Results of 1700 Endoscopic Endonasal Transsphenoidal Adenomectomy

Kalinin, Pavel; Fomichev, Dmitry; Kutin, Maxim; Кадашев, Б А

doi:10.1055/s-0032-1314379

Cited by 3 publications

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“…This can very rarely be done in a standard microscopic transnasal transsphenoidal operation. 3,9,24 Endoscopic transsphenoidal surgery is defined as a procedure performed by visualization using the endoscope alone throughout the procedure. The binostril approach through both nostrils uses no nasal retractors or specula; in contrast, because of the limited space through 1 nostril, the mononostril approach is often performed with a nasal speculum as an integral part of the procedure.…”

mentioning

confidence: 99%

Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery: clinical evaluation and cadaver study

Conrad

Ayyad

Wüster³

et al. 2016

JNS

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S urgical approaches to the pituitary gland have undergone numerous refinements over the last 100 years. Successful application of the transseptal transsphenoidal approach to the pituitary gland was first described by Hermann Schloffer in 1906. This procedure became the most commonly used approach for resection of pituitary adenomas and is associated with a low rate of morbidity.29 In 1910, Hirsch described a direct endonasal approach to the sphenoid sinus and to the sella, but this technique included resection of the middle turbinate and parts of the nasal septum.19 Halstead published the sublabial gingival approach in the same year.17 In the 1960s and after introduction of the operating microscope, Hardy combined lateral fluoroscopy with microsurgical techniques. This significantly improved magnification and illumination, reduced the risk of brain injury, und increased abbreviatioNs ACTH = adrenocorticotrophic hormone; ENT = ear, nose, and throat; FSH = follicle-stimulating hormone; GH = growth hormone; IGF-1 = insulin-like growth factor-1; LH = luteinizing hormone; TSH = thyroid-stimulating hormone. obJective Over the past 2 decades, endoscopy has become an integral part of the surgical repertoire for skull base procedures. The present clinical evaluation and cadaver study compare binostril and mononostril endoscopic transnasal approaches and the surgical techniques involved. methods Forty patients with pituitary adenomas were treated with either binostril or mononostril endoscopic surgery. Neurosurgical, endocrinological, ophthalmological, and neuroradiological examinations were performed. Ten cadaver specimens were prepared, and surgical aspects of the preparation and neuroradiological examination were documented. results In the clinical evaluation, 0° optics were optimal in the nasal and sphenoidal phase of surgery for both techniques. For detection of tumor remnants, 30° optics were superior. The binostril approach was significantly more time consuming than the mononostril technique. The nasal retractor limited maneuverability of instruments during mononostril approaches in 5 of 20 patients. Endocrinological pituitary function, control of excessive hormone secretion, ophthalmological outcome, residual tumor, and rates of adverse events, such as CSF leaks and diabetes insipidus, were similar in both groups. In the cadaver study, there was no significant difference in the time required for dissection via the binostril or mononostril technique. The panoramic view was superior in the binostril group; this was due to the possibility of wider opening of the sella in the craniocaudal and horizontal directions, but the need for removal of more of the nasal septum was disadvantageous. coNclusioNs Because of maneuverability of instruments and a wider view in the sphenoid sinus, the binostril technique is superior for resection of large tumors with parasellar and suprasellar expansion and tumors requiring extended approaches. The mononostril technique is preferable for tumors with limited extension in the intra- and...

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mentioning

confidence: 99%

Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery: clinical evaluation and cadaver study

Conrad

Ayyad

Wüster³

et al. 2016

JNS

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“…Помимо определения точного размера, структуры и расположения опухоли, при МРТ имеется возможность определить соотношение опухоли с основными магистральными сосудами, зрительными нервами, веществом больших полушарий головного мозга. При контрастном усилении аденома гипофиза относительно быстро и интенсивно накапливает контрастное вещество, что позволяет четко отграничивать ткань опухоли от мозговых структур [1][2][3][4][5][6][7][8][9] (рис. 1).…”

Section: стандартunclassified

“…Аденомы гипофиза занимают третье место среди всех опухолей ЦНС и, по данным разных авторов, составляют от 7 до 18% всех внутричерепных новообразований [1][2][3][4][5][6][7][8][9]. Чаще всего они проявляются в наиболее работоспособном возрасте от 20 до 50 лет, одинаково часто у мужчин и женщин.…”

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“…Согласно статистическим данным, ежегодно в России выявляется около 3 тыс. вновь заболевших [1,4,10].…”

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“…Хирургическое лечение пациентов с аденомами гипофиза является серьезной проблемой современной нейрохирургии как из-за значительного количества больных, так и по причине вовлечения в патологический процесс важнейших анатомических структур, что обусловливает сложность радикальной резекции опухоли при минимальном количестве осложнений [1,3,4,6,10,11].…”

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Surgical treatment for pituitary adenomas

Kalinin¹,

Кадашев²,

Fomichev³

et al. 2017

Vopr. neirokhir.

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АКТГ-аденокортикотропный гормон ВСА-внутренняя сонная артерия ЛГ-лютеинизирующий гормон МРТ-магнитно-резонансная томография ПРЛ-пролактин СТГ-соматотропный гормон ТМО-твердая мозговая оболочка ТТГ-тиреотропный гормон ФСГ-фолликулостимулирующий гормон ЦНС-центральная нервная система УЗИ-ультразвуковое исследование ЭКГ-электрокардиография

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High-Definition Imaging in Endoscopic Transsphenoidal Pituitary Surgery

Conrad

Philipps

Oertel

2011

Am J Rhinol�Allergy

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HD imaging in endoscopic transsphenoidal pituitary surgery accounts for significantly better identification of anatomic structures in comparison with SD images. Additionally, the subjective impression of video quality is significantly better in HD. This improved intraoperative orientation by better digital image quality might contribute to reduce the gap in intraoperative visual accuracy between microsurgery and endoscopy in pituitary surgery.

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Results of 1700 Endoscopic Endonasal Transsphenoidal Adenomectomy

Cited by 3 publications

References 0 publications

Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery: clinical evaluation and cadaver study

Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery: clinical evaluation and cadaver study

Surgical treatment for pituitary adenomas

High-Definition Imaging in Endoscopic Transsphenoidal Pituitary Surgery

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