Surgical management of selected pituitary macroadenomas using extended endoscopic endonasal transsphenoidal approach: Early experience

Sankhla, Suresh; Jayashankar, Narayan; Khan, Ghulam M

doi:10.4103/0028-3886.111114

Cited by 19 publications

(9 citation statements)

References 45 publications

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“…The primary steps of the extended endoscopic endonasal technique that we used in these cases have been described in detail in other publications. [ 28 30 33 36 37 ] The bone of the sellar floor, TS, and planum sphenoidale (PS) is first thinned down with a high-speed diamond drill and is then removed carefully using Kerrison rongeur [ Figure 2 ]. The optic canals mark the lateral limits, whereas the posterior ethmoidal arteries mark the anterior limit of the bony resection.…”

Section: Methodsmentioning

confidence: 99%

Extended endoscopic endonasal transsphenoidal approach for retrochiasmatic craniopharyngioma: Surgical technique and results

2015

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Objective:Surgical treatment of retrochiasmatic craniopharyngioma still remains a challenge. While complete removal of the tumor with preservation of the vital neurovascular structures is often the goal of the treatment, there is no optimal surgical approach available to achieve this goal. Transcranial and transsphenoidal microsurgical approaches, commonly used in the past, have considerable technical limitations. The extended endonasal endoscopic surgical route, obtained by removal of tuberculum sellae and planum sphenoidale, offers direct midline access to the retrochiasmatic space and provides excellent visualization of the undersurface of the optic chiasm. In this report, we describe the technical details of the extended endoscopic approach, and review our results using this approach in the surgical management of retrochiasmatic craniopharyngiomas.Methods:Fifteen children, including 9 girls and 6 boys, aged 8 to 15 years underwent surgery using extended endoscopic transsphenoidal approach between 2008 and 2014. Nine patients had a surgical procedure done previously and presented with recurrence of symptoms and regrowth of their residual tumors.Results:A gross total or near total excision was achieved in 10 (66.7%) patients, subtotal resection in 4 (26.7%), and partial removal in 1 (6.7%) patient. Postoperatively, headache improved in 93.3%, vision recovered in 77.3%, and the hormonal levels stabilised in 66.6%. Three patients (20%) developed postoperative CSF leaks which were managed conservatively. Three (20%) patients with diabetes insipidus and 2 (13.3%) with panhypopituitarism required long-term hormonal replacement therapy.Conclusions:Our early experience suggests that the extended endonasal endoscopic approach is a reasonable option for removal of the retrochiasmal craniopharyngiomas. Compared to other surgical approaches, it provides better opportunities for greater tumor removal and visual improvement without any increase in risks.

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Section: Methodsmentioning

confidence: 99%

Extended endoscopic endonasal transsphenoidal approach for retrochiasmatic craniopharyngioma: Surgical technique and results

2015

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“…Various endoscopic techniques are being used with their advantages in different spinal [11] , skull base [12][13][14][15] , and cranial pathologies. [16,17] Different methods like laminectomy, laminoplasty, arcocristectomy (involving multiple partial superior laminectomies), etc.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic decompression of cervical spondylotic myelopathy using posterior approach

et al. 2014

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“…[34,38,40,41,44,47] The bone of the sellar floor, tuberculum sellae, and planum sphenoidale (PD) is first thinned down with a high-speed diamond drill and is then removed carefully using a Kerrison's rongeur [ Figure 4a-b]. The optic canals mark the lateral limits, whereas the posterior ethmoidal arteries mark the anterior limit of the bony resection.…”

Section: Transplanum Transtuberculum Exposurementioning

confidence: 99%

“…We perform a multi-layered reconstruction to achieve a water-tight closure [47] [ Figure 7a-d]. As the first step, we prefer to place autologous fat in the sellar cavity to cover the arachnoid defect [ Figure 7a].…”

Section: Closurementioning

confidence: 99%

Endoscopic endonasal transplanum transtuberculum approach for retrochiasmatic craniopharyngiomas: Operative nuances

2015

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The surgical treatment of craniopharyngiomas is challenging. An optimal surgical approach is extremely important to achieve complete removal of the tumor, which is often the goal of treatment. Conventionally, the endoscopic transsphenoidal approach is used for resection of craniopharyngiomas that are essentially confined to the sellar cavity, or have smaller suprasellar extension. However, the tumors located in the retrochiasmatic space are difficult to remove surgically due to a poor access. Traditionally, various transcranial microsurgical routes have been employed with limited success for resection of retrochiasmatic craniopharyngiomas. The transcranial approaches generally do not provide adequate exposure of the tumors originating in the space under the optic chiasm and nerves. Recently, the extended endonasal endoscopic surgical route, obtained by removal of the tuberculum sellae and planum sphenoidale, has been used with great success in the surgical management of tumors lying ventral to the optic chiasm, including craniopharyngiomas. It offers a direct midline access to the retrochiasmatic space and provides excellent visualization of the undersurface of the optic chiasm. It also allows extracapsular dissection using binostril-bimanual technique and facilitates complete removal of these formidable tumors. In this report, we describe step-by-step, the technical details of the endonasal endoscopic transplanum transtuberculum approach with emphasis on the operative nuances for removal of retrochiasmatic craniopharyngiomas.

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Surgical management of selected pituitary macroadenomas using extended endoscopic endonasal transsphenoidal approach: Early experience

Abstract: Our early experience suggests that the EEEA offers a potentially viable treatment option in certain pituitary tumors which are difficult to remove by the standard endoscopic approaches. However, longer follow-up and larger series are needed to establish the efficacy of this approach.

Cited by 19 publications

References 45 publications

Extended endoscopic endonasal transsphenoidal approach for retrochiasmatic craniopharyngioma: Surgical technique and results

Extended endoscopic endonasal transsphenoidal approach for retrochiasmatic craniopharyngioma: Surgical technique and results

Endoscopic decompression of cervical spondylotic myelopathy using posterior approach

Endoscopic endonasal transplanum transtuberculum approach for retrochiasmatic craniopharyngiomas: Operative nuances

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