EndoscopyEndoscopic-guided direct endonasal approach for pituitary surgery
Section snippets
Patient population
During a 3-year period (01/96–03/99), 41 patients underwent pituitary surgery by the senior author (BB) at the University of Wisconsin, Madison. The first 21 patients were approached through a TS route, whereas the latter 20 patients were operated on via a direct EN approach with endoscopic guidance. Most (34 of 41, 83%) procedures were done for resection of pituitary adenomas. Other patients included three with Rathke’s cleft cysts (7%), one with craniopharyngioma (2%), one with germinoma
Surgical exposure
The extent of sphenoid sinus exposure gained through the EN route was comparable to that of the TS approach as performed through a columellar incision. Except for one patient with a giant prolactinoma and abnormally enlarged sella, the EN approach allowed for visualization of the entire sella and was adequate for resection of most tumors in this series (see below). In contrast to the sublabial TS approach, however, the EN route provided a narrower path and a more limited exposure of both
Discussion
The art of pituitary surgery has been refined since Horsley’s first attempted pituitary tumor resection in 1886. Constant challenge from suboptimal operating conditions and from high surgical morbidity and mortality in the early years has been the driving force for fresh ideas and has brought forth new techniques in the field of pituitary surgery. Inspired by Kanavel and Hirsch, and later by Halstead, Harvey Cushing developed the sublabial transsphenoidal approach to the sella. Although this
Acknowledgements
The authors thank Ms. Pat Giuliani for editorial support.
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Cited by (44)
Pituitary Adenomas: What Are the Key Features? What Are the Current Treatments? Where Is the Future Taking Us?
2019, World NeurosurgeryCitation Excerpt :The endoscopic endonasal approach is commonly used in many centers throughout the world, under the same indications as the conventional microsurgical technique.152 The pure endoscopic endonasal approach to the sellar area, with the endoscope as the sole visualizing tool throughout the procedure, was defined systematically by the Pittsburgh duo of an otorhinolaryngologist and a neurosurgeon, namely Carrau and Jho,153,154 followed by our group in Naples155-157 and teams at other institutions.132,158-162 Indications for surgery have changed and have been refined according to the development of new concepts in terms of diagnosis and new treatment strategies, in terms of pharmacologic agents and radiation techniques,152 but the goals of surgery remain the same163,164:
Pathway and workspace study of Endonasal Endoscopic Transsphenoidal (EET) approach in 80 cadavers
2019, International Journal of Surgery OpenCitation Excerpt :This procedure works on the principle of two procedures i.e. access to sphenoid and tumor eradication [1,20]. During sphenoid sinus approaching process the major limitation is the lack of anatomical landmark inside nasal cavity [4,5,42]. Additionally, this procedure is time consuming and it takes more than an hour to conduct the surgery.
Microscopic versus endoscopic pituitary surgery
2014, NeurocirugiaCitation Excerpt :They included studies with more than 10 patients treated with either microsurgery or endoscopy. This review analyzed a total of 5643 patients, of which 2125 were operated using the endoscope and 3518 using the microscope.11,15,17,20,21,23–54 The results for the microsurgery and endoscopy cohorts were 0.23% versus 0.49%, csf leak 6.34 versus 7%, meningitis 2.08 versus 1.11%, vascular complication 0.5 versus 1.58%, visual loss 0.60 versus 0.72%, diabetes insipidus temporary 10.23 versus 9.10% and permanent 4.25 versus 2.31%, hypopituitarism 1164 versus 8.51%, nerve injury 0.53 versus 0.28% and complete resection 64.44 versus 68.77% respectively.
Microsurgical anatomy of the sphenoid ostia
2010, Journal of Clinical NeuroscienceCitation Excerpt :The smallest diameter of the left ostium averaged 3.15 mm, with a range of 1.5 mm to 5 mm. The location of both ostia of the sphenoid air sinus has implications for the transsphenoidal approach, regardless of whether a microscope3,4,14–17 and/or an endoscope is used.5,18–24 The ostia are located in the vertical axis approximately at the level of the floor of the sella turcica, so they are a good landmark for the surgeon to know the orientation of the approach.4