scholarly journals Endonasal Endoscopic Pituitary Adenoma Resection in light of the COVID-19 Pandemic: A Technical Report

2020 ◽  
Author(s):  
Danilo Talacimon Barbosa ◽  
Dan Zimelewicz Oberman ◽  
Alick Durão Moreira ◽  
Luisa Borges ◽  
Felipe Gonçalves ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Low Cost ◽  
Technical Note ◽  
Surgical Instruments ◽  
Direct Access ◽  
Subtotal Resection ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal ◽  
Severe Visual Loss ◽  
Technical Report

Abstract Introduction The endoscopic endonasal transsphenoidal approach (EETA) is routinely used to treat sellar and suprasellar tumors. It provides safe and direct access to tumors in these locations, with wide visualization of anatomical landmarks and great surgical results. With the COVID-19 pandemic, despite the high risk of transmission involved, various surgical procedures cannot be postponed due to their emergency. Case Report A 62-year-old female presented in the previous two months with headaches, followed by bilateral severe visual loss. In 2016, she was submitted to subtotal resection of a non-secretory macroadenoma. Because of the progressive visual deficits, the EETA was used to the resect the pituitary adenoma. Technical Note We developed a low-cost adaptation to the surgical fields, covering the patient's head and superior trunk with a regular surgical microscope bag with a tiny slit to enable the endoscope and surgical instruments to enter the nose, thus protecting the personnel in the operating room from the aerosolization of particles. This makes surgery safer for the surgical team and for the patient. Conclusion In view of the lack of literature on this subject, except for some reports of experiences from some services around the world, we describe the way we have adjusted the EETA in the context of the COVID-19 pandemic.

Anatomical study of the pterygopalatine fossa using an endoscopic endonasal approach: spatial relations and distances between surgical landmarks

2007 ◽  
Vol 106 (1) ◽  
pp. 157-163 ◽  
Author(s):  
Domenico Solari ◽  
Francesco Magro ◽  
Paolo Cappabianca ◽  
Luigi M. Cavallo ◽  
Amir Samii ◽  
...  
Keyword(s):  
Skull Base ◽  
Anatomical Study ◽  
Spatial Relations ◽  
Pterygopalatine Fossa ◽  
Direct Access ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Invasive Approach

Object The pterygopalatine fossa is an area that lies deep within the skull base. The recent extensive use of the endoscopic endonasal approach has provided neurosurgeons with a method to reach various areas of the skull base through a less invasive approach than traditional transcranial or transfacial approaches. This study aims to provide neurosurgeons with new data concerning direct endoscopic measurements and precise anatomical topography features of the pterygopalatine fossa. Methods An anatomical dissection of six fixed cadaver heads (12 pterygopalatine fossae) was performed to analyze spatial relationships and distances between the most important neurovascular structures in this region, and to estimate the size of the endoscopic surgical field for operations in this area. The endoscopic endonasal approach offers direct access to the pterygopalatine fossa through its anteromedial walls. Conclusions Using an endoscopic endonasal approach makes it possible to identify all of the anatomical landmarks of the pterygopalatine fossa and almost all of the contiguous skull base areas.

scholarly journals REMOVING A RETROSELLAR PITUITARY ADENOMA VIA THE ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL TRANSCAVERNOUS APPROACH

2019 ◽  
Vol 21 (2) ◽  
pp. 39-44
Author(s):  
О. I. Sharipov ◽  
M. A. Kutin ◽  
P. L. Kalinin
Keyword(s):  
Pituitary Adenoma ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Sella Turcica ◽  
Posterior Cranial Fossa ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal ◽  
Cranial Fossa

The study objective is to describe the removal of the pituitary adenoma from the posterior cranial fossa through endoscopic transsphenoidal trans-cavernous approach, when the main surgical corridor was the tumor-intact cavernous sinus. Materials and methods. A 55-year-old male patient with endosupraretrosellar endocrine-inactive pituitary adenoma was admitted to N.N. Burdenko Research Center of Neurosurgery. The patient had earlier undergone two surgeries for pituitary adenoma. Using the endoscopic endonasal transsphenoidal approach, we found that these surgeries resulted in the formation of scar-altered adipose tissue in the sphenoid sinus and partly in the sella turcica; anatomical landmarks indicating the midline and the location of the internal carotid arteries were absent. We formed an access to both retro- and suprasellar portions of the tumor between the sella turcica and cavernous segment of the internal carotid artery (through the cavernous sinus); then we dissected anterior and posterior walls of the sinus and revealed a soft capsule-free pituitary adenoma, which was completely removed by a vacuum aspirator. The skull base defect was repaired using the multilayer technique with autologous tissues. Results. After surgery, neurological status and visual functions did not change. In the postoperative period, we observed no oculomotor disorders, pituitary insufficiency, diabetes insipidus, or nasal liquorrhea. Follow-up computed tomography scans revealed no signs of intracranial complications or obvious residual tumor tissue. Magnetic resonance imaging 4 month postoperatively demonstrated small laterosellar fragments of the tumor in the sella turcica. The patient was further followed up. Conclusion. Cavernous sinus is a natural anatomical corridor providing access to the structures of the posterior cranial fossa and interpeduncular cistern. The main risk (damage to the cavernous segment of the internal carotid artery) can be minimized by using intraoperative dopplerography and visual control of all manipulations.

scholarly journals Comparing Mononostril, Binostril, and One and a Half Nostril Endoscopic Transsphenoidal Approach for Treating Pituitary AdenomaPituitary Adenoma

2021 ◽  
Vol 7 (1) ◽  
pp. 15-22
Author(s):  
Shahrokh Yousefzadeh-Chabok ◽  
◽  
Guive Sharifi ◽  
Mohammad Ghorbani ◽  
Mohammad Samadian ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Tumors ◽  
Surgical Instruments ◽  
Transsphenoidal Approach ◽  
Endoscopic Endonasal ◽  
Minimal Invasiveness ◽  
Transcranial Approach ◽  
Surgical Field ◽  
Surgical Corridor ◽  
Suprasellar Extension

Background and Aim: EETA (Endoscopic Endonasal Transsphenoidal Approach) is a preferred choice for pituitary tumors. EETA offers minimal invasiveness, fewer complications, and better outcomes than the sublabial or transseptal microscopic approach. EETA has three approaches: mononostril endoscopic transsphenoidal approach, binostril endoscopic transsphenoidal approach, and one and a half nostril approach. This study aims to compare three different EETAs and compare between microscopic transsphenoidal approach, transcranial approach and EETA. Methods and Materials/Patients: To provide up-to-date information, we concisely reviewed these three EETAs. Using the keywords of “neuroendoscopy”, “META” (Mononostril Endoscopic Transsphenoidal Approach), “OETA” (One and a half nostril Approach), “BETA” (Binostril Endoscopic Transsphenoidal Approach), “pituitary adenoma”, “EETA”, “endoscopy”, “transsphenoidal approach”, “transcranial approach for pituitary adenoma” and “microscopic transsphenoidal approach”. We retrieved all the relevant articles from Google Scholar, PubMed, and Medline. Then, we reviewed them and critically analyzed them. Results: In BETA there is free and easy movement of surgical instruments in the surgical field and a broader view of the sphenoid sinus and it is an excellent approach to resect large tumors. The META is suitable in tumors with limited involvement of the intra-sellar and supra-sellar area. The mononostril approach is not suitable and has some limitations for the following situations: a crowded narrow nasal cavity, a harder tumor with the invasive appearance or significant suprasellar extension, and lesions other than pituitary adenomas. The OETA provides a sufficient surgical corridor for a 2-surgeon/4 or 3-hands technique with a minimal injury of the nose and good operative results, free and easy movement of surgical instruments in the surgical field, low post-operative morbidity, and good post-operative quality of life. Conclusion: In EETA, knowing the size and consistency of tumor, general versus invasive pituitary adenoma, and the extent of parasellar and suprasellar extension, is essential. If we cannot reach a pituitary macroadenoma with a trans-sphenoidal approach, then we can use a transcranial approach for the removal of the tumor. The microscopic transsphenoidal approach is suitable for pediatric pituitary adenoma

Endoscopic Endonasal Pituitary Adenoma Resection with Intraoperative 3.0 T MRI Scanning

Skull Base ◽  
2009 ◽  
Vol 19 (01) ◽  
Author(s):  
David Netuka ◽  
Vaclav Masopust ◽  
Tomas Belsan ◽  
Vladimir Beneš
Keyword(s):  
Pituitary Adenoma ◽  
Endoscopic Endonasal ◽  
3.0 T ◽  
3.0 T Mri

Early Experience of Endoscopic Endonasal Transphenoidal Surgery for Pituitary Adenoma: Preliminary Report of 56 Cases Operated in a West African Institution

2021 ◽  
Vol 149 ◽  
pp. e329-e335
Author(s):  
Meleine Landry Konan ◽  
Aderehime Haidara ◽  
Wilfried M. Meuga ◽  
Grace Djondé ◽  
Sidoine M. Gbazi ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Preliminary Report ◽  
Early Experience ◽  
West African ◽  
Endoscopic Endonasal ◽  
African Institution

Anterior Communicating Artery Aneurysm Clipped Via an Endoscopic Endonasal Approach: Technical Note

2011 ◽  
Vol 68 (suppl_2) ◽  
pp. ons310-ons316 ◽  
Author(s):  
Sebastien Froelich ◽  
Helene Cebula ◽  
Christian Debry ◽  
Patrick Boyer
Keyword(s):  
Artery Aneurysm ◽  
Technical Note ◽  
Endoscopic Biopsy ◽  
Anterior Communicating Artery ◽  
Endonasal Approach ◽  
Best Interest ◽  
Endoscopic Endonasal ◽  
Endoscopic Techniques ◽  
First Case ◽  
On The Road

Abstract Background: The anterior communicating artery (AcoA) aneurysm is one of the most challenging aneurysms. As endovascular techniques evolve, a remaining challenge is the reduction of complications related to the surgical approach. Although the endonasal approach is widely used for pituitary adenomas and is increasingly popular for suprasellar tumors, only 2 aneurysm cases have been reported. Objective: To the best of our knowledge, we are reporting the first case of successful endoscopic endonasal clipping of an unruptured ACoA aneurysm. Methods: An ACoA aneurysm was discovered in a 55-year-old man before he was to undergo an endoscopic biopsy of an orbital lesion. Because of the operative corridor formed during this first operation and ideal conformation of the aneurysm for this line of sight, we formulated an endoscopic route for this ACoA aneurysm. Results: An endoscopic endonasal transplanum-transtuberculum approach was performed. Proximal and distal control was obtained, and the AcoA aneurysm was successfully clipped. The postoperative course was uneventful with a rapid recovery. Conclusion: On the road of innovation in the treatment of intracranial aneurysms, the endoscopic approach provided another option whose value must be weighed in terms not only of feasibility but in the patient’s best interest. We caution extreme prudence if considering this procedure as an alternative to well-established techniques. Yet its upward route offers limited retraction for deep-seated lesions. Rapid progress of endoscopic techniques may prove promising for well-selected cases of ACoA aneurysms.

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