Endoscopic Endonasal Transsphenoidal Approach to the Sella: Towards Functional Endoscopic Pituitary Surgery (FEPS)*

Abstract

Standard microscopical transsphenoidal surgery is used world-wide in most sellar lesions, but continuing technological progress leaves room for further possibilities. The authors have employed a slightly modified Jho-Carrau technique for endoscopic endonasal transsphenoidal removal of pituitary lesions. This approach has been successfully used in 15 consecutive patients; the preliminary results are reported. The advantages and the limitations of this technique are discussed and compared to standard transsphenoidal surgery. In consideration of the low invasiveness of this approach and of the improved respect for the inner nose and sinus structures, the authors suggest the new term of Functional Endoscopic Pituitary Surgery (FEPS) to characterize this simple one-nostril endoscopic endonasal procedure.

Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing's disease (CD)

“…have described previously. [33][34][35][36] However, a binostril, transsphenoidal, endoscopic approach to the sella turcica during which the endoscope is handheld was used.…”

Endoscopic endonasal surgery for skull base tumours: technique and preliminary results in a consecutive case series report

“…As a result of the experience gained in Endoscopic Sinus Surgery (ESS) over two decades (1,2) , the endoscope was rst introduced for conventional transsphenoidal surgery and, thereafter, as the main visualizing tool throughout the whole procedure. This 'endoscopic endonasal approach' (3,4) currently provides minimally invasive and adequate access to di erent skull base lesions. Recent anatomical studies (5)(6)(7) and clinical reports (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) have detailed and categorized this procedure into a series of anatomical modular approaches to the skull base, drawing on the pioneering, specialised and innovative work of Kassam, Carrau, and co-workers (10,(19)(20)(21) .…”

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

“…The endoscopic endonasal approach avoids transseptal dissection, thus reducing patient discomfort and postoperative pain. The endoscope has increasingly been used in pituitary surgery since the mid 1990s either in conjunction with the microscopic technique (24) or as a pure endoscopic procedure (18,25,26). Especially the better panoramic visualization of sellar, supra-and parasellar anatomy with increased illumination and magnification are recognized as major advantages offered by the endoscopic technique (21,25,27).…”

“…The endoscopic approach is safe, all authors reporting low complication rates (25, 26, 30 -35). It is minimally traumatic and permits easier reoperations (18)(19)(20)(21)23). This makes the endoscopic pituitary approach attractive for patients with Cushing's disease in an attempt to avoid bleeding complications that are particularly feared because of the hypercortisolemic status.…”