The transsphenoidal route is the most widely used technique for pituitary adenoma surgery due to its rapidity, good tolerance, effectiveness and low complication rate. These are the parameters we utilized in comparing endoscopic with microscopic transsphenoidal surgery. We reviewed the medical records of 418 patients affected by pituitary adenomas who underwent endoscopic transsphenoidal surgery between May 1998 and December 2004, and in this paper, we present the results of 381 patients who fulfilled the follow-up criteria after a minimum period of 15 months. Our experience confirms the previous data on the rapidity and satisfactory tolerance of the endoscopic procedure. We also confirm the low complication rate, specifying that complications characteristic of the approaching phase were certainly reduced; instead, complications characteristic of tumor removal still remained similar to those reported in the microsurgical literature. The results were comparable with those of the best microsurgical series regarding endosellar lesions, but tumor removal was notably superior when dealing with tumors having an extrasellar extension. The improvement may be explained by the excellent vision of the deep surgical fields due to the endoscope and by the extreme flexibility of the surgical trajectory, mainly due to the absence of the divaricator, giving access to the ramifications of the tumor, otherwise difficult to reach.

The endoscopic technique allows results comparable with the best microscopic series. We think that this technique increases the safety of the procedure because of improved vision. Further studies are required to better define the exact location of the tumor with respect to the arachnoidal plane, the extra-arachnoidal craniopharyngioma being the most suitable for a radical removal using a transsphenoidal supradiaphragmatic approach.

The flexibility of this new technique with respect to the classical microscopic transsphenoidal approach permits us to widen the horizon of surgical management of aggressive cranial base tumors such as clival chordomas and chondrosarcomas.

No abstract

The transsphenoidal endoscopic approach represents a straightforward and mini-invasive approach for the drainage and biopsy of a Rathke's cleft cyst.

Objective The aims of the present study were to evaluate the clinical significance of the delay for surgical treatment and the prognostic value of other clinical, pathologic, and microbiological variables among hematologic patients affected by acute invasive fungal rhinosinusitis (AIFRS). Furthermore, we propose our early diagnosis and treatment protocol, reporting its 10-year results. Study Design Monocentric retrospective analysis. Setting The study was conducted from 2001 to 2017 at the University Hospital of Bologna, Italy. Subjects and Methods The impact of time to treatment and clinical, pathologic, and microbiological variables were analyzed among patients with histologically and microbiologically proven AIFRS. The outcomes of patients treated before the introduction of the early diagnosis protocol were compared with those treated afterward. Results Nineteen patients affected by AIFRS were eligible for the study. Treatment delay >4 days ( P = .002), infection caused by Mucorales ( P = .015), and extension of the disease were negative prognostic variables ( P = .017). The application of our protocol significantly reduced the delay for diagnosis and appropriate treatment by an average of 7.3 days ( P = .02). Conclusion The promptness of the diagnosis and surgical treatment may play a significant role in the management of AIFRS, as it appears to be significantly associated with the disease outcome. Our protocol may help to reduce the time required for diagnosis of high-risk hematologic patients.

Schwannomas are tumors that rarely involve the sinonasal tract or the pterygopalatinefossa. Three cases of benign schwannomas originating in the nasal cavity, the nasal-ethmoid, and the pterygopalatine fossa are reported. Surgical treatment is considered the treatment of choice to achieve long-term success. In this study, the effectiveness of the endoscopic endonasal approach is outlined for the diagnosis and treatment of these benign tumors.

Reconstruction of skull base defects following tumor resection is of paramount importance in avoiding serious and life-threatening complications. Cranial base surgery has evolved and outcomes have steadily improved as increasingly reliable reconstructive techniques have been adapted to repair the challenging wounds in this complex anatomic region. The most significant development has been the introduction and refinement of microvascular free tissue transfer to the skull base over the past 15 to 20 years. Free flaps can reliably provide the requisite tissue to not only seal the intracranial space from the subjacent cavities, but also to restore complex craniofacial defects that often result from skull base tumor excision. Advances in alloplast technology have also expanded the armamentarium available to the reconstructive surgeon. In particular, bone substitutes, titanium hardware, and resorbable plate fixation have been shown to be very efficacious when used in carefully selected situations. Finally, tissue sealants and adhesives have become widely used as an adjunctive method to achieve a water-tight dural repair.