Endoscopic Endonasal Transsphenoidal Approach: Outcome Analysis of 100 Consecutive Procedures

Abstract

The endoscopic endonasal transsphenoidal approach has been proposed in the past decade as a minimally invasive surgical technique for the removal of pituitary tumors. From January 1997 to November 1999, 100 consecutive patients with pituitary tumors underwent endoscopic endonasal surgery, according to Jho's technique. We employed 0 degrees, 30 degrees, 45 degrees, and 70 degrees rigid endoscopes, 18 - 30 cm in length, 4 mm in diameter with an outer sleeve for irrigation and secured to a holder. Among the 87 pituitary adenomas, tumor removal was total in 51, subtotal (> 80 %) in 20 and partial in 16 cases. Four craniopharyngiomas were totally removed and an intra-suprasellar arachnoid cyst was emptied; a biopsy was performed in the two patients with a clivus chordoma. The two cases of sphenoid sinusitis were cured by surgery, the three patients with spontaneous CSF rhinorrhea were successfully treated and the residual nasal meningocele was removed. The endoscopic endonasal transsphenoidal approach appeared to be less traumatic than the traditional microsurgical approach, was very effective, and was characterized by a reduced number of complications. However, the relatively small series together with the short follow-up do not allow us to draw definitive conclusions. The post-operative reduction in hospital stay (two days in 40 of 100), significantly reduced the cost of patient's management.

Transsphenoidal pituitary surgery via the endoscopic technique: results in 35 consecutive patients with Cushing’s disease

“…Due to its recent introduction, there are only few reports describing larger series of patients with pituitary tumors operated via the endoscopic technique (25,29,35). It seems that the endocrine outcomes of the patients reported in these initial series are similar to those achieved by the conventional microscopic technique.…”

“…It seems that the endocrine outcomes of the patients reported in these initial series are similar to those achieved by the conventional microscopic technique. Cappabianca et al (29) reported on 87 patients with various pituitary adenomas, including 8 patients with Cushing's disease, that were treated with endoscopic endonasal transsphenoidal pituitary surgery between 1997 and 1999. As remission criterion for patients with Cushing's disease the authors adopted a restoration of the circadian rhythm of cortisol together with the normalization of urinary cortisol levels.…”

Endonasal Endoscopic Transsphenoidal Chiasmapexy With Silicone Plates for Empty Sella Syndrome-Technical Note-

“…9) The patients returned to daily activities within days of the operation because the endonasal endoscopic approach involves less pain and discomfort than the conventional approach. 1,9) We suggest that the endonasal endoscopic approach could be used to treat skull base lesions other than empty sella syndrome. 4) …”

“…The overall approach to the sella turcica was the same as that of endonasal endoscopic pituitary surgery. 1,9) Briefly, the sphenoethmoidal recess was approached under endoscopic vision, where the natural ostium of the sphenoid sinus was identified. The septal mucosa was cauterized 1 or 2 cm anterior to the ostium and the anterior wall of the sphenoid sinus was exposed on the same side.…”

Tumores hipofisários: opções terapêuticas atuais e perspectivas futuras de tratamento

“…Tem sido utilizado tanto para a remoção dos adenomas hipofisários como de craniofaringeomas e permite também correção cirúrgica de fístula liquórica. Vários autores que têm experimentado esta nova técnica demonstram resultados iguais ou superiores aos da cirurgia transefenoidal clássica com menor tempo de internação e menor desconforto pós-operatório (49)(50)(51).…”