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. Endoscopic endonasal transsphenoidal approach request pdf. 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. 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. Sublabial transsphenoidal approach and resection of pituitary tumors. Original article endoscopic endonasal transsphenoidal. Endoscopic surgery is performed through the nose to remove tumors from the pituitary gland and skull base. 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 is a commonly used surgical approach for pituitary region masses, with many significant advantages over open craniotomy. Advances in the understanding of the biology of pituitary tumours, close cooperation between endocrinologists, surgeons and oncologists, and huge advances. The endoscopic endonasal approach for the management of. Pdf endoscopic endonasal transsphenoidal approach in the. The transseptal transsphenoidal approach to pituitary.
Transsphenoidal approach with nasoseptal flap pedicle transposition. Transsphenoidal definition of transsphenoidal by medical. 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. The transsphenoidal approach for craniopharyngiomas is widely accepted for intrasellar craniopharyngiomas. Describe postoperative care and complication avoidance in the different variants of the transsphenoidal approach. 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. More recently, modifications of transsphenoidal surgery in. 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. Endoscopic pituitary and skull base surgery karl storz. Sublabial transsphenoidal approach and resection of. Such considerations give an idea of the extended endoscopic endonasal.
Apr 22, 2014 surgical approach to pituitary adenoma 1. Indications indications for the transsphenoidal approach have significantly increased with the addition of the endoscope. Transsphenoidal surgery an overview sciencedirect topics. 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.
Managing the patient with transsphenoidal pituitary tumor. Mcdermott, md the transphenoidal approach to intracranial lesions is most commonly used for pituitary tumors. Anatomy and surgery of the endoscopic endonasal approach to the. Transsphenoidal surgery post operative instructions mgh. 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. The endoscopic endonasal transsphenoidal approach can be a choice for sellar tumors beyond the sellar turcica, but it is. History of pituitary surgery in 1893,caton and paul attempted to explore sella turcica via lateral sub temporal route along with orbital exenteration. However, eeta still has some limitations that can cause serious complications. Endoscopic transsphenoidal surgery for the treatment of pituitary sella lesions has been used for the past 10 years. Microsurgical and endoscopic techniques are commonly utilized surgical approaches to pituitary pathologies. Arrange to have someone drive you home after surgery. If neurosurgeons wanted to perform both minimally invasive surgery and safer surgery at the same time, what was the best choice of treatment.
It is very important for the neurosurgeon to choose the right approach in order to reach the lesion without harming the other intact structures. 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. Endoscopic endonasal transsphenoidal approach to large and. In transnasal transsphenoidal endoscopic surgery, a surgical instrument is placed through the nostril and alongside. Endoscopic transnasal transsphenoidal surgery mayo clinic. Otto md department of otolaryngologyhead and neck surgery, the ohio state university wexner medical center, columbus, ohio, u. 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 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. 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.
Endoscopic endonasal transsphenoidal approach for pituitary. The transfrontal approach was first used by krause in 1905. 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. 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. The transsphenoidal approach is contraindicated when the sellar lesion involves the brain 7, 8, cavernous sinus, or middle fossa 1,7,9. During the past six years, we have operated upon a total of 59 pituitary adenomas with suprasellar extension. The authors report on a series of purely endoscopic. In this minimally invasive surgery, the surgeon works through the nostrils with a tiny endoscope. 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.
Eeta can serve many patients in many aspects especially the hospital stay and the scarification. Endoscopic endonasal transsphenoidal approach eeta is an acceptable procedure as truly minimally invasive neurosurgery in handling pituitary tumor. Pituitary tumors with substantial intracranial extension can engulf important structures and should be treated using a transcranial approach. Vivian l smith department of neurosurgery at mcgovern medical school medical school administrative offices. There are different structures that can be injured easily, by operating in the skull base. Extended endoscopic endonasal approach to the midline skull. Transsphenoidal surgery is used to remove tumors of the pituitary gland. Transsphenoidal surgery tss is a wellknown approach for the treatment of pituitary tumors. 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. Transsphenoidal surgery is the mainstay of treatment for most kinds of pituitary adenomas and other sellar masses. Tell your surgeon about all medicines you currently take.
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. Endoscopic transnasal transsphenoidal approach for the. Endoscopic pituitary and skull base surgery anatomy and surgery of the endoscopic endonasal approach. The outcome of endoscopic endonasal transsphenoidal surgery in 10 patients. At aurora health care, our expert neurosurgeons perform two types of transsphenoidal surgery.
Various authors have recently reported extensive series on the treatment of craniopharyngiomas using the microscopic supradiaphragmatic transsphenoidal approach 5, 7, 10, 19, 21, 22. Pdf the endoscopic endonasal transsphenoidal approach to. Extended endoscopic endonasal approach to the midline. Special article what is the better minimally invasive surgery. Transsphenoidal surgery has evolved much over nearly 100 years. The skull base surgery is one of the most demanding surgeries. Initially operations were performed often without any input from endocrinology colleagues, and without preoperative imaging, operative magnification and illumination. Although this is a binasal operation, choose the nasal cavity with the most generous working room for the initial portions of the approach. Microscopeguided endonasal transsphenoidal approach the. The transsphenoidal approach developed perfectly fitting this conceptual way of thinking, being founded on the possibility of gaining access.
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. Anatomy and surgery of the endoscopic endonasal approach to. As a result, this approach has lower morbidity and mortality rates when compared with transcranial procedures. Endoscopic endonasal transsphenoidal approach eeta no one denies that endoscopic surgery is a true minimally invasive surgery. Transsphenoidal approaches to anterior skull base lesions. Important considerations regarding the specific approach to the sphenoid are the size of the nose and nostril, the pres. Advances in the understanding of the biology of pituitary tumours, close cooperation between endocrinologists, surgeons and oncologists, and huge advances in. Transsphenoidal approach with nasoseptal flap pedicle. The pituitary gland is attached to the brain and sits behind the bridge of the nose.
Transsphenoidal medical definition merriamwebster medical. Select centers have also advocated the transsphenoidal route for tumors with subdiaphragmatic origin and subsequent suprasellar extension. In 2000, the direct endonasal approach for transsphenoidal surgery was developed at ucsf making this surgery even less invasive and greatly reducing surgical complications. Transnasal transsphenoidal approach to pituitary iowa head. Among the 10 individuals subjected to pure endoscopy. Get a printable copy pdf file of the complete article 2. The transsphenoidal route has become the standard endoscopic approach for surgical treatment of most intrasellar tumors. With the constant improvement in neural navigation technology and. The transsphenoidal approach is the least traumatic nasal route to the sella turcica, avoids brain retraction, and offers improved visualization of the surgical field. Transsphenoidal approach to pituitary adenomas with. The extended transsphenoidal approach is a less invasive method for removing purely suprasellar lesions compared with traditional transcranial approaches. The feasibility of a purely endoscopic extended transsphenoidal approach to remove suprasellar lesions has been reported previously, but few cases have been. Pdf transsphenoidal approaches have been used for a century for the resection of pituitary and other sellar 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. More of these operations have been performed at ucsf than any other site in the united states. Josephs hospital and medical center, phoenix, arizona. Multimodal navigation in endoscopic transsphenoidal.
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. Relative contraindications to the trans sphenoidal approach include an incompletely pneu. 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. 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. Case example transphenoidal approach to pituitary tumorreturn to. Endoscopic endonasal transsphenoidal surgery springerlink. 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. Due to the pioneering work of cushing, hirsch, yasargil, krause, dandy and other dedicated. Original article endoscopic endonasal transsphenoidal surgery. Pdf endoscopic endonasal transsphenoidal approach for sellar.
Transsphenoidal approach complications neurosurgery. May 23, 2004 discussion complications related to indications. Complications of transsphenoidal surgery latest news and. Special article what is the better minimally invasive. 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. 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. Transsphenoidal approach to pituitary adenomas with suprasellar extension toshichi nakane, m. In 1992, jankowski and coworkers published their results from three cases of a pure endoscopic transsphenoidal approach to. Images were saved to the neuronavigation computer and used to plan the drilling approach. Most advocates have used a sublabial incision and a microscope and have reported a significant risk of cerebrospinal fluid csf leakage. 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. The glands complexity and location in the brain have a serious impact on the diagnosis and treatment of pituitary pathology. Use the 4mm outer diameter, 18cm length, 0degree endoscope for the transsphenoidal approach. Transsphenoidal hypophysectomy radiology reference article.
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. The endonasal endoscopic approach for pituitary tumors is. Pedicled nasoseptal flap hadadbassagasteguy flap protocolclick on videos below to active. The histological results confirmed the coexistence of the pituitary macroadenoma and meningioma, world health organization who grade i. 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. Cushing2 systematically applied a transsphenoidal approach for sellar lesions. Please tell us where you read or heard it including the quote, if possible. Endoscopic, endonasal extended transsphenoidal, transplanum. 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. 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.
Sublabial transsphenoidal approach and resection of pituitary. Endoscopic endonasal transsphenoidal approach to the sellar region. With the constant improvement in neural navigation technology and neuroendoscopy technology 4, transs. It is also indicated for removal of some tumors of the parasellar area. Pdf endoscopic endonasal transsphenoidal approach to. Several surgical approaches are available to treat pituitary tumors. Transnasal transsphenoidal approach to pituitary transnasal transsphenoidal approach to pituitary see. For transsphenoidal surgery, there are several alternative approaches to the sphenoid sinus. The endoscopic endonasal approach for the management of craniopharyngiomas domenico solari 1, roberta morace 2, luigi m.
Endoscopic endonasal transsphenoidal approach ncbi nih. The cadavers were placed in the surgical head clamp of the brainsight system and positioned for a. The transseptal transsphenoidal approach to pituitary tumors. History of the transsphenoidal endoscopic surgical approach.
It can also be used to biopsy or treat midline skull base lesions from the planum sphenoidale to the clivus. Pituitary surgery california center for pituitary disorders. Original article effect of transsphenoidal surgery and. Transsphenoidal approaches to anterior skull base lesions g. 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 is performed to remove tumors from the pituitary gland, sellar region, and sphenoid sinus of the skull. Transsphenoidal approach to pituitary tumors was for a long time reserved for sellar region tumors. Endoscopic pituitary surgery, transsphenoidal cincinnati. Sep 27, 2018 the endonasal transsphenoidal approach has evolved during the past century.
Transsphenoidal surgery for pituitary tumors precare what. Feb 03, 2020 transsphenoidal surgery for pituitary tumors is done to remove a tumor on the pituitary gland. Describe the various aspects of the endonasal transsphenoidal and endoscopic transsphenoidal approaches. Recall the guidelines for tumor resection of pituitary adenomas.
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. Traditionally, there have been two approaches to surgical removal of pituitary tumors. Transsphenoidal approach in endoscopic endonasal surgery. Endoscopic pituitary surgery transsphenoidal overview. History the transsphenoidal approach was first described in 1907 by schloffer, modified by. Division of neurological surgery, barrow neurological institute, st. Computed tomography ct and mri were performed on each cadaver with fiducials in place. Dumbbellshaped tumors constricted at the diaphragm are best approached transcranially 1, 4. Early outcomes of endoscopic transsphenoidal surgery for. The demographics, presenting symptoms, lesion type and location, and outcome for each patient are shown in table 1.
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