The Use of a Simple Self-Retaining Retractor in the Endoscopic Endonasal Transsphenoidal Approach to the Pituitary Macroadenomas: Technical Note

2013 ◽  
Vol 73 (2) ◽  
pp. ons206-ons210
Author(s):  
Murat Kutlay ◽  
Engin Gönül ◽  
Bülent Düz ◽  
Yusuf İzci ◽  
Özkan Tehli ◽  
...  
Keyword(s):  
Technical Note ◽  
Tumor Removal ◽  
Endoscopic Endonasal ◽  
Working Space ◽  
Flexible Material ◽  
Surgical Field ◽  
Diaphragma Sellae ◽  
Total Tumor Removal ◽  
Subtotal Removal ◽  
Suprasellar Extension

Abstract BACKGROUND: During tumor removal in the endoscopic endonasal approach to pituitary adenomas with a significant suprasellar extension, the early descent of diaphragma sellae obscuring the visualization of the surgical field is a surgical challenge. OBJECTIVE: To describe a simple diaphragma retraction technique to eliminate this problem. METHODS: A transparent flexible material (a strip of polypropylene) was used as a self-retaining retractor to elevate the redundant diaphragma and to maintain the diaphragma elevation. This technique was performed in 3 patients who had pituitary adenoma with suprasellar extension. The degree of tumor removal was determined by a combination of surgeon's intraoperative impression and the postoperative magnetic resonance imaging obtained 3 months later. RESULTS: The technique was performed very easily and no complication was observed owing to this technique and self-retaining retractor. Total tumor removal was achieved in 2 patients with this technique and subtotal removal in 1 patient. CONCLUSION: This technique was effective and practicable to elevate the diaphragma sellae during the tumor removal phase of transsphenoidal surgery. This simple self-retaining retractor may support the neurosurgeon's skill by providing control of the entire surgical field and adequate working space. It may also eliminate the risks of blind curettage during surgery.

scholarly journals Recent results of primary transnasal surgery for infradiaphragmatic craniopharyngioma

1997 ◽  
Vol 3 (6) ◽  
pp. E6 ◽  
Author(s):  
Takumi Abe ◽  
Dieter K. Lüdecke
Keyword(s):  
Tumor Resection ◽  
Diagnostic Techniques ◽  
Cerebrospinal Fluid Leakage ◽  
Tumor Removal ◽  
Transnasal Approach ◽  
First Choice ◽  
Transnasal Surgery ◽  
Cyst Aspiration ◽  
Total Tumor Removal ◽  
Subtotal Removal

Results of primary transnasal surgery were evaluated in 35 patients (18 males and 17 females) with intrasellar and suprasellar craniopharyngiomas treated between 1985 and 1996 when more refined surgical and diagnostic techniques were available. Patients ranged in age from 8 to 72 years (mean 27 years); 14 patients were younger than 18 years of age. The transnasal approach was chosen because of sellar enlargement and presence of infradiaphragmatic tumor. The paramedian portion of the normal pituitary gland was incised vertically to reach a dorsally located tumor in 25 patients. Complete tumor resection was achieved in 15 patients and subtotal removal in 19; in one patient, only aspiration of cyst contents was performed. Tumor regrowth was seen in three patients after subtotal removal; in two, total tumor removal was achieved by a second transnasal surgery, whereas radiotherapy was administered in the other. In a single patient, total tumor removal was achieved by a second transcranial surgery after cyst aspiration. The duration of the clinical follow-up period was at least 1 year. Persistent diabetes insipidus appeared after total tumor resection in five patients. Cerebrospinal fluid leakage occurred in three patients, with two requiring revision. Among 29 patients with preoperatively normal pituitary functions, 20 (69%) were preserved after primary total resection, whereas six (19.4%) of 31 previously disturbed functions were normalized. After subtotal removal including cyst aspiration, 39 (88.6%) of 44 normal functions were preserved, whereas nine (24.3%) of 37 disturbed functions were normalized. The transnasal approach should be the first choice in infradiaphragmatic craniopharyngiomas with sellar enlargement in cases in which the extrasellar portion is mostly cystic and is accessible. The concept of subtotal removal with preservation of pituitary functions, especially when treating craniopharyngioma in children, seems to be justified.

Surgical implementation and efficacy of endoscopic endonasal extradural posterior clinoidectomy

2020 ◽  
Vol 133 (1) ◽  
pp. 135-143 ◽  
Author(s):  
Hiroki Ohata ◽  
Takeo Goto ◽  
Alhusain Nagm ◽  
Narasinga Rao Kannepalli ◽  
Kosuke Nakajo ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Abducens Nerve ◽  
University Hospital ◽  
Skull Base Tumors ◽  
Resection Rate ◽  
Endoscopic Endonasal ◽  
Working Space ◽  
Nerve Paresis ◽  
Posterior Clinoid Process ◽  
Surgical Field

OBJECTIVEThe endoscopic endonasal approach (EEA) for skull base tumors has become an important topic in recent years, but its use, merits, and demerits are still being debated. Herein, the authors describe the nuances and efficacy of the endoscopic endonasal extradural posterior clinoidectomy for maximal tumor exposure.METHODSThe surgical technique included extradural posterior clinoidectomy following lateral retraction of the paraclival internal carotid artery and extradural pituitary transposition. In cases with prominent posterior clinoid process, a midline sellar dura cut was added to facilitate extradural exposure. Forty-four consecutive patients, in whom this technique was performed between 2016 and 2018 at Osaka City University Hospital, were reviewed. The pathology included 19 craniopharyngiomas, 7 chordomas, 6 meningiomas, 6 pituitary adenomas, 4 chondrosarcomas, and 2 miscellaneous. Utilization and effectiveness of this approach were further demonstrated with neuroimaging.RESULTSExtradural posterior clinoidectomies were successfully applied in all patients without permanent neurovascular injury and with better maneuverability and greater resection rate of the tumors. Four patients experienced transient postoperative abducens nerve paresis, and 1 patient experienced transient postoperative oculomotor nerve paresis; however, the patients with deficits recovered within 3 months. On radiological examination, the surgical field was 2.2 times wider in cases with bilateral posterior clinoidectomy than in cases without posterior clinoidectomy.CONCLUSIONSThe extended EEA with extradural posterior clinoidectomy creates an extra working space and allows adequate accessibility with safe surgical maneuverability to remove tumors that extend behind the posterior clinoid and dorsum sellae.

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

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.

Endoscopic endonasal lateral transellar approach for growth hormone-secreting adenomas with cavernous sinus invasion: Technical note and surgical results

2021 ◽  
Vol 32 (4) ◽  
pp. 170-177
Author(s):  
Juan Luis Gómez-Amador ◽  
Jaime Jesús Martínez-Anda ◽  
Pablo David Guerrero-Suarez ◽  
Arturo Miguel Rosales-Amaya ◽  
Julio Cesar Delgado-Arce ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Cavernous Sinus ◽  
Technical Note ◽  
Surgical Results ◽  
Endoscopic Endonasal ◽  
Cavernous Sinus Invasion ◽  
Growth Hormone Secreting Adenomas

scholarly journals Combined endoscopic endonasal and subciliary approach in revision DCR cases

2017 ◽  
Vol 3 (3) ◽  
pp. 693
Author(s):  
Manjunatharao S. V. ◽  
Rajshekar M. M.
Keyword(s):  
Team Work ◽  
Tertiary Level ◽  
External Approach ◽  
Combined Approach ◽  
Interventional Study ◽  
Endoscopic Endonasal ◽  
Subciliary Approach ◽  
Endoscopic Dcr ◽  
Surgical Field ◽  
External Dcr

<p class="abstract"><strong>Background:</strong> Study conducted to know surgical outcome of combined endoscopic endonasal and subciliary approach in revision DCR cases and complications associated with the procedure.</p><p class="abstract"><strong>Methods:</strong> Prospective, single-blinded, randomized, interventional study is carried out in Tertiary level center from August 2009 to April 2016. Totally 18 patients (11 female and 7 male) were involved in the study who has undergone previous DCR (11 external DCR and 7 endoscopic DCR). The results were analyzed at end of the 3<sup>rd</sup> and 6<sup>th</sup> month both subjectively and objectively.  </p><p class="abstract"><strong>Results:</strong> All the 18 patients who underwent combined approach were relived from epiphora. None of the patients developed any complications following surgery.</p><p><strong>Conclusions:</strong> The combination of endoscopic and external approach gives benefits of the both approaches giving huge advantages in revision cases. It gives excellent visualization of the surgical field, ability to correct internal nasal pathologies, make clear rhinostoma, workprecisely on fibrosed lacrimal sac and nearly no external scar. It provides good team work opportunity between otorhinologist and ophthalmologist.</p>

scholarly journals Endoscopic-assisted microsurgical resection of giant vestibular schwannoma in semi-sitting position

2021 ◽  
Vol 5 (2) ◽  
pp. V3
Author(s):  
Gang Song ◽  
Liyong Sun ◽  
Yuhai Bao ◽  
Jiantao Liang
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Residual Tumor ◽  
Nerve Function ◽  
Tumor Removal ◽  
Function Preservation ◽  
Microsurgical Resection ◽  
Dissection Technique ◽  
Total Tumor Removal ◽  
Facial Function

The main objectives of microsurgery for vestibular schwannoma are total tumor removal and preservation of facial and cochlear nerve function. For giant tumors, total tumor removal and facial nerve function preservation are challenging. The semisitting position has some advantages. In this video the authors show the removal of a giant vestibular schwannoma with the patient in a semisitting position. They demonstrate the advantages of the semisitting technique, such as the two-handed microsurgical dissection technique and a clear operative field. Finally, a small residual tumor in the internal auditory canal was removed by endoscopy. The patient’s facial function was House-Brackmann grade I at discharge. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2176

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