446Giant pituitary tumours (GPTs) are rare tumours of 30 mm or more, that have major extensions into the suprasellar and parasellar compartments. [1][2][3][4][5][6][7] Despite the major neurosurgical challenge that resecting GPTs presents, [8][9][10][11][12][13][14][15][16] both transsphenoidal and transcranial approaches have been used. 2,17,18 Transsphenoidal approaches offer a more direct route to the sellar components and can stay outside the arachnoid whenever possible. Transcranial approaches offer direct visualization of the suprasellar components but, because they must come from the subarachnoid position, visualizing the sellar contents can be difficult without drilling the planum sphenoidale or mobilizing the optic nerve.Surgical morbidity and mortality for these lesions can be high, although the safety of the surgery has progressively ABSTRACT: Objective: To evaluate the outcomes of patients with giant pituitary tumours (GPTs) who underwent a purely binasal endoscopic transsphenoidal surgery (BETS) and compare their outcomes with those achieved through craniotomy and microscopic transsphenoidal surgery (MTS). Methods: Seventy-two consecutive patients with GPTs (greater than 10 cm 3 in volume) who were treated surgically with BETS, craniotomy, or MTS from October 1994 to July 2009 were reviewed for clinical outcomes, degree of tumor resection, recurrence rates, and surgical complications. Results: The BETS group had significantly better mean reduction of tumor volume (91%) than the craniotomy (63%, p = 0.001), and the MTS (63%, p = 0.010) groups. Gross total resection rates were also higher for BETS patients than for craniotomy patients (p = 0.010). Improvements in vision and headaches were noted in 96% and 100% of patients in the BETS group, respectively; these rates were similar to those in the craniotomy and MTS groups. Of the four patients with hormone-secreting tumours in the BETS group, three remained in remission. The median length-of-stay (four days) for the BETS group was shorter (p = 0.010), and surgical complications were less frequent (p = 0.037) and less severe compared to the craniotomy group. There were no differences in the recurrence rates: 79% percent of patients in the BETS group, 69% in the craniotomy group, and 79% in the MTS group were recurrence free at last follow-up (p = 0.829). Conclusions: Treatment of GPT with BETS offers excellent oncologic and clinical outcomes and can frequently obviate the need for craniotomy in these patients. RÉSUMÉ: Résultats du traitement chirurgical des tumeurs géantes de l'hypophyse (TGH).Objectif : Le but de l'étude était d'évaluer les résultats de la chirurgie transsphénoïdale endoscopique binasale (CTEB), de la craniotomie et de la chirurgie transsphénoïdale par microscopie (CTM) chez des patients atteints de tumeurs géantes de l'hypophyse et de comparer les résultats obtenus suite à ces chirurgies. Méthode : Les dossiers de patients consécutifs atteints de TGH (volume supérieur à 10 cm3), qui ont été traités chirurgicalement soit par CTEB, crani...

Rhinomanometric nasal airflow resistances and concurrent acoustic rhinometric nasal airway volumes are closely correlated. The combination of the two objective methods provides insight into nasal airflow physiology and nasal airway anatomy.

A number of milestones have marked the development of transsphenoidal pituitary tumor resection this century. The introduction of headlamp illumination, followed by the use of the operating microscope and fluoroscopy have allowed neurosurgeons to perform this surgery in a safe and highly effective manner. With the aid of a case report, we describe the incorporation of endoscopic techniques in pituitary tumor resection. The technique described is minimally invasive, avoiding septal dissection and allowing unsurpassed, unobstructed, and panoramic visualization of the region of interest to the surgeon and operative team.

By contrast with the smoiced drum and other mechanical systems, modern electronic rhinomanometers provide superior sensitivity and frequency response. They enable accurate measurement of nasal airflow resistance to be made and are commercially available. In addition to a rhinomanometer, nasal airflow measurements require a face mask fitted witb a flow measuring device (a pneumotach connected to an electronic differential pressure transducer) or, as an alternative to a face mask, a head-out body plethysmograpb. Concurrently with nasal respiratory airflow, transnasal pressures between the nostril and pbarynx ate measured via nasal or oral tubing by a second differential pressure transducer. Tbe transduced electronic analogue signals are digitized, and nasal airflow resistances are computed from tbe ratio between transnasal pressure and airflow. At a single sitting, a series of measurements witb modern rbinomanometry can determine (1) the response to topical decongestant of the mucovascular contribution to nasal airflow resistance at tbe time of examination and (2) in tbe decongested nose, the presence, side, site, and severity of structural obstruction. Rbinomanometry is not "medically necessary" in assessment of all cases of nasal obstructive symptoms, but, in many situations, it can provide valuable objective information in compliance with the requirements of evidence-based medicine. This article includes a table listing situations in which rbinomanometry is particularly useful. SommaireContrairement aux anciens systemes mecaniques, les rbinomanometres electroniques modernes ont une bonne sensibilite, permettent une mesure precise de la resistance nasale et sont facilement disponibles sur le marcbe. En plus du rhinomanometre, la mesure du flux nasal exige un masque facial couple a un appareil pouvant mesure le flux (un pneumotach brancbe sur un transducteur de pression electronique) ou au lieu d'un masque facial, un pletbysmograpbe fonctionnant avec la tete sortie. En meme temps que le flux nasal, la pression trans-nasale entre la narine et le pbarynx doit etre mesuree par un second transducteur brancbe sur un tube nasal ou oral. Les signaux analogues sont ensuite numetises et la resistance nasale calculee par l'ordinateut qui divise la pression transnasale par le flux. En une seule session, un rhinomanometre moderne peut determiner 1) la reponse au decongestionnant, evaluant la composante muqueuse a la resistance nasale au moment de l'examen 2) et dans le nez decongestionne, la presence, le cote, le site et la severite d'une obstruction structurelle. La rbinomanometrie n'est pas medicalement necessaire dans devaluation de tous les cas d'obstruction nasale mais dans plusieurs situations peut fournir de l'information objective utile dans un contexte de medecine probante. Cet article inclut une liste des situations ou la rbinomanometrie peut ette particulierement utile.