The transsphenoidal approach developed perfectly fitting this conceptual way of thinking, being founded on the possibility of gaining access. Several surgical approaches are available to treat pituitary tumors. Advances in the understanding of the biology of pituitary tumours, close cooperation between endocrinologists, surgeons and oncologists, and huge advances in. At the beginning of our century, in 1906, schloffer was the first to describe an extradural approach to the pituitary gland schloffer 1906, 1907, and thus became a pioneer of numerous similar approaches with the common goal of removing pituitary adenomas without craniotomy, for in those days subfrontal craniotomy caused much greater strain and risk for the patient than now. The demographics, presenting symptoms, lesion type and location, and outcome for each patient are shown in table 1. Anatomy and surgery of the endoscopic endonasal approach to. Arrange to have someone drive you home after surgery. Pedicled nasoseptal flap hadadbassagasteguy flap protocolclick on videos below to active. Harvey cushing played an instrumental role in popularizing the endonasal route as it was pioneered by surgeons of his time, including schloffer and halstead. Transsphenoidal hypophysectomy radiology reference article.
Sublabial transsphenoidal approach and resection of. Pdf endoscopic endonasal transsphenoidal approach to. Transsphenoidal surgery is used to remove tumors of the pituitary gland. Get a printable copy pdf file of the complete article 2. Pdf endoscopic endonasal transsphenoidal approach for sellar. Endoscopic endonasal transsphenoidal approach request pdf. The endoscopic endonasal transsphenoidal approach to pituitary tumors is a safe and minimally invasive procedure, which can be employed safely in any of our centers in nepal, equipped. Complications of transsphenoidal surgery latest news and. In this minimally invasive surgery, the surgeon works through the nostrils with a tiny endoscope. Due to the pioneering work of cushing, hirsch, yasargil, krause, dandy and other dedicated.
Microsurgical and endoscopic techniques are commonly utilized surgical approaches to pituitary pathologies. It is also indicated for removal of some tumors of the parasellar area. Images were saved to the neuronavigation computer and used to plan the drilling approach. Multimodal navigation in endoscopic transsphenoidal. Transsphenoidal surgery is the mainstay of treatment for most kinds of pituitary adenomas and other sellar masses. Transsphenoidal definition of transsphenoidal by medical. The transsphenoidal approach is the least traumatic nasal route to the sella turcica, avoids the need for brain retraction, and offers improved visualization of the surgical field. The outcome of endoscopic endonasal transsphenoidal surgery in 10 patients with pituitary adenomas was compared with that of traditional transnasal transsphenoidal approach tta in 20 subjects. In 1992, jankowski and coworkers published their results from three cases of a pure endoscopic transsphenoidal approach to.
Transsphenoidal approach to pituitary adenomas with. Using a team approach with a skilled endoscopic rhinologist has rendered the endoscopic transsphenoidal approach a valid minimal access method for exposing various midline skull base pathologies involving the planum sphenoidale, tuberculum sellae, medial cavernous. History of pituitary surgery in 1893,caton and paul attempted to explore sella turcica via lateral sub temporal route along with orbital exenteration. Managing the patient with transsphenoidal pituitary tumor resection wen yuan abstract patients who undergo transsphenoidal pituitary tumor resection require a multidisciplinary team approach, consisting of a neurosurgeon, an endocrinologist, and nurses. Advances in the understanding of the biology of pituitary tumours, close cooperation between endocrinologists, surgeons and oncologists, and huge advances. Indications indications for the transsphenoidal approach have significantly increased with the addition of the endoscope. Endoscopic pituitary surgery, transsphenoidal cincinnati. Transnasal transsphenoidal approach to pituitary transnasal transsphenoidal approach to pituitary see. Endoscopic, endonasal extended transsphenoidal, transplanum. However, eeta still has some limitations that can cause serious complications. Pdf the endoscopic endonasal transsphenoidal approach to. Among the 10 individuals subjected to pure endoscopy. Transsphenoidal surgery using the operating microscope was introduced in the 1970s, and endoscopic surgery 7072 instead of or in addition to the operating microscope was introduced in the 2000s. Tell your surgeon about all medicines you currently take.
The expanded endonasal approach is a minimally invasive procedure in which a tumor is removed through the nasal passages, resulting in no incisions, a shorter hospital stay and faster recovery. Transsphenoidal approach complications neurosurgery. Original article endoscopic endonasal transsphenoidal surgery. Transnasal transsphenoidal approach to pituitary iowa head. Most advocates have used a sublabial incision and a microscope and have reported a significant risk of cerebrospinal fluid csf leakage. Mcdermott, md the transphenoidal approach to intracranial lesions is most commonly used for pituitary tumors. Couldwell wt, weiss mh, rabb c et al 2004 variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches. In 2000, the direct endonasal approach for transsphenoidal surgery was developed at ucsf making this surgery even less invasive and greatly reducing surgical complications. Division of neurological surgery, barrow neurological institute, st. The full name of transsphenoidal surgery is the transsphenoidal approach surgery, which has advantages of completely removing the tumor, simple approach in operation, faster recovery and fewer complications etc. Select centers have also advocated the transsphenoidal route for tumors with subdiaphragmatic origin and subsequent suprasellar extension. Endoscopic endonasal transsphenoidal approach eeta no one denies that endoscopic surgery is a true minimally invasive surgery.
Transsphenoidal approach in endoscopic endonasal surgery. The endoscopic, endonasal, transsphenoidal approach is a safe and reliable minimal invasive surgical alternative for resection of the intra, supra and parasellar lesions, avoiding additional craniotomy. The endoscopic endonasal approach for the management of craniopharyngiomas domenico solari 1, roberta morace 2, luigi m. Eeta can serve many patients in many aspects especially the hospital stay and the scarification. Computed tomography ct and mri were performed on each cadaver with fiducials in place. Patients who fail this first approach can be treated either by repeat transsphenoidal surgery, medical therapy, radiotherapy, or, as a final resort, surgical or medical adrenalectomy. The authors report on a series of purely endoscopic. As a result, this approach has lower morbidity and mortality rates when compared with transcranial procedures.
Early outcomes of endoscopic transsphenoidal surgery for. To date, only a few articles have described the usefulness of the endoscopic transsphenoidal approach for the treatment of cranial base chordomas 8, 15, 20, 21. The aim of this study was to evaluate the effectiveness of the endoscopic endonasal transsphenoidal approach for the removal of recurrent and residual pituitary adenomas, already treated by a. Endoscopic endonasal transsphenoidal approach for pituitary. Describe the various aspects of the endonasal transsphenoidal and endoscopic transsphenoidal approaches. The transfrontal approach was first used by krause in 1905. Endoscopic surgery is performed through the nose to remove tumors from the pituitary gland and skull base. Extended endoscopic endonasal approach to the midline. Recall the guidelines for tumor resection of pituitary adenomas.
The transseptal transsphenoidal approach to pituitary tumors. Transsphenoidal approach complications no significant differences in surgical outcomes, mortality during the perioperative period or complications were observed between patients younger than 14 years old and similar patients in the general population 1. Endoscopic transsphenoidal surgery for the treatment of pituitary sella lesions has been used for the past 10 years. Special article what is the better minimally invasive surgery. Original article effect of transsphenoidal surgery and.
With the constant improvement in neural navigation technology and neuroendoscopy technology 4, transs. The book is a useful addition to the library of all surgeons who deal with skull base cranial surgery, and provides outstanding information and reference sources for complex skull base procedures amenable to the transsphenoidal approach. Endoscopic pituitary and skull base surgery karl storz. It is very important for the neurosurgeon to choose the right approach in order to reach the lesion without harming the other intact structures. Transsphenoidal approach to pituitary tumors was for a long time reserved for sellar region tumors. Endoscopic endonasal transsphenoidal approach eeta is an acceptable procedure as truly minimally invasive neurosurgery in handling pituitary tumor.
Sep 27, 2018 the endonasal transsphenoidal approach has evolved during the past century. Endoscopic endonasal transsphenoidal surgery springerlink. Reports on endoscopic endonasal transsphenoidal surgery to achieve improved resection rates via transsphenoidal approaches for large and giant pituitary adenomas continue to show promising results. Transsphenoidal surgery has evolved much over nearly 100 years. Dumbbellshaped tumors constricted at the diaphragm are best approached transcranially 1, 4. Endoscopic transnasal transsphenoidal approach for the. However, lateral misdirection and vascular damage, intraoperative csf leakage, and optic nerve and vascular injuries are all wellknown complications, and the risk of adverse events is more likely in less experienced hands. Endoscopic endonasal transsphenoidal approach to large and. Transsphenoidal surgery is performed to remove tumors from the pituitary gland, sellar region, and sphenoid sinus of the skull.
Josephs hospital and medical center, phoenix, arizona. Transsphenoidal medical definition merriamwebster medical. The feasibility of a purely endoscopic extended transsphenoidal approach to remove suprasellar lesions has been reported previously, but few cases have been. Managing the patient with transsphenoidal pituitary tumor. Jan 18, 2012 the endoscopic endonasal approach provides the same advantages of direct route and minimal neurovascular manipulation offered by the transoral approach, but with a wider and closer view. More of these operations have been performed at ucsf than any other site in the united states. Transsphenoidal hypophysectomy is a commonly used surgical approach for pituitary region masses, with many significant advantages over open craniotomy. Anatomy and surgery of the endoscopic endonasal approach to the. Furthermore it avoids some of the disadvantages related to the transoral approach, such as the need for mouth retractors and splitting of the soft palate. Transsphenoidal surgery for pituitary tumors precare what. Describe postoperative care and complication avoidance in the different variants of the transsphenoidal approach. The outcome of endoscopic endonasal transsphenoidal surgery in 10 patients. The skull base surgery is one of the most demanding surgeries.
Please tell us where you read or heard it including the quote, if possible. Pituitary surgery california center for pituitary disorders. Transsphenoidal surgery complication avoidance and. Apr 22, 2014 surgical approach to pituitary adenoma 1. The extended transsphenoidal approach is a less invasive method for removing purely suprasellar lesions compared with traditional transcranial approaches. Relative contraindications to the trans sphenoidal approach include an incompletely pneu. Pdf endoscopic endonasal transsphenoidal approach in the. Transsphenoidal surgery an overview sciencedirect topics. Transsphenoidal approaches to anterior skull base lesions g.
Endoscopic pituitary and skull base surgery anatomy and surgery of the endoscopic endonasal approach. Case example transphenoidal approach to pituitary tumorreturn to. Although this is a binasal operation, choose the nasal cavity with the most generous working room for the initial portions of the approach. Transsphenoidal approach with nasoseptal flap pedicle transposition. Transsphenoidal approach to pituitary adenomas with suprasellar extension toshichi nakane, m. Sublabial transsphenoidal approach and resection of pituitary tumors.
Pituitary tumors with substantial intracranial extension can engulf important structures and should be treated using a transcranial approach. Pdf transsphenoidal approaches have been used for a century for the resection of pituitary and other sellar tumors. The transseptal transsphenoidal approach allows the surgeon to reach lesions located in the middle of the skull base and is widely accepted as the procedure of choice for the surgical treatment of pituitary adenomas with a primary sellar extension. During the past six years, we have operated upon a total of 59 pituitary adenomas with suprasellar extension. Transsphenoidal surgery is a type of surgery in which an endoscope andor surgical instruments are inserted into part of the brain by going through the nose and the sphenoid bone a butterflyshaped bone forming the anterior inferior portion of the brain case into the sphenoidal sinus cavity.
Original article endoscopic endonasal transsphenoidal surgery for treating pituitary adenoma via a subseptum mucosa approach sheng nie 1,2, keqin li, yi huang 1,2, jikuang zhao, xiang gao, jie sun1,2 1department of neurosurgery, ningbo first hospital, ningbo. The cadavers were placed in the surgical head clamp of the brainsight system and positioned for a. For transsphenoidal surgery, there are several alternative approaches to the sphenoid sinus. Vivian l smith department of neurosurgery at mcgovern medical school medical school administrative offices. The transsphenoidal route has become the standard endoscopic approach for surgical treatment of most intrasellar tumors. Microscopic transsphenoidal surgery is a wellaccepted technique for the treatment of such tumors growing in the sella and upper clivus and confined to the midline.
Such considerations give an idea of the extended endoscopic endonasal. Various authors have recently reported extensive series on the treatment of craniopharyngiomas using the microscopic supradiaphragmatic transsphenoidal approach 5, 7, 10, 19, 21, 22. Transnasal transsphenoidal approach to pituitary iowa. There are different structures that can be injured easily, by operating in the skull base. The endoscopic endonasal approach for the management of. May 23, 2004 discussion complications related to indications. Transsphenoidal approach with nasoseptal flap pedicle. Microscopeguided endonasal transsphenoidal approach the. Transphenoidal approach for pituitary lesions surgical technique there are a number of reasons that a surgeon would need to operate on the pituitary gland a hormone secreting gland at the base of the brain, just behind and between the. Sublabial transsphenoidal approach and resection of pituitary. Complications resulting from transsphenoidal surgery can be traced to a number of causes, including improper indications, a variety of intercurrent medical conditions, anesthesia, the anatomy surrounding the approach and pituitary, the endocrine systems involved, and, clearly, the surgical technique. Otto md department of otolaryngologyhead and neck surgery, the ohio state university wexner medical center, columbus, ohio, u. Extended endoscopic endonasal approach to the midline skull.
Initially operations were performed often without any input from endocrinology colleagues, and without preoperative imaging, operative magnification and illumination. Important considerations regarding the specific approach to the sphenoid are the size of the nose and nostril, the pres. Sublabial transsphenoidal approach and resection of pituitary tumors suboccipital craniectomy for microvascular decompression of the trigeminal nerve or facial nerve or cerebellopointine angle tumor splitting the sylvian fissure, drilling of the anterior clinoid process and ophthalmic aneurysm clipping. The transsphenoidal transplanum, transtuberculum approach to the suprasellar cistern, also called the extended transsphenoidal approach, has been used during the past 10 years by experienced transsphenoidal surgeons to remove a limited number of well. In this minimally invasive surgery, the surgeon works through the nostrils with a tiny endoscope camera and light to remove tumors with long instruments. The transsphenoidal approach for craniopharyngiomas is widely accepted for intrasellar craniopharyngiomas. History the transsphenoidal approach was first described in 1907 by schloffer, modified by. If neurosurgeons wanted to perform both minimally invasive surgery and safer surgery at the same time, what was the best choice of treatment. Cushing2 systematically applied a transsphenoidal approach for sellar lesions. Feb 03, 2020 transsphenoidal surgery for pituitary tumors is done to remove a tumor on the pituitary gland.
More recently, modifications of transsphenoidal surgery in. At aurora health care, our expert neurosurgeons perform two types of transsphenoidal surgery. Traditionally, there have been two approaches to surgical removal of pituitary tumors. The endoscopic endonasal transsphenoidal approach can be a choice for sellar tumors beyond the sellar turcica, but it is. The transsphenoidal approach is the least traumatic nasal route to the sella turcica, avoids brain retraction, and offers improved visualization of the surgical field. Original article endoscopic endonasal transsphenoidal. Endoscopic pituitary surgery transsphenoidal overview. With the constant improvement in neural navigation technology and. Special article what is the better minimally invasive. The histological results confirmed the coexistence of the pituitary macroadenoma and meningioma, world health organization who grade i. Mueller rhoton transsphenoidal speculum was developed in conjunction with albert rhoton, md, of the university of florida and designed especially for the endonasal approach to pituitary tumor removal. In transnasal transsphenoidal endoscopic surgery, a surgical instrument is placed through the nostril and alongside.
The transseptal transsphenoidal approach to pituitary. Endoscopic transnasal transsphenoidal surgery mayo clinic. The endonasal endoscopic approach for pituitary tumors is. Transsphenoidal surgery post operative instructions mgh. Original article endoscopic endonasal transsphenoidal surgery for treating pituitary adenoma via a subseptum mucosa approach sheng nie 1,2, keqin li, yi huang 1,2, jikuang zhao, xiang gao, jie sun1,2 1department of neurosurgery, ningbo first hospital, ningbo hospital, zhejiang university, ningbo 315010, zheji. The glands complexity and location in the brain have a serious impact on the diagnosis and treatment of pituitary pathology. Transsphenoidal approach history as an alternative to the transcranial route the transsphenoidal approach was developed simultaneously in the first decade of the 20th century in the united states and in europe, in particular in the austrian monarchy. Use the 4mm outer diameter, 18cm length, 0degree endoscope for the transsphenoidal approach. It can also be used to biopsy or treat midline skull base lesions from the planum sphenoidale to the clivus. The transsphenoidal approach is contraindicated when the sellar lesion involves the brain 7, 8, cavernous sinus, or middle fossa 1,7,9. The pituitary gland is attached to the brain and sits behind the bridge of the nose.
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