Transnasal Transsphenoidal Hypophysectomy: Choice of Approach for the Otolaryngologist

Dew, Leigh Anne; Haller, Jeffrey R.; Major, Scott B.

doi:10.1016/s0194-5998(99)70321-9

Cited by 27 publications

(29 citation statements)

References 12 publications

(34 reference statements)

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“…2,9,18 Since these initial reports, there have been several more case series describing the successful application of the endoscope to the resection of pituitary tumors. 1,7,13,[19][20][21][22]26,27,[30][31][32] The endoscope has several potential advantages compared with traditional techniques. 8,16 Endoscopy provides additional lighting and a superior field of vision.…”

Section: H Alsteadmentioning

confidence: 99%

Comparison of endoscopic and microscopic removal of pituitary adenomas: single-surgeon experience and the learning curve

O’Malley

Grady²,

Gabel³

et al. 2008

FOC

172

116

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Object The endoscopic endonasal approach for resection of pituitary lesions is an effective surgical option for tumors of the sella turcica. In this study the authors compared outcomes after either purely endoscopic resection or traditional microscope-aided resection. They also attempted to determine the learning curve associated with a surgical team converting to endoscopic techniques. Methods Retrospective data were collected on patients who were surgically treated for a pituitary lesion at the Hospital of the University of Pennsylvania between July 2003 and May 2008. Age, sex, race, presenting symptoms, length of hospital stay, surgical approach, duration of surgery, tumor pathological features, gross-total resection (GTR) of tumor, recurrence of the lesion, and intraoperative and postoperative complications were noted. All procedures were performed by the same senior neurosurgeon, who was initially unfamiliar with the endoscopic endonasal approach. Results A total of 25 patients underwent microscopic resection and 25 patients underwent endoscopic resection performed by a single skull base team consisting of the same senior neurosurgeon and otorhinolaryngologist (M.S.G. and B.W.O.). In the microscopically treated cohort, there were 8 intra- or postoperative complications, 6 intraoperative CSF leaks, 17 (77%) of 22 patients had GTR on postoperative imaging, 5 patients underwent ≥ 2 operations, and 10 (59%) of 17 patients reported total symptom resolution at follow-up. The endoscopically treated group had 7 intraor postoperative complications and 7 intraoperative CSF leaks. Of the patients who had pre- and postoperative imaging studies, 14 (66%) of 21 endoscopically treated patients had GTR; 4 patients had ≥ 2 operations, and 10 (66%) of 15 patients reported complete symptom resolution at follow-up. The first 9 patients who were treated endoscopically had a mean surgical time of 3.42 hours and a mean hospital stay of 4.67 days. The next 8 patients treated had a mean surgical time of 3.11 hours and a mean hospital stay of 3.13 days. The final 8 patients treated endoscopically had a mean surgical time of 2.22 hours and a mean hospital stay of 3.88 days. The difference in length of operation between the first 9 and the last 8 patients treated endoscopically was significantly different. There was a trend toward decreased CSF leaks and other complications from the first 2 groups compared with the third group. Conclusions In this subset of patients, the use of endoscopic endonasal resection results in a similar complication and symptom resolution rate compared with traditional techniques. The authors postulate that the learning curve for endoscopic resection can be ≤ 17 procedures.

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Section: H Alsteadmentioning

confidence: 99%

Comparison of endoscopic and microscopic removal of pituitary adenomas: single-surgeon experience and the learning curve

O’Malley

Grady²,

Gabel³

et al. 2008

FOC

172

116

View full text Add to dashboard Cite

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“…Whereas a shortcoming of endoscopic endonasal pituitary surgery is the loss of binocular vision, microscopic techniques typically result in more sinonasal dissection and potentially more sinonasal morbidity postoperatively. Notwithstanding short-term data suggest that outcomes and complication rates of MIPS compare well to traditional transnasal transsphenoidal approaches, with reduced need for packing, 4 shorter operative times, [5][6][7] decreased blood loss, 8 improved differentiation between normal tissue and tumor, 9 better visualization of intrasellar and parasellar structures, and shorter hospital stays. 1,4,10 While these factors have been thought to translate into improved patient satisfaction and comfort, few studies have examined patient perceptions before and after MIPS.…”

mentioning

confidence: 98%

Sinonasal quality‐of‐life before and after endoscopic, endonasal, minimally invasive pituitary surgery

Suberman

Zanation

Ewend

et al. 2011

Int Forum Allergy Rhinol

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“…More recently, modifications of the transsphenoidal approach that allow additional exposure of the suprasellar, parasellar, and retroclival spaces have been used for various cranial base lesions (14,15,17). In contrast to traditional cranial base surgical approaches, the endonasal technique offers a direct and minimally invasive approach that allows excellent midline access to and visibility of the suprasellar, retrosellar, and retroclival spaces, while obviating brain retraction (12,15,16).…”

Section: Resultsmentioning

confidence: 99%

“…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).…”

Section: Discussionmentioning

confidence: 99%

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

Chowdhury

Haque²,

Kawsar³

et al. 2011

Turkish Neurosurgery

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AIm: Endonasal transsphenoidal approaches are getting rapidly popular in removing many midline skullbase lesions from crista galli to foramen magnum. For safe removal of these lesions, familiarity with endoscopic endonasal anatomy of circle of Willis is very important. Furthermore, for safe development of this approach in vascular neurosurgery in the near future, endoscopic endonasal exposure of circle of Willis is a fundamental step. The goals in this study were to dissect the circle of Willis completely through the endoscopic endonasal approach and to become more familiar with the views and skills associated with the technique by using fresh cadaveric specimens. mAterIAl and methOds: After obtaining ethical clearance, 26 fresh cadaver heads were used without any preparation. Using a neuroendoscope, complete exposure of the circle of Willis was done endonasaly, and various observations including relation of circle of Willis was recorded.results: Complete exposure of the circle of Willis was made through an endonasal approach in all cases without injuring surrounding structures.COnClusIOn: Endoscopic endonasal extended transsphenoidal exposure of CW can make the surgeon more efficient in removing midline skullbase lesions with safe handling of different parts of circle of Willis and it may help in development of endonasal endoscopic vascular neurosurgery in the near future. KeywOrds: Endoscpic endonasal transsphenoidal, Circle of Willis, Exposure ÖZAmAÇ: Kafa kaidesinde, krista gali ile foramen magnum arasına yerleşmiş orta hat lezyonlarının çıkarılması için endonazal transsfenoidal yaklaşım giderek artan bir popülarite kazanmaktadır. Güvenli bir yaklaşım için bu bölgede Willis poligonunun anatomisinin iyi bilinmesi gereklidir. Bunun yanında bu bölgede endonasal transsfenoidal yaklaşım ile yapılacak Vasküler girişimlerde Willis poligonunun anatomisinin bilinmesi temel bir adım olacaktır. Taze kadavralarda yapılan bu çalışma ile; endonasal transsfenoidal yaklaşımla bu bölge anatomisinin daha iyi anlaşılması ve daha iyi bir teknik geliştirilmesine yardımcı olacaktır. yÖntem ve GereÇ: Etik inceleme izni sonrası, taze kadavradan elde olunan 26 kafa herhangi bir işleme tabi tutulmadan incelemeye alındı. Nöroendoskop kullanılarak, transnasal olarak Willis poligonuna ekspozür sağlandı ve Willis poligonunun değişik ilişkileri ortaya kondu.BulGulAr: Tüm vakalarda çevre dokulara zarar vermeden endonazal yaklaşımla Willis poligonu tam olarak ortaya çıkarıldı.sOnuÇ: Genişletilmiş endoskopik endonazal yol ile Willis poligonuna ulaşılması ile hem kafa kaidesi orta hat lezyonları daha güvenli olarak çıkarılabilecek, hem de ilerisi için endonasal vasküler yaklaşımlar için gelişim sağlanacaktır.

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Transnasal Transsphenoidal Hypophysectomy: Choice of Approach for the Otolaryngologist

Cited by 27 publications

References 12 publications

Comparison of endoscopic and microscopic removal of pituitary adenomas: single-surgeon experience and the learning curve

Comparison of endoscopic and microscopic removal of pituitary adenomas: single-surgeon experience and the learning curve

Sinonasal quality‐of‐life before and after endoscopic, endonasal, minimally invasive pituitary surgery

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

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