Endoscopic Endonasal Transsphenoidal Surgery

Neurosurgery ◽  
2004 ◽  
Vol 55 (4) ◽  
pp. 933-941 ◽  
Author(s):  
Paolo Cappabianca ◽  
Luigi Maria Cavallo ◽  
Enrico de Divitiis
Keyword(s):  
Surgical Technique ◽  
Nasal Septum ◽  
Transsphenoidal Surgery ◽  
Sphenoid Sinus ◽  
Surgical Instruments ◽  
Endoscopic Endonasal ◽  
Minimally Invasive Surgical ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Microsurgical Procedure ◽  
Sellar Floor

Abstract THE ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL approach is a minimally invasive surgical technique for the removal of sellar and parasellar lesions. The procedure is performed via an anterior sphenoidotomy. The two main characteristics of the endoscopic approach, when compared with the standard microsurgical operation, arise from the use of the endoscope as a unique optical device and from the absence of a transsphenoidal retractor. More convenient straight surgical instruments are employed, whereas bayonet-shaped tools are used in the microsurgical procedure, to avoid any interference with the light beam generated by the microscope. The standard surgical technique is composed of three main time phases: the nasal, sphenoid, and sellar phase. During the nasal phase, the scope is introduced through the chosen nostril and advanced up to the sphenoethmoid recess, where the sphenoidotomy is performed. The sphenoid phase consists of the detachment of the nasal septum from the sphenoid rostrum, the anterior sphenoidotomy, removal of the sphenoid septum or septa, and identification of the landmarks inside the sphenoid sinus. In the sellar phase, an opening of the sellar floor is performed for removal of the lesion. A wide view of the sellar environment is obtained through angled scopes to detect eventual tumor remnants. The procedure ends with the reconstruction of the sella and removal of the endoscope from the nostril, without any postoperative nasal packing.

Endoscopic endonasal transsphenoidal approach to large and giant pituitary adenomas: institutional experience and predictors of extent of resection

2014 ◽  
Vol 121 (1) ◽  
pp. 75-83 ◽  
Author(s):  
Kyle Juraschka ◽  
Osaama H. Khan ◽  
Bruno L. Godoy ◽  
Eric Monsalves ◽  
Alexandra Kilian ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Sphenoid Sinus ◽  
Tumor Volume ◽  
Extent Of Resection ◽  
Tumor Diameter ◽  
Endoscopic Endonasal ◽  
Posterior Extension ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Giant Pituitary Adenomas

Object While the use of endoscopic approaches has become increasingly accepted in the resection of pituitary adenomas, limited evidence exists regarding the success of this technique for patients with large and giant pituitary adenomas. This study reviews the outcomes of a large cohort of patients with large and giant pituitary adenomas who underwent endoscopic endonasal transsphenoidal surgery at the authors' institution and focuses on identifying factors that can predict extent of resection and hence aid in developing guidelines and indications for the use of endoscopic endonasal transsphenoidal surgery versus open craniotomy approaches to large and giant pituitary adenomas. Methods The authors reviewed 487 patients who underwent endoscopic endonasal transsphenoidal resection of sellar masses. From this group, 73 consecutive patients with large and giant pituitary adenomas (defined as maximum diameter ≥ 3 cm and tumor volume ≥ 10 cm3) who underwent endoscopic endonasal transsphenoidal surgery between January 1, 2006, and June 6, 2012, were included in the study. Clinical presentation, radiological studies, laboratory investigations, tumor pathology data, clinical outcomes, extent of resection measured by volumetric analysis, and complications were analyzed. Results The mean preoperative tumor diameter in this series was 4.1 cm and the volume was 18 cm3. The average resection rate was 82.9%, corresponding with a mean residual volume of 3 cm3. Gross-total resection was achieved in 16 patients (24%), near-total in 11 (17%), subtotal in 24 (36%), and partial in 15 (23%). Seventy-three percent of patients experienced improvement in visual acuity, while 24% were unchanged. Visual fields were improved in 61.8% and unchanged in 5.5%. Overall, 27 patients (37%) experienced a total of 32 complications. The most common complications were sinusitis (14%) and CSF leak (10%). Six patients underwent subsequent radiation therapy because of aggressive tumor histopathology. No deaths occurred in this cohort of patients. Statistically significant predictors of extent of resection included highest Knosp grade (p = 0.001), preoperative tumor volume (p = 0.025), preoperative maximum tumor diameter (p = 0.002), hemorrhagic component (p = 0.027), posterior extension (p = 0.001), and sphenoid sinus invasion (p = 0.005). Conclusions Endoscopic endonasal transsphenoidal surgery is an effective treatment method for patients with large and giant pituitary adenomas, which results in high (> 80%) rates of resection and improvement in visual function. It is not associated with high rates of major complications and is safe when performed by experienced surgeons. The preoperative Knosp grade, tumor volume, tumor diameter, hemorrhagic components on MRI, posterior extension, and sphenoid sinus invasion may allow a prediction of extent of resection and in these patients a staged operation may be required to maximize extent of resection.

Effect of Sphenoid Sinus Pneumatization on the Surgical Windows for Extended Endoscopic Endonasal Transsphenoidal Surgery

2020 ◽  
Vol 133 ◽  
pp. e695-e701
Author(s):  
Waleed A. Azab ◽  
Ehab A. Abdelnabi ◽  
Kamal H. Mostafa ◽  
Talal A. Burhamah ◽  
Ahmad K.H. Alhaj ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Sphenoid Sinus ◽  
Endoscopic Endonasal ◽  
Endoscopic Endonasal Transsphenoidal Surgery

scholarly journals Clinical utility of three-dimensional magnetic resonance imaging using a zero-echo-time sequence in endoscopic endonasal transsphenoidal surgery

2019 ◽  
Author(s):  
Akihiro Inoue ◽  
Shohei Kohno ◽  
Naoya Nishida ◽  
Satoshi Suehiro ◽  
Shirabe Matsumoto ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Pituitary Tumor ◽  
Transsphenoidal Surgery ◽  
Three Dimensional ◽  
Resonance Imaging ◽  
3D Mri ◽  
Endoscopic Endonasal ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Echo Time ◽  
Sellar Floor

Abstract Background: Recognizing the anatomical orientation surrounding the sellar floor is crucial in endoscopic endonasal transsphenoidal surgery (ETSS). Zero-echo-time (ZTE) sequences were recently suggested for a new bone identification technique on magnetic resonance imaging (MRI). This study aimed to evaluate the clinical usefulness of three-dimensional (3D)-ZTE-based MRI models in providing anatomical guidance for ETSS.Methods: ZTE-based MRI and magnetic resonance angiography (MRA) data from 15 consecutive patients with pituitary tumor treated between September 2018 and May 2019 were used to create 3D-MRI models. From these, the architecture surrounding the sellar floor, particularly anatomical relationships between tumors and internal carotid arteries (ICAs), was visualized to preoperatively plan surgical procedures. In addition, 3D-ZTE-based MRI models were compared to actual surgical views during ETSS to evaluate model applicability.Results: These 3D-ZTE-based MRI models clearly demonstrated the morphology of the sellar floor and matched well with intraoperative views, including pituitary tumor, by successively eliminating sphenoidal structures. The models also permitted determination of the maximum marginal line of the opening of the sellar floor by presenting vital structures such as ICAs and tumors. With such 3D-MRI models, the surgeon could access the intracranial area through the sellar floor more safely, and resect the pituitary tumor maximally without complications. Conclusions: Our 3D-MRI models based on ZTE sequences allowed distinct visualization of vital structures and pituitary tumor around the sellar floor. This new method using 3D-ZTE-based MRI models showed low invasiveness for patients and was useful in preoperative planning for ETSS, facilitating maximum tumor resection without complications.

Endoscopic endonasal transsphenoidal surgery in acromegaly with conchal sphenoid sinus

2021 ◽  
pp. 1-3
Author(s):  
Daisuke Yamazaki ◽  
Toshihiro Ogiwara ◽  
Shuichi Hirayama ◽  
Yoshikazu Kusano ◽  
Yota Suzuki ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Sphenoid Sinus ◽  
Endoscopic Endonasal ◽  
Endoscopic Endonasal Transsphenoidal Surgery

scholarly journals Application of 3D printed model for planning the endoscopic endonasal transsphenoidal surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xing Huang ◽  
Ni Fan ◽  
Hai-jun Wang ◽  
Yan Zhou ◽  
Xudong Li ◽  
...  
Keyword(s):  
3D Printing ◽  
Skull Base ◽  
Transsphenoidal Surgery ◽  
Three Dimensional ◽  
Spatial Relationship ◽  
Cranial Computed Tomography ◽  
Imaging Data ◽  
Endoscopic Endonasal ◽  
Endoscopic Endonasal Transsphenoidal Surgery

AbstractThe application of 3D printing in planning endoscopic endonasal transsphenoidal surgery is illustrated based on the analysis of patients with intracranial skull base diseases who received treatment in our department. Cranial computed tomography/magnetic resonance imaging data are attained preoperatively, and three-dimensional reconstruction is performed using MIMICS (Materialise, Leuven, Belgium). Models of intracranial skull base diseases are printed using a 3D printer before surgery. The models clearly demonstrate the morphologies of the intracranial skull base diseases and the spatial relationship with adjacent large vessels and bones. The printing time of each model is 12.52–15.32 h, and the cost ranges from 900 to 1500 RMB. The operative approach was planned in vitro, and patients recovered postoperatively well without severe complications or death. In a questionnaire about the application of 3D printing, experienced neurosurgeons achieved scores of 7.8–8.8 out of 10, while unexperienced neurosurgeons achieved scores of 9.2–9.8. Resection of intracranial skull base lesions is demonstrated to be well assisted by 3D printing technique, which has great potential in disclosing adjacent anatomical relationships and providing the required help to clinical doctors in preoperative planning.

Sign in / Sign up

Export Citation Format

Share Document