Au. Song et al., Success of preoperative imaging and unilateral neck exploration for primary hyperparathyroidism, OTO H N SUR, 121(4), 1999, pp. 393-397
The surgical treatment of hyperparathyroidism has become controversial with
the recent advent of reliable preoperative imaging modalities. This study
examines the efficacy and economy of using preoperative imaging studies to
localize the pathology and allow for unilateral neck exploration. From Janu
ary 1990 to May 1996, a total of 91 patients with primary hyperparathyroidi
sm were treated at Swedish Medical Center in Seattle, WA, by 2 surgeons. Ei
ghty-six nuclear scintigraphy studies were performed, of which 44 were tech
netium 99m sestamibi (Tc-99m-sestamibi) scans and 42 were thalium 99m techn
etium (Th-99m-Tc) scans, The overall sensitivity for Tc-99m-sestamibi was 9
1% (40/44), and that for Th-99m-Tc scans was 81% (34/42). Ultrasound examin
ation revealed a sensitivity of 80% (66/82). There was a statistically sign
ificant difference in surgical time between the unilateral and bilateral ne
ck explorations (45 minutes, P < 0.0001). Unilateral neck exploration for h
yperparathyroidism has been successful in curing hypercalcemia 93% (85/91)
of the time with the use of preoperative imaging studies. Tc-99m-sestamibi
is a reliable tool for planning the initial unilateral neck exploration for
treatment of primary hyperparathyroidism.