | ==Surgery== | ||
The mainstay of treatment for delayed [[puberty]] is medical therapy. [[Surgery]] is usually reserved for patients with either: | |||
*[[Pituitary tumors]] | |||
*[[Hypothalamus]] [[hamartomas]] | |||
*[[Turner syndrome]] | |||
=== Pituitary tumors === | |||
==== Endoscopic transsphenoidal surgery<ref name="pmid24533411">{{cite journal| author=Fan YP, Lv MH, Feng SY, Fan X, Hong HY, Wen WP et al.| title=Full Endoscopic Transsphenoidal Surgery for Pituitary Adenoma-emphasized on Surgical Skill of Otolaryngologist. | journal=Indian J Otolaryngol Head Neck Surg | year= 2014 | volume= 66 | issue= Suppl 1 | pages= 334-40 | pmid=24533411 | doi=10.1007/s12070-011-0317-4 | pmc=3918297 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24533411 }}</ref> ==== | |||
* In this method, the [[pituitary tumor]] is excised through [[nostrils]] by means of a tiny fiber-optic [[endoscopic]] tube. | |||
* First bilateral [[nasal]] septal [[mucosa]] are incised in a C-shaped manner. The septal [[bone]] is been approached through the incisions. | |||
* Then, the [[sphenoidal]] rostrum and anterior wall of [[sphenoid sinus]] are gradually removed, a [[bone]] window is opened through the [[skull]] space. | |||
* After that, the [[dura mater]] is passed and the lesion become visualized. | |||
* Finally, the [[tumor]] is removed using the [[curette]] and basket with suction. | |||
* '''Advantages:''' | |||
** No harm to other parts of the [[brain]] | |||
** High cure rate | |||
** No visible [[scar]] | |||
* '''Disadvantages''': | |||
** Not for large [[tumors]] | |||
** Recurrent [[sinusitis]] in the future | |||
** Low cure rate in case of [[suprasellar]] adhesion to adjunct tissues | |||
==== Craniotomy<ref name="pmid15987585">{{cite journal |vauthors=Youssef AS, Agazzi S, van Loveren HR |title=Transcranial surgery for pituitary adenomas |journal=Neurosurgery |volume=57 |issue=1 Suppl |pages=168–75; discussion 168–75 |year=2005 |pmid=15987585 |doi= |url=}}</ref> ==== | |||
* Although the preferred procedure to excise the [[pituitary tumors]] is transsphenoidal approach, but in some cases (1-4%) the size of the tumor or any [[suprasellar]] adhesion push the surgeon through transcranial method. | |||
* Some positions that lead to choose the transcranial method are include: | |||
** Isolation by a narrow waist at the [[diaphragma sellae]] | |||
** Containment within the [[cavernous sinus]] lateral to the [[carotid artery]] | |||
** Projection anteriorly onto the planum sphenoidale | |||
** Projection laterally into the middle fossa | |||
* [[Skull]] base surgical procedure is also the option for [[pituitary tumor]] treatment, but may encounter the problems that transsphenoidal method is faced with. | |||
* '''Advantages:''' | |||
** Resection of large [[tumors]] | |||
** Ability to excise the tumors with [[suprasellar]] specific conditions | |||
* '''Disadvantages:''' | |||
** Long duration of post operation recovery | |||
** Harm to other parts of the [[brain]] | |||
=== Turner syndrome<ref name="pmid25475798">{{cite journal |vauthors=Kanakatti Shankar R, Inge TH, Gutmark-Little I, Backeljauw PF |title=Oophorectomy versus salpingo-oophorectomy in Turner syndrome patients with Y-chromosome material: clinical experience and current practice patterns assessment |journal=J. Pediatr. Surg. |volume=49 |issue=11 |pages=1585–8 |year=2014 |pmid=25475798 |doi=10.1016/j.jpedsurg.2014.06.012 |url=}}</ref> === | |||
* Since the dysgenetic [[ovaries]] in [[Turner syndrome]] have higher risk of [[malignancy]], they have to be resected whenever the disease is diagnosed. | |||
* In presence of [[Y chromosome]] the chance of becoming malignant is higher in [[Turner syndrome]], [[oophorectomy]] (even [[salpingo-oophorectomy]]) has to be done urgently. | |||
==References== | ==References== | ||
Revision as of 20:17, 13 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
The mainstay of treatment for delayed puberty is medical therapy. Surgery is usually reserved for patients with either pituitary tumors, hypothalamus hamartomas, and Turner syndrome. There are two procedures for excision of pituitary tumors, including endoscopic transsphenoidal surgery and craniotomy. In presence of Y chromosome the chance of becoming malignant is higher in Turner syndrome, oophorectomy (even salpingo-oophorectomy) has to be done urgently.
Surgery
The mainstay of treatment for delayed puberty is medical therapy. Surgery is usually reserved for patients with either:
Pituitary tumors
Endoscopic transsphenoidal surgery[1]
- In this method, the pituitary tumor is excised through nostrils by means of a tiny fiber-optic endoscopic tube.
- First bilateral nasal septal mucosa are incised in a C-shaped manner. The septal bone is been approached through the incisions.
- Then, the sphenoidal rostrum and anterior wall of sphenoid sinus are gradually removed, a bone window is opened through the skull space.
- After that, the dura mater is passed and the lesion become visualized.
- Finally, the tumor is removed using the curette and basket with suction.
- Advantages:
- Disadvantages:
- Not for large tumors
- Recurrent sinusitis in the future
- Low cure rate in case of suprasellar adhesion to adjunct tissues
Craniotomy[2]
- Although the preferred procedure to excise the pituitary tumors is transsphenoidal approach, but in some cases (1-4%) the size of the tumor or any suprasellar adhesion push the surgeon through transcranial method.
- Some positions that lead to choose the transcranial method are include:
- Isolation by a narrow waist at the diaphragma sellae
- Containment within the cavernous sinus lateral to the carotid artery
- Projection anteriorly onto the planum sphenoidale
- Projection laterally into the middle fossa
- Skull base surgical procedure is also the option for pituitary tumor treatment, but may encounter the problems that transsphenoidal method is faced with.
- Advantages:
- Resection of large tumors
- Ability to excise the tumors with suprasellar specific conditions
- Disadvantages:
- Long duration of post operation recovery
- Harm to other parts of the brain
Turner syndrome[3]
- Since the dysgenetic ovaries in Turner syndrome have higher risk of malignancy, they have to be resected whenever the disease is diagnosed.
- In presence of Y chromosome the chance of becoming malignant is higher in Turner syndrome, oophorectomy (even salpingo-oophorectomy) has to be done urgently.
References
- ↑ Fan YP, Lv MH, Feng SY, Fan X, Hong HY, Wen WP; et al. (2014). "Full Endoscopic Transsphenoidal Surgery for Pituitary Adenoma-emphasized on Surgical Skill of Otolaryngologist". Indian J Otolaryngol Head Neck Surg. 66 (Suppl 1): 334–40. doi:10.1007/s12070-011-0317-4. PMC 3918297. PMID 24533411.
- ↑ Youssef AS, Agazzi S, van Loveren HR (2005). "Transcranial surgery for pituitary adenomas". Neurosurgery. 57 (1 Suppl): 168–75, discussion 168–75. PMID 15987585.
- ↑ Kanakatti Shankar R, Inge TH, Gutmark-Little I, Backeljauw PF (2014). "Oophorectomy versus salpingo-oophorectomy in Turner syndrome patients with Y-chromosome material: clinical experience and current practice patterns assessment". J. Pediatr. Surg. 49 (11): 1585–8. doi:10.1016/j.jpedsurg.2014.06.012. PMID 25475798.