{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,7,13]],"date-time":"2024-07-13T00:25:58Z","timestamp":1720830358024},"reference-count":7,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground: <\/jats:title>\nGrowth hormone (GH)--secreting pituitary adenomas can be aggressive and difficult to manage. Surgical resection for GH-secreting tumors remains the gold standard with increasing use of expanded endoscopic endonasal (EEA) techniques. Certain anatomical considerations make postsurgical biochemical remission challenging.<\/jats:p>\n<\/jats:sec>\n\nCase Description: <\/jats:title>\nWe describe the case of a 43-year-old male presenting with acromegaly after a lack of biochemical remission from a previous surgery. Resection of the residual tumor invading the retrogenu compartment of the cavernous sinus was challenging for several reasons: (a) its location adjacent to the right parasellar horizontal internal carotid artery (ICA) with involvement of the medial wall, (b) the large kissing bilateral ICAs reducing the intercarotid distance, and (c) potential scar tissue. EEA was undertaken with key surgical steps, including wide bilateral sphenoidotomies, right middle clinoidectomy to access the clinoidal ICA and the retrogenu compartment, identification of the top of the paraclival ICA by drilling across the sella floor, division of the sellar floor dura to increase the intercarotid distance and transcavernous mobilization of medial wall, and the tumor capsule away from the horizontal parasellar ICA and across to the diaphragm and pituitary gland. Postoperatively, biochemical remission was achieved with no new endocrine deficits.<\/jats:p>\n<\/jats:sec>\n\nConclusion: <\/jats:title>\nThese surgical nuances permit biochemical remission in complex revisional cases with acromegaly.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_292_2024","type":"journal-article","created":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T08:55:33Z","timestamp":1720774533000},"page":"239","update-policy":"http:\/\/dx.doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Expanded endoscopic endonasal approach for resection of residual parasellar growth hormone-secreting pituitary adenoma in a patient with kissing internal carotid arteries: Technical nuances"],"prefix":"10.25259","volume":"15","author":[{"given":"Mustafa","family":"Motiwala","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, United States"},{"name":"Department of Neurosurgery, Southmead Hospital, Bristol, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricio","family":"Gimenez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Southmead Hospital, Bristol, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Waqas Saeed","family":"Baqai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Southmead Hospital, Bristol, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jahangir","family":"Sajjad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Southmead Hospital, Bristol, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faisal","family":"Hasan","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Southmead Hospital, Bristol, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Bradley","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Cheltenham General Hospital, Cheltenham, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Southmead Hospital, Bristol, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Warren","family":"Bennett","sequence":"additional","affiliation":[{"name":"Department of Ear Nose and Throat, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kumar","family":"Abhinav","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Southmead Hospital, Bristol, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2024,7,12]]},"reference":[{"key":"10.25259\/SNI_292_2024\/ref-1","doi-asserted-by":"crossref","first-page":"1123267","DOI":"10.3389\/fendo.2023.1123267","article-title":"Multidisciplinary management of difficult\/aggressive growth-hormone pituitary neuro-endocrine tumors","volume":"14","author":"Bianchi","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"key":"10.25259\/SNI_292_2024\/ref-2","first-page":"241","article-title":"Diagnosis and treatment of pituitary adenomas","volume":"29","author":"Chanson","year":"2004","journal-title":"Minerva 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review","volume":"13","author":"Dumitriu-Stan","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"10.25259\/SNI_292_2024\/ref-6","doi-asserted-by":"crossref","first-page":"60","DOI":"10.3171\/2017.2.JNS162114","article-title":"A morphometric survey of the parasellar region in more than 2700 skulls: Emphasis on the middle clinoid process variants and implications in endoscopic and microsurgical approaches","volume":"129","author":"Sharma","year":"2018","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_292_2024\/ref-7","doi-asserted-by":"crossref","first-page":"122","DOI":"10.3171\/2018.3.JNS18596","article-title":"The medial wall of the cavernous sinus. Part 1: Surgical anatomy, ligaments, and surgical technique for its mobilization and\/or resection","volume":"131","author":"Truong","year":"2018","journal-title":"J Neurosurg"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/expanded-endoscopic-endonasal-approach-for-resection-of-residual-parasellar-growth-hormone-secreting-pituitary-adenoma-in-a-patient-with-kissing-internal-carotid-arteries-technical-nuances\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/expanded-endoscopic-endonasal-approach-for-resection-of-residual-parasellar-growth-hormone-secreting-pituitary-adenoma-in-a-patient-with-kissing-internal-carotid-arteries-technical-nuances\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T08:55:39Z","timestamp":1720774539000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/expanded-endoscopic-endonasal-approach-for-resection-of-residual-parasellar-growth-hormone-secreting-pituitary-adenoma-in-a-patient-with-kissing-internal-carotid-arteries-technical-nuances\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,12]]},"references-count":7,"alternative-id":["10.25259\/SNI_292_2024"],"URL":"https:\/\/doi.org\/10.25259\/sni_292_2024","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2024,7,12]]},"article-number":"239"}}