Image-guided Endoscopic Transnasal Removal of Recurrent Pituitary Adenomas

Lasio, Giovanni; Ferroli, Paolo; Felisati, Giovanni; Broggi, Giovanni

doi:10.1097/00006123-200207000-00020

Cited by 75 publications

(30 citation statements)

References 23 publications

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“…Image guided neuronavigation systems are very useful for intraoperative identification of the limits of the lesion and of the bony, vascular and nervous structures, especially if they are encased by the tumor [46,101,117,129]. In some select cases, the classic landmarks for endoscopic transsphenoidal surgery (sellar floor, clival indentation, carotid and optic nerve protuberances, optico-carotid recess) are not easily identifiable and neuronavigation can help to maintain the surgeon's orientation even in the presence of distorted anatomy.…”

Section: Instruments and Tools For Extended Approachesmentioning

confidence: 99%

Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery

Cappabianca

Cavallo

Esposito

et al. 2008

Advances and Technical Standards in Neurosurgery

337

189

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Section: Instruments and Tools For Extended Approachesmentioning

confidence: 99%

Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery

Cappabianca

Cavallo

Esposito

et al. 2008

Advances and Technical Standards in Neurosurgery

337

189

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“…Other authors have underlined the usefulness of navigation systems to help locate anatomical landmarks, particularly in cases of tumor recurrence. 39,40 Two important surgical intercurrences were noted in this paper, perioperative bleeding and sellar diaphragm injuries. Most of the severe complications of nasosinusal endoscopic surgery (perforation of the ethmoidal roof, optic nerve injury) occur in those cases operated under unfavorable visibility conditions due to intense bleeding.…”

Section: Discussionmentioning

confidence: 78%

Acesso endoscópico transnasal aos tumores selares

Santos

Zymberg

Filho

et al. 2007

Rev. Bras. Otorrinolaringol.

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Transsphenoi dal surgery for sellar region tumors is traditionally done only by neurosurgeons. The use of endoscopes has permitted a direct transnasal approach to the sphenoidal sinus, without dissection of the septal mucosa, reducing postoperative morbidity. Aim: The purpose of this study was to assess the technical difficulties, and per and postoperative complications of the otolaryngological management of the endoscopic transnasal approach to the sellar region. Material and Method: 159 patients undergoing sellar region surgery between March 2001 and December 2006 were assessed retrospectively. 91 patients who underwent 95 endoscopic transnasal procedures were included in this study. Study design: a clinical retrospective study. Results: The endoscopic transnasal technique was feasible for every patient, independent of age, anatomical variations, tumor characteristics, tumor etiology, and previous surgical history. There was no need to remove the middle turbinate or septal deviations in any of the cases. The most significant peroperative complication was CSF leak during tumor removal (13.68%). Postoperative complications were: nasal bleeding (8.42%), CSF leak (8.42%), and meningitis (2.19). Conclusion: The transnasal endoscopic approach was accomplished with minimal invasion, preserving nasal structures in all 95 procedures, independent of age, anatomical variations, tumor characteristics,tumor etiology, and previous surgical history.

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“…3). General use of navigation systems in operations of pituitary adenomas has been proposed by some authors, but this might actually not be necessary in centres with a high patient load [9]; it is certainly appreciated and undisputedly useful in every situation in which the anatomical relationships are more complex than normal (table 3) [36,37]. There are pointer-based systems which show the location of the pointer tip in a 3D CT or MRI model of the patient's head.…”

Section: Neuronavigationmentioning

confidence: 99%

“…This might be due to the small patient series, the lack of long-term outcome data and the fact that in experienced hands complication rates are low anyway [9,10]. The technology is equally useful for transsphenoidal microsurgery and endoscopic pituitary surgery [36,37]. With the advantages of neuronavigation, the spectrum of operable lesions has been widened.…”

Section: Neuronavigationmentioning

confidence: 99%

Novel Techniques in the Surgical Treatment of Acromegaly: Applications and Efficacy

Buchfelder

Schlaffer

2015

Neuroendocrinology

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Since the establishment of transsphenoidal microsurgery as the operative treatment of choice in most patients with acromegaly 40 years ago, a few novel technical developments have evolved. Their application, utility and efficacy will be briefly discussed in this review article, based on an analysis of published results and the authors' personal experience. The endoscope was additionally used to search for residual tumours in locations which could not be visualised with the operating microscope. In many centres it has by now fully replaced the operating microscope. Extended endoscopic operations hardly have limits in respect to accessible pathology. Overall, the results and complications reported from microsurgical and endoscopic series are comparable. Intraoperative magnetic resonance imaging allows depicting the completeness of a tumour resection. While in many patients additional tumour resections are performed on the basis of intraoperative imaging, the improvements in hormonal remission rates reported are less impressive. Neuronavigation uses imaging data to improve the surgeon's orientation, and it is certainly a major asset to the inexperienced. In high-caseload centres it is mainly appreciated in anatomical variants and reoperations. While the Doppler probe is a valuable and easily affordable gadget to avoid vascular arterial injury, intraoperative ultrasound imaging of tumour extension has a much poorer resolution than magnetic resonance imaging and is thus not widely implemented. The clinical value of intraoperative growth hormone measurements is controversially discussed. In summary, the application of modern technology has only led to a minor improvement of results, but it has widened the spectrum of accessible pathologies and increased the safety of the procedures for the patient. It is expected that outcomes will continue to improve as novel techniques and concepts are being developed.

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Image-guided Endoscopic Transnasal Removal of Recurrent Pituitary Adenomas

Abstract: Neuronavigation can be applied during endonasal transsphenoidal endoscopic surgery and requires a minimal amount of time. It makes reoperation easier, faster, and probably safer.

Cited by 75 publications

References 23 publications

Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery

Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery

Acesso endoscópico transnasal aos tumores selares

Novel Techniques in the Surgical Treatment of Acromegaly: Applications and Efficacy

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