Instruments for Endoscopic Endonasal Transsphenoidal Surgery

Cappabianca, Paolo; Alfieri, Andreina; Thermes, S; Buonamassa, Simona; E, De Divitiis

doi:10.1097/00006123-199908000-00041

Cited by 139 publications

(61 citation statements)

References 8 publications

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“…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.…”

Section: Surgical Proceduresmentioning

confidence: 99%

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

Wagenmakers¹,

Netea‐Maier²,

Lindert

et al. 2009

Clinical Endocrinology

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SummaryBackground No data on results of repeated transsphenoidal surgery via the endoscopic technique for patients with persistent or recurrent Cushing's disease are available. Design and patients We retrospectively evaluated the remission rates and complications of repeated transsphenoidal surgery via the endoscopic technique in 14 patients with persistent ( N = 6) or recurrent ( N = 8) Cushing's disease treated in our centre between 1999 and 2007. Main outcomes Remission was defined as the disappearance of symptoms of hypercortisolism with basal plasma cortisol level ≤ 50 nmol/l 24-48 h after glucocorticoid withdrawal and/or suppression of plasma cortisol level ≤ 50 nmol/l after 1 mg dexamethasone overnight within the first 3 months after transsphenoidal surgery. Results With repeated endoscopic transsphenoidal surgery a remission rate of 10/14 (71%) was achieved. No patient had a relapse during a median follow-up of 24 months. Cerebrospinal fluid leakage was the most frequent complication (6 patients) and 11 patients required hormonal substitution after surgery. The success of repeated transsphenoidal surgery could not be predicted by visualization of an adenoma on MRI before first or second surgery, histopathological confirmation of an ACTH secreting adenoma after first or second surgery, treatment with cortisol lowering agents before first or second surgery, the operation technique used during the first surgery, persistent vs. recurrent disease after the first surgery, age, gender and interval between the two surgeries. Conclusion Repeated transsphenoidal surgery via the endoscopic technique is a good treatment option for selected patients with recurrent or persistent Cushing's disease following primary pituitary surgery.

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“…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.…”

Section: Surgical Proceduresmentioning

confidence: 99%

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

Wagenmakers¹,

Netea‐Maier²,

Lindert

et al. 2009

Clinical Endocrinology

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“…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). Some concerns have been raised regarding the lack of stereoscopic view with the endoscope and the lack of maneuverability as surgeons can only manipulate tools with one hand unless a holder is used, which in turn may crowd the operative field (19,27,28). These disadvantages can, however, be reduced by using more refined instrumentation (19,27).…”

Section: Introductionmentioning

confidence: 99%

“…Some concerns have been raised regarding the lack of stereoscopic view with the endoscope and the lack of maneuverability as surgeons can only manipulate tools with one hand unless a holder is used, which in turn may crowd the operative field (19,27,28). These disadvantages can, however, be reduced by using more refined instrumentation (19,27). Initial reports showed a decrease in postoperative discomfort and hospitalization time as well as a quick recovery in patients operated by the endoscopic technique in comparison with the conventional microscopic technique (25, 29 -31).…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Netea‐Maier

Lindert²,

Heijer³

et al. 2006

eur j endocrinol

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Objective and design: The endoscopic technique has been recently introduced in the field of transsphenoidal pituitary surgery. This technique allows inspection of sellar, supra-and parasellar structures and removal of the tumor under direct visualization, is minimally traumatic and permits easier reoperations. This is the first report on the results of endoscopic surgery for patients with Cushing's disease. Our aim was to retrospectively analyze the results of pituitary surgery in 35 consecutive patients with Cushing's disease operated in our hospital after the introduction of the endoscopic technique (1998 -2004). Methods: Remission was defined as suppression of plasma cortisol (# 50 nmol/L) after 1 mg dexamethasone overnight determined in the first 3 months after surgery and disappearance of clinical signs and symptoms of hypercortisolism. The patients were followed for an average of 27 months (range 4 to 81 months, median 20 months). Results: Pituitary MRI showed a macroadenoma in 6 patients, a microadenoma in 17 patients and no adenoma in 12 patients. After the initial surgery 27 patients (77%) were in remission. None of the patients had a relapse during follow-up. In the remaining 8 patients hypercortisolemia persisted after surgery. Three of them had a second endoscopic pituitary surgery resulting in remission in two patients. In one patient a second endoscopic pituitary surgery will soon follow. The remaining four patients were treated with radiotherapy postoperatively. Two of them were at the time of data collection in remission. One patient from the remission group had a serious epistaxis and three patients had cerebrospinal fluid leakage, one requiring an external lumbar drain, shortly after surgery. No complications were recorded in the failure group. Postoperatively 34% of all patients required substitution with levothyroxine, 40% required substitution with glucocorticoids, 17% received estrogens or testosterone and 6% still required desmopressin. Conclusions: Endoscopic transsphenoidal pituitary surgery resulted in our series of patients with Cushings disease in an excellent postoperative remission rate. A randomized clinical trial, comparing endoscopic and conventional pituitary surgery in patients with Cushings disease, is needed to determine the pros and cons of both techniques.European Journal of Endocrinology 154 675-684

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“…Previously intraoperative fluoroscopy has been used to monitor the transsphenoidal approach, but this technique can only provide sagittal guidance. Recent discussion of the transsphenoidal approach has described minimally invasive techniques such as endoscopy, 3) and computer-assisted image guidance may be another technique enabling less-invasive procedures. The computer-assisted neurosurgical (CANS) navigation system can provide both axial and coronal images, and thus obtain three-dimensional information for localization and surgical trajectory.…”

Section: Introductionmentioning

confidence: 99%

Computer-Assisted Neurosurgical Navigational System for Transsphenoidal Surgery. Technical Note.

Onizuka

Tokunaga

Shibayama

et al. 2001

Neurol. Med. Chir.(Tokyo)

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Transsphenoidal surgery carries the risk of carotid artery injury even for very experienced neurosurgeons. The computer-assisted neurosurgical (CANS) navigational system was used to obtain more precise guidance, based on the axial and coronal images during the transsphenoidal approach for nine pituitary adenomas. The CANS navigator consists of a three-dimensional digitizer, a computer, and a graphic unit, which utilizes electromagnetic coupling technology to detect the spatial position of a suction tube attached to a magnetic sensor. Preoperatively, the magnetic resonance images are transferred and stored in the computer and the tip of the suction tube is shown on a real-time basis superimposed on the preoperative images. The CANS navigation system correctly displayed the surgical orientation and provided localization in all nine patients. No intraoperative complications were associated with the use of this system. However, outflow of cerebrospinal fluid during tumor removal may affect the accuracy, so the position of the probe when the tumor is removed must be accurately determined. The CANS navigator enables precise localization of the suction tube during the transsphenoidal approach and allows safer and less-invasive surgery.

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Instruments for Endoscopic Endonasal Transsphenoidal Surgery

Cited by 139 publications

References 8 publications

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

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

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

Computer-Assisted Neurosurgical Navigational System for Transsphenoidal Surgery. Technical Note.

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