The Use of Micro Retractor in Endoscopic Endonasal Posterior Pseudocapsule Resection of Pituitary Macroadenoma. Technical Note

BackgroundThe endoscopic endonasal approach and extra-pseudocapsule resection may be the main progress in modern pituitary surgery. However, for pituitary macroadenomas, discerning the pseudocapsule in the posterior plane of the tumor may be difficult. When the anterior-inferior debulking is performed, the early subsidence of the thinning normal pituitary gland and enlarged diaphragm may obstruct the surgical dissection view.MethodWe describe the technique of using a micro retractor for the endoscopic endonasal posterior pseudocapsule resection of pituitary macroadenomas. This micro retractor that was 2 mm in width was placed at the 12 o’clock position on the nostrils, and the end was fixed in the flexible arms of the self-retaining retractor system. The head of the micro retractor elevated the herniated diaphragm sellae in order to continue the posterior pseudocapsule resection of the pituitary macroadenoma.ResultThe technique was performed very easily and no complication was observed.ConclusionThe use of this micro retractor can increase the view of the posterior margin of the adenomas to facilitate the pseudocapsule dissection.

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Prevention of Intra-Operative Cerebrospinal Fluid Leaks by Lumbar Cerebrospinal Fluid Drainage during Endoscopic Endonasal Trans- Sphenoidal Surgery for Pituitary Macroadenomas

Bangladesh Journal of Neurosurgery ◽

10.3329/bjns.v10i1.49162 ◽

2020 ◽

Vol 10 (1) ◽

pp. 52-56

Author(s):

Mohammad Shahnawaz Bari ◽

Shaireen Akhtar ◽

Md Shamsul Alam ◽

Md Atikur Rahman ◽

Asifur Rahman ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Transsphenoidal Surgery ◽

Csf Leak ◽

Cerebrospinal Fluid Leakage ◽

Pituitary Macroadenoma ◽

Endoscopic Endonasal ◽

Lumbar Drain ◽

Csf Drainage ◽

Csf Leaks ◽

Pituitary Macroadenomas

Aim and Objective: Postoperative cerebrospinal fluid leak is a recognized complication of endoscopic endonasal trans- sphenoidal surgery for pituitary macroadenomas. In this study we assess the utility of prophylactic use of lumbar drain in preventing intra-operative cerebrospinal fluid leakage during endscopic endonasal transsphenoidal surgery for pituitary macroadenoma which will ultimately reduce the rate of persistent post-operative cerebrospinal fluid leakage. Materials and Methods: 34 patients who underwent endscopic endonasal transsphenoidal surgery for pituitary macroadenoma were dividedd into two groups by non-probability convenient sampling technique. In one group of which lumbar subarachnoid drain were given just before induction of anesthesia named LD Group and another group went through conventional method without giving lumbar drain named No LD Group. In all patients of LD Group 20-30 ml of CSF was drawn through lumbar drain before giving dural incision. Valsalva maneuver was used in each group to identify intraoperative CSF leaks at the end of definitive surgery before repairing the sellar floor.Zero degree rigid endoscope was used in all cases. Intraoperative CSF leak was categorized as ‘Yes’ or ‘No’ which was decided by surgeon.Lumbar drains were removed within 24 hours of operation in 16 patients of LD Group and in case 1,who developed intraoperative CSF leak, lumbar drain was removed later. Results: Thirty four patients were eligible for inclusion, of which 17 were assigned to the LD Group and 17 to the no LD Group. There were no statistically significant differences in patient demographics, tumor pathology, or radiology between the two groups. In LD Group intraoperative CSF leak occurred in 1(5.9%) patient and leak did not occur in 16(94.1%) patients, in No LD Group intraoperative CSF leak occurred in 14(82.4%) patients and leak did not occur in 3(17.6%) patients. Intraoperative CSF drainage significantly reduced the incidence of intraoperative CSF leaks from 82.4% in the No LD group to 5.9% in the LD group (P < 0.001). There were no catheter related complications. Conclusion: Intraoperative CSF drainage significantly reduces the incidence of intraoperative CSF leakage in patients undergoing endoscopic endonasal transsphenoidal surgery for pituitary macroadenomas. Bang. J Neurosurgery 2020; 10(1): 52-56

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Frameless Stereotactic Placement of Brachytherapy Seeds within a Pituitary Adenoma via Endoscopic, Endonasal Approach: A Technical Note

10.1055/s-0040-1702660 ◽

2020 ◽

Author(s):

Aaron R. Plitt ◽

Ashleigh Halderman ◽

Robert Timmerman ◽

Samuel L. Barnett

Keyword(s):

Pituitary Adenoma ◽

Technical Note ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal

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The Role and Place of Endoscopic Endonasal Transsphenoidal Technique in Pituitary Surgery

Skull Base ◽

10.1055/s-2009-1222276 ◽

2009 ◽

Vol 19 (01) ◽

Author(s):

Pavel Kalinin ◽

Dmitry Fomichev ◽

Boris Kadashev ◽

Maxim Kutin ◽

Ravshan Faizullaev ◽

...

Keyword(s):

Pituitary Surgery ◽

Endoscopic Endonasal

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

Operative Neurosurgery ◽

10.1227/neu.0b013e3182117063 ◽

2011 ◽

Vol 68 (suppl_2) ◽

pp. ons310-ons316 ◽

Cited By ~ 9

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

Neurocirugía (English Edition) ◽

10.1016/j.neucie.2020.05.002 ◽

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

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Skull Base Dural Closure Using a Modified Nonpenetrating Clip Device via an Endoscopic Endonasal Approach: Technical Note

Neurologia medico-chirurgica ◽

10.2176/nmc.tn.2020-0103 ◽

2020 ◽

Vol 60 (10) ◽

pp. 514-519

Author(s):

Shinichiro TERAMOTO ◽

Shigeyuki TAHARA ◽

Yujiro HATTORI ◽

Akio MORITA

Keyword(s):

Skull Base ◽

Technical Note ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Dural Closure

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Endoscopic Transsphenoidal Approach for Resection of Malignant Pituitary Blastoma in an 18-Month-Old Infant: A Technical Note

Operative Neurosurgery ◽

10.1227/neu.0000000000000474 ◽

2014 ◽

Vol 10 (4) ◽

pp. 649-653 ◽

Cited By ~ 3

Author(s):

Malik Zaben ◽

Mohsin Zafar ◽

Shafqat Bukhari ◽

Paul Leach ◽

Charoline Hayhurst

Keyword(s):

Malignant Tumor ◽

Intraoperative Complications ◽

Tumor Resection ◽

Cerebrospinal Fluid Leak ◽

Technical Note ◽

Transsphenoidal Approach ◽

Nasoseptal Flap ◽

Endoscopic Endonasal ◽

One Year ◽

Fluid Leak

Abstract BACKGROUND: Sella and suprasellar tumors are increasingly managed via an endoscopic transsphenoidal approach, but infant endoscopic surgery has not been reported. Pituitary blastoma is a rare sellar malignant tumor that primarily occurs in infants and is managed by surgical resection (cytoreduction) followed by adjuvant therapy. OBJECTIVE: To describe the technique and feasibility of resection of a pituitary blastoma via endoscopic endonasal transsphenoidal approach in an 18-month-old infant. METHODS: Endoscopic endonasal transsphenoidal approach for resection of a pituitary malignant tumor in an infant. RESULTS: Near-total tumor resection was achieved. The skull base was reconstructed by using a nasoseptal flap with no cerebrospinal fluid leak or any other intraoperative complications. The postoperative course was uneventful. One-year follow-up showed complete resolution of the tumor. CONCLUSION: The endoscopic endonasal transsphenoidal approach with nasoseptal flap reconstruction could be used as a safe, yet minimally invasive and innovative technique for the resection of pituitary blastoma in infants.

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