Gestione pre, intra e post-operatoria del cane sottoposto ad ipofisectomia transfenoidale

Surgical excision of pituitary adenomas represents the first line treatment in humans with pituitary-dependent hypercortisolism (PDH). Transsphenoidal hypophysectomy in dogs is a surgical technique available in few veterinary centres. The most common treatment for PDH in dogs is the medical therapy with inhibitors of cortisol secretion. Pituitary adenomas can enlarge, reaching considerable size with subsequent neurological symptoms, in these cases the surgical removal of the tumor or radiotherapy are the only therapeutic options. A wide collaboration between different specialists is needed in case of transsphenoidal hypophysectomy. In this thesis 8 cases of transsphenoidal hypophysectomy in 7 dogs operated at the Department of Veterinary Medical Sciences, University of Bologna, are described. The main intraoperative difficulties for the surgeon were the localization of the pituitary fossa in relationship with the surgical landmarks visible in computed tomography (CT) or magnetic resonance imaging, besides bleeding problems during the removal of the mass. In the post-operative period major complication were encountered in patients with the most enlarged pituitary glands, together with a higher failure rate. On the contrary in cases of smaller tumor, the post-operative recovery was faster and with a higher success rate. In order to reach the targeted removal of the neoplasia, as in humans, a CT study has been conducted on 86 dogs with PDH. Unfortunately the CT protocol didn't permit to identify precisely the location of the tumor and to guide the surgeon in its removal. In two cases reported in the present work, the pituitary tumor recurred. In one case reoperation was decided, while in the other dog radiotherapy was chosen. Both therapeutic options allowed a good quality of life for more than one year. These cases demonstrate that both reoperation and radiotherapy can be considered valid options in case of recurrence.