Endoscopic-guided direct endonasal approach for pituitary surgery

Badie, Behnam; Nguyen, Peter H.; Preston, Jacqueline

doi:10.1016/s0090-3019(99)00195-0

Cited by 38 publications

(28 citation statements)

References 10 publications

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“…Although anatomic and clinical studies have shown the sublabial approach affords a larger exposure to the sphenoid sinus and sella than the direct or transseptal endonasal approaches (1,9), the findings here suggest that in the majority of cases, the full anatomic potential of both the sublabial and endonasal routes were not fully used by the surgeon. Using cadaveric dissections, Das et al (9) compared the sublabial, endonasal, and transethmoidal approaches and found the amount of side to side exposure at the sella was similar for all approaches.…”

Section: Inadequate Exposurecontrasting

confidence: 60%

“…In regard to rhinological recovery, the questionnaire results indicate an endonasal reoperation is well tolerated and typically affords an easier and less painful recovery than the sublabial route. Other studies have also shown the superiority of the endonasal microscopic or endoscopic approaches over the sublabial route in terms of nasal complaints and complications (1,5,16,18,32). In considering the mucosal scarring along the nasal septum in reoperative transsphenoidal surgery, the direct endonasal approach, which bypasses the great majority of the nasoseptal scar, is ideal for such cases and obviates the need for nasal packing, a major source of acute postoperative discomfort (33).…”

Section: Complications and Rhinological Recoverymentioning

confidence: 99%

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Suboptimal Sphenoid and Sellar Exposure: A Consistent Finding in Patients Treated with Repeat Transsphenoidal Surgery for Residual Endocrine-inactive Macroadenomas

et al. 2006

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In patients with residual sellar endocrine-inactive adenomas, a suboptimal opening at the sphenoid keel or sella at the first surgery and a high proportion of fibrous/rubbery tumors likely contributed to prior subtotal removal of otherwise accessible tumor. With a wider exposure, most noninvasive tumors can be totally removed, whereas invasive tumors can be effectively debulked. An endonasal reoperation is well tolerated with a low complication rate.

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Section: Inadequate Exposurecontrasting

confidence: 60%

Section: Complications and Rhinological Recoverymentioning

confidence: 99%

Suboptimal Sphenoid and Sellar Exposure: A Consistent Finding in Patients Treated with Repeat Transsphenoidal Surgery for Residual Endocrine-inactive Macroadenomas

et al. 2006

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“…12 19 24 26 28 30 31 33 37 39 41 42 46 Eight manuscripts included both techniques 1517 18 21 27 32 36 45 Study type and demographics of all the studies are presented in table 1.…”

Section: Resultsmentioning

confidence: 99%

Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis

Ammirati

Wei

Cirić

2012

Journal of Neurology, Neurosurgery & Psychiatry

272

173

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Endoscopic transsphenoidal pituitary surgery has become increasingly more popular for the removal of pituitary adenomas. It is also widely recognised that transsphenoidal microscopic removal of pituitary adenomas is a well-established procedure with good outcomes. Our objective was to meta-analyse the short-term results of endoscopic and microscopic pituitary adenoma surgery. We undertook a systematic review of the English literature on results of transsphenoidal surgery, both microscopic and endoscopic from 1990 to 2011. Series with less than 10 patients were excluded. Pooled data were analysed using meta-analysis techniques to obtain estimate of death, complication rates and extent of tumour removal. Complications evaluated included cerebrospinal fluid leak, meningitis, vascular complications, visual complications, diabetes insipidus, hypopituitarism and cranial nerve injury. Data were also analysed for tumour size and sex. 38 studies met the inclusion criteria yielding 24 endoscopic and 22 microscopic datasets (eight studies included both endoscopic and microscopic series). Meta-analysis of the available literature showed that the endoscopic transsphenoidal technique was associated with a higher incidence of vascular complications (p<0.0001). No difference was found between the two techniques in all other variables examined. Meta-analysis of the available literature reveals that endoscopic removal of pituitary adenoma, in the short term, does not seem to confer any advantages over the microscopic technique and the incidence of reported vascular complications was higher with endoscopic than with microscopic removal of pituitary adenomas. While we recognise the limitations of meta-analysis, our study suggests that a multicentre, randomised, comparative effectiveness study of the microscopic and endoscopic transsphenoidal techniques may be a reasonable approach towards establishing a true valuation of these techniques.

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“…8,17,38 This direct endonasal method has been adopted by others 7 and more recently used with endoscopic assistance. 2,21,23,35,38 Most of these studies, however, have provided limited data on tumor remission rates and postoperative hormonal changes. Furthermore, in no studies have patient complaints been assessed after the direct endonasal approach with the operating microscope.…”

mentioning

confidence: 99%

Endonasal transsphenoidal approach to treat pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions of the surgery

Zada¹,

Kelly²,

Cohan³

et al. 2003

Journal of Neurosurgery

294

162

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The direct endonasal route for pituitary tumor removal has efficacy and complication rates comparable to those of the sublabial route. Patients generally recover rapidly from this minimally invasive procedure and have no or minimal sinonasal complaints. For patients requiring a repeated operation, the endonasal route appears to be less painful and easier to recover from than the sublabial route. Given the minimal nasal mucosal dissection required and the frequent patient complaints related to nasal packing, use of packing is no longer used for this procedure.

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Endoscopic-guided direct endonasal approach for pituitary surgery

Cited by 38 publications

References 10 publications

Suboptimal Sphenoid and Sellar Exposure: A Consistent Finding in Patients Treated with Repeat Transsphenoidal Surgery for Residual Endocrine-inactive Macroadenomas

Suboptimal Sphenoid and Sellar Exposure: A Consistent Finding in Patients Treated with Repeat Transsphenoidal Surgery for Residual Endocrine-inactive Macroadenomas

Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis

Endonasal transsphenoidal approach to treat pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions of the surgery

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