Amenorrhea surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

The mainstay of treatment for amenorrhea is medical therapy. Surgery is usually reserved for patients with either hypothalamus or pituitary tumors, Turner syndrome, and genital anatomical defects (imperforate hymen or transverse vaginal septum). The surgical treatment for hypothalamus or pituitary tumors includes tumor resection via endoscopic transsphenoidal surgery. Ovaries have to be excised in Turner syndrome to prevent malignant transformation. Small incision is the preferred surgical procedure for imperforate hymen and septal excision is the main treatment for transverse vaginal septum.

Surgery

Pituitary and hypothalamus tumors

Transsphenoidal approach to pituitary tumor - Source: Wikimedia.org

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 is incised in a C-shaped manner. The septal bone is approached through this incision.
  • Then, 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 becomes visible.
  • Finally, the tumor is removed using curette and basket with suction.
  • Advantages:
    • No harm to other parts of the brain
    • High cure rate
    • No visible scar
  • Disadvantages:

Craniotomy[2]

  • Although the preferred procedure to excise the pituitary tumors is a trans-sphenoidal approach, but in some cases (1-4%) the size of the tumor or any suprasellar adhesion may require trans-cranial method.
  • Situations requiring transcranial method include:
  • 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
    • Damage to other parts of the brain

Turner syndrome[3]

Anatomical defect

Imperforate hymen

Transverse vaginal septum

  • The surgical procedure includes excision of septum via vaginal canal. Prognosis is generally good with most patients reporting normal menstruation cycles after surgery.[5]

References

  1. 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.
  2. Youssef AS, Agazzi S, van Loveren HR (2005). "Transcranial surgery for pituitary adenomas". Neurosurgery. 57 (1 Suppl): 168–75, discussion 168–75. PMID 15987585.
  3. 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.
  4. Temizkan O, Kucur SK, Ağar S, Gözükara I, Akyol A, Davas I (2012). "Virginity sparing surgery for imperforate hymen: report of two cases and review of literature". J Turk Ger Gynecol Assoc. 13 (4): 278–80. doi:10.5152/jtgga.2012.46. PMC 3881718. PMID 24592057.
  5. Al-Abdulhadi F, Diejomaoh MF, El Biaa A, Jirous J, Al-Qenae M (2010). "Excision of high vaginal septum". Arch. Gynecol. Obstet. 281 (5): 955–7. doi:10.1007/s00404-009-1293-8. PMID 19943056.

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