Endoscopic Transnasal Pituitary Surgery: Report on 180 Cases

2001 ◽  
Vol 15 (4) ◽  
pp. 281-287 ◽  
Author(s):  
Shawn S. Nasseri ◽  
Jan L. Kasperbauer ◽  
Scott E. Strome ◽  
Thomas V. McCaffrey ◽  
John L. Atkinson ◽  
...  
Keyword(s):  
Operative Time ◽  
Operative Procedure ◽  
Full Range ◽  
Sella Turcica ◽  
Length Of Hospital Stay ◽  
Pituitary Surgery ◽  
Transsphenoidal Approach ◽  
Transnasal Approach ◽  
Endoscopic Transnasal Approach ◽  
Revision Operations

The endoscopic transnasal approach is an evolving technique for treating lesions in the sella turcica. Since this method was introduced at our institution 4 years ago, the majority of transsphenoidal procedures are performed with it. The records of all patients having endoscopic transnasal hypophysectomy at the Mayo Clinic during the last 4 years were reviewed retrospectively. The criteria analyzed were safety, functional and cosmetic outcome, and complications. During the 4-year period, the operative procedure was modified to improve operative exposure and safety. The results of our review showed a significant decrease in length of hospital stay, reduced operative time, reduced need for nasal packing, and elimination of a sublabial incision. The complication rate was equivalent to that reported for the traditional transseptal transsphenoidal approach. As the neurosurgeons at our institution gained experience with this approach, an increasing number of pituitary microadenomas were resected safely and successfully. In addition, because of the limited septal dissection, this approach is particularly helpful for revision operations. This approach also can be used for the full range of pituitary lesions and in conjunction with adjunctive techniques, including frontal craniotomy and -knife irradiation. Currently, the endoscopic transsphenoidal approach is the method preferred for surgically treating pituitary lesions in adults at our institution.

scholarly journals Trans-nasal Trans-sphenoidal Endoscopic Hypophysectomy

2017 ◽  
Vol 53 (04) ◽  
pp. 210-221
Author(s):  
Saurabh Varshney
Keyword(s):  
Sella Turcica ◽  
Pituitary Tumors ◽  
Pituitary Surgery ◽  
Transsphenoidal Approach ◽  
Sinus Surgery ◽  
Subtotal Resection ◽  
Transnasal Approach ◽  
Average Hospital ◽  
Invasive Approach ◽  
Female Ratio

ABSTRACTAdvances in optics, miniaturization, and endoscopic instrumentation have revolutionized surgery in the past decades. Current progress in the field of endoscopy promises to further this evolution: endoscopic telescopes and instruments have improved upon the optical and technical limitations of the microscope, and require an even less invasive approach to the sella. The minimally invasive endoscopic pituitary surgery is performed through the natural nasal pathway without any incisions and is performed via Trans-nasal Trans-sphenoidal approach. pituitary surgery is traditionally within the realm of the neurosurgeon. However, since the introduction of the endoscopic transnasal transsphenoidal approach to the sella turcica for resection of pituitary adenoma, otolaryngologists have been active partners in the surgical management of these patients. Otolaryngologists have lent their expertise in nasal and sinus surgery, assisting the neurosurgeon with the operation. The otolaryngologist has the advantage of familiarity with the techniques and instruments used to gain exposure of the sella turcica by transnasal approach. Hence, the otolaryngologist provides the exposure, and the neurosurgeon resects the tumour. Such collaboration has resulted in decreased rates of complication and morbidity.We hereby discuss our experience of treating 72 cases of pituitary tumour by endoscopic trans-nasal trans-sphenoidal approach. In our study, conducted from 2005 to 2016, the mean age of patients was 32.5 years (18-56 years), Male and female ratio was 1.3:1.0, MRI was done in all the cases, CT scan was done in 94.44 % cases, 9.72% cases had Intra op./ post op. complications which were managed successfully. Subtotal resection could be done in 6.94% cases, recurrence was seen in 7.46% cases and lumbar drain was required in 4.17 % cases. Average hospital stay was 4.4 days and average surgery time was 120 minutes. Close follow-up was maintained for an average period of 09 months. In our experience of 10 years, adopting the endoscope heightens the surgeons' visualization of pituitary tumors, thus no external incision, no nasal packing and minimal stay with minimal complications. Endoscopic transsphenoidal approach is the less traumatic route to the sella turcica, avoiding brain retraction, and also permitting good visualization, with lower rates of morbidity and mortality.

The Nasal Gateway for Pituitary Surgery

1988 ◽  
Vol 2 (4) ◽  
pp. 193-200 ◽  
Author(s):  
Mary D. Lekas
Keyword(s):  
Pituitary Gland ◽  
Sella Turcica ◽  
Pituitary Tumors ◽  
Pituitary Surgery ◽  
Transsphenoidal Approach ◽  
External Rhinoplasty

There has been an evolution in the transseptal transsphenoidal approach for pituitary surgery. The nasal approach to the pituitary gland can be from the sublabial transseptal transsphenoidal; the transseptal transsphenoidal; the alotomy transseptal transsphenoidal; the external rhinoplasty transsphenoidal; the transnasal by mobilizing the whole nose on a pedicle; the transseptal infranasal; the midline columellar incision; all types of nasofacial incisions; and transethmoidal approach with nasal instrumentation. The transsphenoidal hypophysectomy surgery has become a safe and effective approach for pituitary tumors. We are mainly concerned with the transnasal and not the transethmoidal approach to the sella turcica at this time.

A novel transnasal transsphenoidal speculum: a design for both microscopic and endoscopic transsphenoidal pituitary surgery

2011 ◽  
Vol 114 (5) ◽  
pp. 1380-1385 ◽  
Author(s):  
Richard A. Chole ◽  
Chris Lim ◽  
Brian Dunham ◽  
Michael R. Chicoine ◽  
Ralph G. Dacey
Keyword(s):  
Transsphenoidal Surgery ◽  
Sella Turcica ◽  
Pituitary Surgery ◽  
Transsphenoidal Approach ◽  
Surgical Approaches ◽  
Surgical Experience ◽  
Endoscopic Techniques ◽  
Minimally Invasive Surgical ◽  
Transsphenoidal Pituitary Surgery ◽  
Microscopic Techniques

Over the last several years minimally invasive surgical approaches to the sella turcica and parasellar regions have undergone significant change. The transsphenoidal approach to this region has evolved from a sublabial transnasal, to transnasal, to pure endonasal approaches with the increasing popularity of endoscopic over microscopic techniques. Endoscopic and microscopic techniques individually or in combination have their own unique advantages, and the preference of one over the other awaits further technological refinements and surgical experience. In parallel with this evolution in techniques for transsphenoidal surgery, the authors designed an adaptable versatile speculum for the endonasal/transnasal transsphenoidal approach to the sella turcica and parasellar regions that can be used equally effectively with a microscope or an endoscope. The development of this instrument and its unique features are described, and its initial clinical use is summarized. This transnasal transsphenoidal speculum has interchangeable blades, unique blade angulations, and independent blade opening mechanisms and allows safe, optimal exposure in all patients regardless of the size and anatomical aberrations of individual nasal and endonasal regions. An attached endoscope carrier further allows it to be used interchangeably with microscopic or endoscopic techniques without having to remove the speculum; likewise, a single surgeon can use both hands without need of an assistant. A forehead headrest component adds further stabilization. This device has been used successfully in 90 transsphenoidal procedures.

scholarly journals Laparoscopic Versusopen Appendectomy - Which One Is Better?

2019 ◽  
Vol 17 (1) ◽  
pp. 7-13
Author(s):  
Md Atiar Rahman ◽  
Md Shahadot Hossain Sheikh ◽  
Md Ibrahim Siddique ◽  
Md Shahidul Islam ◽  
AKM Ahsan Ullah ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Operative Procedure ◽  
Open Appendectomy ◽  
Length Of Hospital Stay ◽  
Laparoscopic Group ◽  
Patient Characteristics ◽  
Laparoscopic Technique ◽  
Analgesia Requirement ◽  
Initial Procedure

Objective: Appendectomy, being the most common surgical procedure performed in general surgery, is still being performed by both open and laparoscopic methods due to a lack of consensus as to which is the most appropriate method. Because further trials are necessary and few such studies have been performed in developing countries, we decided to evaluate the outcomes of the 2 procedures to share our experience with others. Methods: Prospectively collected data from 618 consecutive patients with appendicitis were studied. These comprised of 340 patients who underwent conventional open appendectomy and 260 patients treated laparoscoplcally&18 were excluded because of protocol violations. The two groups were compared with respect to operative time, length of hospital stay, postoperative pain, return to normal work, complication rate and cost. Results: There were no statistical differences regarding patient characteristics between the two groups. Conversion to laparotomy was necessary in 5 patients (1.88%). Laparoscopic appendectomy was associated with a shorter hospital stay (1.5 d vs 2.5 d), lower incidence of wound infection (3.07% vs 8.29%,) &less analgesia requirement. The operative time was more (45.6 vs 24.5 min) and the cost of treatment was higher in the laparoscopic group. Conclusion: The laparoscopic technique is a safe and clinically beneficial operative procedure. It provides certain advantages over open appendectomy, ·including short hospital stay, decreased requirement .of postoperative analgesia, early food tolerance, and earlier return to normal activities, Where feasible, laparoscopy should be undertaken as the initial procedure of choice for most cases of appendicitis. Journal of Surgical Sciences (2013) Vol. 17 (1) : 7-13

Hermann Schloffer and the origin of transsphenoidal pituitary surgery

2012 ◽  
Vol 33 (2) ◽  
pp. E5 ◽  
Author(s):  
Richard F. Schmidt ◽  
Osamah J. Choudhry ◽  
Ramya Takkellapati ◽  
Jean Anderson Eloy ◽  
William T. Couldwell ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Skull Base Surgery ◽  
Sella Turcica ◽  
Pituitary Surgery ◽  
Transsphenoidal Approach ◽  
Harvey Cushing ◽  
Transsphenoidal Pituitary Surgery ◽  
Transsphenoidal Operation ◽  
Technological Limitations ◽  
The University

A little over a century ago, in 1907, at the University of Innsbruck, Hermann Schloffer performed the first transsphenoidal surgery on a living patient harboring a pituitary adenoma. Schloffer used a superior nasal route via a transfacial lateral rhinotomy incision. This was perhaps his greatest academic contribution to neurosurgery. Despite the technological limitations of that time, Schloffer's operation was groundbreaking in that it laid the foundation for future development and refinement of transsphenoidal pituitary surgery, influencing prominent surgeons such as Oskar Hirsch and Harvey Cushing. Even after undergoing multiple modifications and a brief fall into obscurity, the transsphenoidal approach has endured through generations of surgeons and remains the preferred approach for lesions of the sella turcica to this day. Although Schloffer performed primarily abdominal surgery in his practice, his contributions to the transsphenoidal approach have had a lasting impact in the field of pituitary and skull base surgery. The authors review the life and career of Hermann Schloffer, the surgical details of his transsphenoidal operation, and the legacy that it has left on the field of pituitary surgery.

Endoscopic Image-Guided Transethmoid Pituitary Surgery

2002 ◽  
Vol 127 (5) ◽  
pp. 409-416 ◽  
Author(s):  
Roy F. Thomas ◽  
William T. Monacci ◽  
Eric A. Mair
Keyword(s):  
Tumor Resection ◽  
Sella Turcica ◽  
Surgical Techniques ◽  
Pituitary Surgery ◽  
Direct Access ◽  
Wide Field ◽  
Transnasal Approach ◽  
Advantages And Disadvantages ◽  
Image Guided ◽  
Transseptal Approach

OBJECTIVE: We describe a new endoscopic transethmoid approach for pituitary surgery and to compare it with other surgical techniques. STUDY DESIGN AND SETTING: Eleven patients undergoing pituitary surgery from September 2000 through January 2002 underwent an image-guided endoscopic transethmoid procedure to remove pituitary tumors. Ease of approach, resection, exposure of the surgical field, and operative complications were documented. RESULTS: Endoscopic ethmoidectomy permits enhanced exposure and simplified tumor resection. The use of one nostril to stabilize the endoscope and the other to pass instruments affords a bimanual procedure that avoids the difficulty of small nares and keeping the scope fixed while exchanging instruments. Operative morbidity was low with no significant complications in this pilot study. CONCLUSIONS: This approach opens a generous operative exposure while safely allowing room to endoscopically maneuver and affords direct access should revision surgery be needed. SIGNIFICANCE: This procedure uses a technique familiar to otolaryngologists and may be used for pituitary and other skull base tumors. The transseptal approach to the sella turcica is the most commonly performed procedure to reach the pituitary gland. Three major variations of the transseptal approach are used: sublabial approach, external rhinoplasty approach, and transnasal approach. Each has unique advantages and disadvantages relative to each other and the endoscopic procedure, apart from the shared transseptal route ( Table 1 ). The techniques have been described elsewhere previously. 1–3 More recently, endoscopy has been used to aid the approach to the pituitary. The first endoscopic procedures used the transseptal dissection route through a standard sublabial incision, with the endoscope passed through a self-retaining speculum. 4–6 In other cases the endoscope was used for the approach only, with the binocular operating microscope subsequently used for the tumor resection. 7 Except for the wide field of vision afforded by the endoscopic approach, the morbidity of a transseptal dissection remained. More recent advances have used an endonasal approach, which allows the surgeon to bypass the transseptal dissection. 8–11 The majority of procedures performed use one nostril to pass the endoscope and other instruments, with limited endoscopic operative maneuverability. We introduce an endonasal transethmoid approach bypassing the need for a nasal retractor, headrest, and postoperative nasal packing, while providing enhanced endoscopic operative maneuverability through bimanual instrumentation using both nares and an endoscope stabilizer.

Treatment of Enchondromas of the Hand with Bone Substitute

1997 ◽  
Vol 22 (4) ◽  
pp. 476-478 ◽  
Author(s):  
P. JACOULET ◽  
P. FAURE
Keyword(s):  
Bone Substitute ◽  
Operative Time ◽  
Operative Procedure ◽  
Full Range ◽  
Donor Site ◽  
Infectious Complications ◽  
Normal Function ◽  
X Ray ◽  
Allogenic Bone

We report five patients with enchondromas of long bones in the hand. They were successfully treated by curettage and implantation of a biodegradable bone substitute (calcium phosphate). Bone regained normal X-ray appearance by 9 months. The full range of motion and normal function of the hand were restored. There were no complications and no recurrence at follow-up visits 28 months after operation. There are several advantages to this technique. The operative procedure may be performed under local anaesthesia on an out-patient basis and the operative time is shortened. Complications of a cancellous bone donor site are avoided, as are the potential infectious complications of allogenic bone implantation.

scholarly journals Late Occurrence of Sphenoid Pyocele after Pituitary Surgery

2016 ◽  
Vol 06 (01) ◽  
pp. 044-046
Author(s):  
George Kovoor ◽  
Kamble Harsha ◽  
Akash George ◽  
Venkat Reddy
Keyword(s):  
Minimally Invasive ◽  
Female Patient ◽  
Rare Case ◽  
Sella Turcica ◽  
Pituitary Tumors ◽  
Pituitary Surgery ◽  
Effective Procedure ◽  
Morbidity And Mortality ◽  
Transsphenoidal Approach ◽  
Patient Morbidity

The transsphenoidal approach to lesions of the sella turcica, especially for pituitary tumors, has been favored by neurosurgeons because of decreased perioperative patient morbidity and mortality of this approach compared with others. It is widely accepted because of its minimally invasive and maximally effective procedure. We report a rare case of a 63-year-old female patient with the asymptomatic delayed occurrence of sphenoid pyocele, 6 years after the initial pituitary surgery, and remained asymptomatic during this long interval.

scholarly journals Endoscopic transnasal approach for removing pituitary tumors

2014 ◽  
Vol 72 (5) ◽  
pp. 378-382
Author(s):  
Mirian Cabral Moreira de Castro ◽  
Luciane Maria Pereira Michel ◽  
Mariana Moreira de Castro Denaro ◽  
Pollyana Anício Magalhaes Gontijo ◽  
Atos Alves de Sousa
Keyword(s):  
Growth Hormone ◽  
Intracerebral Hemorrhage ◽  
Health Professionals ◽  
Pituitary Tumor ◽  
Public Hospital ◽  
Cerebral Spinal Fluid ◽  
Pituitary Tumors ◽  
Transsphenoidal Approach ◽  
Transnasal Approach ◽  
Endoscopic Transnasal Approach

To describe a series of 129 consecutive patients submitted to the resection of pituitary tumors using the endoscopic transsphenoidal approach in a public medical center.Method:Retrospective analysis based on the records of patients submitted to the resection of a pituitary tumor through the endoscopic transsphenoidal approach between 2004 and 2009.Results:One hundred and twenty-nine records were analyzed. The tumor was non-secreting in 96 (74.42%) and secreting in 33 patients (22.58%). Out of the secretory tumors, the most prevalent was the growth hormone producer (7.65%), followed by the prolactinoma, (6.98%). Eleven patients developed cerebral spinal fluid (CSF) fistulas, and four of them developed meningitis. One patient died due to intracerebral hemorrhage in the postoperative period.Conclusion:The endoscopic transsphenoidal approach to sellar tumors proved to be safe when the majority of the tumors were non-secreting. The most frequent complication was CSF. This technique can be done even in a public hospital with financial limits, since the health professionals are integrated.

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