Mediastinal Paratiroid Adenomlarının Tedavisinde SPECT/BT Rehberliğinde Uygulanan Minimal İnvazif Girişimler

Year 2020, , 54 - 57, 30.04.2020

Oya Yıldız , Alper Fındıkçıoğlu , Dalokay Kılıç , Neşe Torun

https://doi.org/10.18678/dtfd.652697

Abstract

Ektopik paratiroid dokusunun yerini saptamak ve çıkarmak %20’nin üzerinde başarısızlıkla sonuçlanabilmektedir. Tc-99m sestamibi ile yapılan tek foton emisyon bilgisayarlı tomografi/bilgisayarlı tomografi (single photon emission computed tomography/computed tomography, SPECT/CT) görüntülemesinde saptanan ve minimal invaziv cerrahi yöntemler ile tedavi edilen yedi olgu sunulmuştur. Total/subtotal paratiroidektomi operasyonu sonrası yüksek parathormon (PTH) seviyesi nedeni ile SPECT/CT uygulanan ve mediastende ektopik paratiroid saptanan olgular dahil edilmiştir. Cerrahinin başarısı preoperatif ve postoperatif PTH düzeyleri ile değerlendirildi. Beş olguya video yardımlı toraks cerrahisi (video-assisted thoracic surgery, VATS), diğer ikisine video yardımlı mediastinoskopi (video-assisted mediastinoskopi, VAM) uygulandı. Ortalama yaş 52,4±19,0 idi. Altı olgu kadın, bir olgu erkek idi. 1,5 ile 6 cm arasında değişen mediastinal adenomlar tek denemeden sonra basit girişimler ile başarılı bir şekilde tedavi edildi. Mediastinal ektopik paratiroid adenomu ameliyat öncesi tam olarak lokalize edilebilirse minimal invaziv cerrahi yöntemlerle tedavi edilebilir.

Keywords

ektopik paratiroid, parathormon, tek foton emisyon bilgisayarlı tomografi

Minimally Invasive Interventions Used with the Guidance of SPECT/CT in the Treatment of Mediastinal Parathyroid Adenomas

Abstract

Locating and removing ectopic parathyroid tissue may result in more than 20% failure. Seven cases which were detected by single photon emission computed tomography/computed tomography (SPECT/CT) imaging with Tc-99m sestamibi and treated with minimally invasive surgical methods were presented. The cases that underwent SPECT/CT due to high parathormone (PTH) level after total/subtotal parathyroidectomy operation, and detected to have mediastinal ectopic parathyroid were included. The success of the surgery was assessed with preoperative and postoperative PTH levels. Video-assisted thoracic surgery (VATS) was performed on five of the cases and video-assisted mediastinoscopy (VAM) was performed on remaining two. The mean age was 52.4±19.0. There were six women and one man. Mediastinal adenomas ranging from 1.5 to 6 cm in size, were successfully treated after single attempt. If the mediastinal ectopic parathyroid adenomas are fully localized before surgery, it can be treated with minimally invasive surgical methods.

Keywords

Ectopic parathyroid, parathormone, single photon emission computed tomography

References

• Sarıcı İŞ, Kılıç B, Doğan S, Tanju S, Çaynak M, Ağcaoğlu O, et al. Surgical resection of ectopic parathyroid adenoma by sternotomy. Journal of Dialog in Endocrinology. 2012:9(3):140-4.
• Erdil TY, Uslu Beşli L. Clinical value of single photon emission computed tomography/computed tomography in the evaluation of Tc-99m MIBI parathyroid scintigraphy. Nucl Med Semin. 2016:2(1):49-56.
• Kim YS, Kim J, Shin S, Thoracoscopic removal of ectopic mediastinal parathyroid adenoma. Korean J Thorac Cardiovasc Surg. 2014:47(3):317-9.
• Khafif A, Masalha M, Landsberg R, Domachevsky L, Bernstine H, Groshar D, et al. The role of F18-fluorocholine positron emission tomography/magnetic resonance imaging in localizing parathyroid adenomas. Eur Arch Otorhinolaryngol. 2019:276(5):1509-16.
• Beheshti M, Hehenwarter L, Paymani Z, Rendl G, Imamovic L, Rettenbacher R, et al. 18F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with 99mTc-MIBI or 99mTc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients. Eur J Nucl Med Mol Imaging. 2018:45(10):1762-71.
• Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab. 2014:99(10):3561-9.
• Kedarisetty S, Fundakowski C, Ramakrishnan K, Dadparvar S. Clinical value of Tc99m-MIBI SPECT/CT versus 4D-CT or US in management of patients with hyperparathyroidism. Ear Nose Throat J. 2019:98(3):149-57.
• Korukluoğlu B, Kıyak G, Çelik A, Uçar AE, Ergül E, Kuşdemir A. Our surgical approach to parathyroid adenoma and the role of localization studies. Turkiye Klinikleri J Med Sci. 2008:28(1):24-9.
• Fatimi SH, Inam H, Chagan FK, Choudry UK. Management of mediastinal parathyroid adenoma via minimally invasive thoracoscopic surgery: Case report. Int J Surg Case Rep. 2017:40(1):120-3.
• Naik D, Jebasingh KF, Ramprasath, Roy GB, Paul MJ. Video assisted thoracoscopic surgery (VATS) for excision of an ectopic anterior mediastinal intra-thymic parathyroid adenoma. J Clin Diagn Res. 2016:10(6):PD22-4.
• Taubman ML, Goldfarb M, Lew JI. Role of SPECT and SPECT/CT in the surgical treatment of primary hyperparathyroidism. Int J Mol Imaging. 2011;2011:141593.
• Grant CS, Thompson G, Farley D, van Heerden J. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectorny: Mayo Clinic experience. Arch Surg. 2005:140(5):472-9.
• Iihara M, Suzuki R, Kawamata A, Horiuchi K, Okamoto T. Thoracoscopic removal of mediastinal parathyroid lesions: selection of surgical approach and pitfalls of preoperative and intraoperative localization. World J Surg. 2012:36(6):1327-34.
• Bagul A, Patel HP, Chadwick D, Harrison BJ, Balasubramanian SP. Primary hyperparathyroidism: An analysis of failure of parathyroidectomy. World J Surg. 2014:38(3):534-41.