Endoscopic management of lesions of the sella turcica

Abstract

The excellent visualization and minimally invasive surgical technique of endoscopic sinus surgery was applied to the management of 40 patients with sellar lesions. Endoscopic management of sellar lesions offers, not only the advantage of improved visualization, but also magnification, and a panoramic perspective of the important relationships of the sella turcica. In the past year, we have managed 40 subjects with sellar lesions, endoscopically: 38 patients had pituitary adenomas and two a craniopharyngioma.At our hospital, the endoscope has replaced the operating microscope for surgery for pituitary adenomas and other sellar lesions. The endoscopic approach to the sphenoid sinus and the sella is performed by an ENT surgeon and the ablative surgery performed by a neurosurgeon.Our experiences, using the endoscope to perform surgery on sellar and parasellar lesions, are reported and the advantages, over the operating microscope, which is traditionally used are discussed. The technique for endoscopic management of sellar lesions is described.

Endoscopic endonasal transsphenoidal exposure of circle of willis (cw); can it be applied in vascular neurosurgery in near future? a cadaveric study of 26 cases

“…During the last two decades the role of endoscopes has been firmly established in the diagnosis and treatment of nasal and sinuses as well as developing surgeons expertise made the use of endoscope, beyond the paranasal sinuses such as sella turcica, seem a logical progression (1,7,10,17,21,27,28,38,48). Busch and Halves reported first use of endoscope for pituitary in the mid 1990s (22,38).…”

“…The endoscope can provide better illumination, magnification and visualization than the operating microscope (21,32,48). Meanwhile the advantage of angled vision and a panoramic and tuber cinereum.…”

“…view are crucial for safety of the surgical procedure (48), where associated complications such as arterial injury, visual deterioration, ocular falsies and dural injury to para and supraseller areas can be avoided using the endoscope (6,32). Moreover, the ability of angled telescope to visualize the para and suprasellar areas has resulted in better tumor resection (8,21,40,48).…”

“…Moreover, the ability of angled telescope to visualize the para and suprasellar areas has resulted in better tumor resection (8,21,40,48). The smaller size of the endoscopic instruments (as compared to microscopic equipments (40) ) and the ability to quickly change the field to view at the surgical site and more panoramic perspective facilitate permanent monitoring of important anatomical landmarks increasing the surgeon's confident (48).…”

Outcomes following Purely Endoscopic Endonasal Resection of Pituitary adenomas

“…Mortality was due to electrolyte imbalance and improper management of infection and hydrocephalus. 8 In a study of Tabaee et al 9 , endoscopic pituitary surgery was done on 821 patients where the overall mortality was 0.24%, permanent diabetes insipidus 1% and CSF leak was 2%. In our study, we had high rate of mortality, diabetes insipidus and CSF leak due to learning curve and improper postoperative management.…”