Complications associated with microscopic and endoscopic. Division of neurological surgery, barrow neurological institute, st. Anatomy and surgery of the endoscopic endonasal approach. Endonasal approach via the sphenoid ostium was carried out for pituitary lesions without the nasal speculum. Transsphenoidal surgery has evolved much over nearly 100 years. With regard to the first point less room in which to work, ensuring a secure grip is necessary. Endoscopic endonasal transsphenoidal surgery american. This study focuses on 50 patients 28 females and 22 males with a median age of 38 years range 1488 years. Existing open skull base surgery cpt codes, involving a skin incisions, were implemented in 1994 several years prior to the introduction of the endoscopic.
Microscopic versus endoscopic transsphenoidal surgery in. Endoscopic pituitary surgery, transsphenoidal cincinnati. Perioperative management of endoscopic transsphenoidal. Endoscopic transsphenoidal pituitary adenoma resection is carried out under general anaesthetic. Endoscopic pituitary surgery is useful in all micro and macropituitary adenomas including. Important considerations regarding the specific approach to the. If the goal of surgery is partial resection and cyst decompression, this can also be easily achieved with an endoscopic, transsphenoidal, transtuberculum. Endoscopic transsphenoidal surgery orange county, ca.
However, retraction of the hypothalamus is unnecessary from below. What we consider pure endoscopic transsphenoidal surgery is a procedure. Cohort study with inclusion and followup of consecutive cushings disease patients primarily treated by. Transsphenoidal surgery, either microscopic or endoscopic, is a safe procedure in experienced hands, but serious complications still occur and must be reduced as much as possible. Binostril versus mononostril approaches in endoscopic. Endoscopic transsphenoidal surgery is performed with less disruption to the nose to reach the sphenoid sinus and pituitary.
With gross total pa resection set as the preferred goal, extracapsular dissection is encouraged to identify a tissue plane or cleavage between tumors pseudocapsule and normal pituitary gland, arachnoid, or diaphragma sellae. Pure endoscopic endonasal transsphenoidal surgery, with the endoscope used alone throughout the approach to visualize the surgical trajectory and the surgical target area, has been described in. Initially operations were performed often without any input from endocrinology colleagues, and without preoperative imaging, operative magnification and illumination. Endoscopic surgery is performed through the nose to remove tumors from the pituitary gland and skull base. The complications of endoscopic transsphenoidal surgery for pituitary neoplasms ailing zhong, jiujun pu, lunliang ruan, kai jin, song tan, fuchao wang, jiamin mou, gang yang department of neurosurgery, the first affiliated hospital of chongqing medical university, chongqing, china. The endoscopic transsphenoidal approach for pituitary adenomas and other sellar lesions is quickly becoming the procedure of choice in their surgical management. Endoscopic endonasal surgery is a minimally invasive technique used mainly in neurosurgery and otolaryngology. Risk factors for surgical complications associated with transsphenoidal surgery for pas included prior surgery and pa invasion into surrounding structures.
Transsphenoidal approach in endoscopic endonasal surgery. Transsphenoidal surgery is performed to remove tumors from the pituitary gland, sellar region, and sphenoid sinus of the skull. The patient was subject to the endoscopic endonasal transsphenoidal approach procedure 2 days after admission. The endoscope has also been used to confirm findings during microscopic surgery, which is called endoscopy assisted surgery. Additional improvement can be expected with greater experience and new technical developments. During the past decade, endoscopic transsphenoidal surgery, a minimal invasive transsphenoidal approach performed with an endoscope as a standalone visualizing and operating instrument, has been progressively accepted by surgeons and patients. Endoscopic views demonstrate that the sellar floor was opened and the dura of sellar floor exhibited high tension. Endoscopic pituitary surgery johns hopkins medicine. Preoperative management multidisciplinary disease management approach. Instruments for endoscopic endonasal transsphenoidal surgery. Endoscopic pituitary and skull base surgery karl storz. Nose is not packed after the surgery, no lumbar drain is used even when there is a csf leak. Outcomes of endoscopic and microscopic transsphenoidal.
Here we describe the procedures of endoscopic pituitary and skull base surgery in our institute. Endoscopic transsphenoidal pituitary surgery ent surgeon. A neurosurgeon or an otolaryngologist, using an endoscope that is entered through the nose, fixes or removes brain defects or tumors in the anterior skull base. Postoperative nasal packing was basically not needed in such cases. What radiologists and surgeons need to know1 in the last 2 decades, endoscopic endonasal transsphenoidal sur gery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal. There were 120 cases having a paranasal sinus ct scan in the database.
This surgical technique can also be used to remove tumors located in other regions of the skull base. The surgery is performed through the nose with a microscope or more commonly with an endoscope. Microsurgical versus endoscopic transsphenoidal resection. These tumors cause hormonal imbalance in the body by either. Microscopic surgery used to be the established method for transsphenoidal surgery. Proposing a strategy for sellar reconstruction in endoscopic transsphenoidal transsellar approachfor pituitary adenoma.
Recent findings endoscopic guidance has improved tumor visualization while minimizing the risk of nasal and dental complications and septal perforation. One disadvantage of this approach is the development of early postoperative nasal symptoms. Endoscopic transsphenoidal surgery etss for pituitary adenoma pa is one of the most commonly performed procedures in neurosurgery. This endonasal transsphenoidal endoscopy eliminates a sublabial or transfixional incision, the use of a transsphenoidal retractor and any nasal packing. We developed a series of instruments targeted to endoscopic endonasal transsphenoidal surgery. Outcomes of the endoscopic transsphenoidal surgery for. Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery. The hallmark feature of endoscopic transsphenoidal surgery is the superior view one has of the sphenoid sinus and the pituitary fossa 78,15,17,20,22,30,34,36. The endoscopic technique is also used to tackle lesions around the pituitary fossa in the socalled extended transsphenoidal approach.
In this minimally invasive surgery, the surgeon works through the nostrils with a tiny endoscope. It is responsible for regulating most of your bodys hormones, the. Josephs hospital and medical center, phoenix, arizona. The transseptal transsphenoidal approach to pituitary tumors. The transseptal transsphenoidal approach to pituitary. However, since 1992, when the endoscope was first used as a tool to assist. With the rapid evolution of endoscopy, the degree of visualization and surgical maneuverability has improved greatly. Four of which directly compared endoscopic and microscopic approaches 710, while the other 15 articles are singlearmed studies 1123, reporting purely endoscopic or microscopic transsphenoidal surgery on nfpa 1118, 2023. Reported are 160 patients who had undergone endoscopic transsphenoidal surgery from.
Cureus endoscopic transsphenoidal surgery for cushings. Transsphenoidal approach in endoscopic endonasal surgery for. Pdf perspectives on endoscopic transsphenoidal surgery. Overview endoscopic transsphenoidal pituitary adenoma. Perspectives on endoscopic transsphenoidal surgery. Mononostril endoscopic transsphenoidal surgery introduction. The endoscopic endonasal transsphenoidal approach to the sella is performed via an anterior sphenoidotomy, through the enlargement of the natural sphenoid ostium, with a rigid diagnostic endoscope as the sole visualizing tool, and without the use. Endoscopic transsphenoidal surgery newport beach, ca endoscopic transsphenoidal surgery in orange county. Pituitary adenomas are benign slowgrowing tumours that. The pure endoscopic transsphenoidal surgery consisting of a whole procedure performed with the endoscope alone and without the use of any transsphenoidal retractor offers some advantages due.
Anatomical workspace study of endonasal endoscopic. Endoscopic transsphenoidal pituitary surgical technique vula. Taken together, when performed at highvolume centers, transsphenoidal surgery for pas is safe, with a. Anatomy, instrumentation, and technique the skull base is one of the most fascinating and complex. To determine the workspace through an anatomical dimensional study of the skull base to further facilitate the design of the robot for endonasal endoscopic transsphenoidal eet surgery. The pituitary gland is a peasized organ that lies at the base of the brain above the back of the. Existing open skull base surgery cpt codes, involving a skin incisions, were implemented in 1994 several. The pituitary gland is located at the bottom of your brain and above the inside of your nose. The use of the microscope popularized the transsphenoidal approach to the sellar region, which has eventually given way to the endoscope in conjunction with the use of endoscopic procedures in general by ear, nose, and throat surgeons, to replace the more invasive sinus surgery. Endoscopic versus microscopic transsphenoidal surgery in the treatment of pituitary tumors. Advances in the understanding of the biology of pituitary tumours, close cooperation between endocrinologists, surgeons and oncologists, and huge advances. An endoscope was used in transsphenoidal surgery and eventually replaced the operating microscope as the tool for visualization.
Orange county neurosurgeon robert louis, md specializes in minimally invasive endoscopic transsphenoidal surgery for removal of tumors in the pituitary gland, sellar region, and sphenoid sinus of the skull. Bastos rv, silva cm, tagliarini jv, zanini ma, romero fr, boguszewski cl, nunes vd. Methods there were 120 cases having a paranasal sinus ct scan in the database. Pituitary adenomas are noncancerous tumors that form in the pituitary gland. Tanei t, nagatani t, nakahara n, watanabe t, nishihata t, nielsen ml, takebayashi s, hirano m, wakabayashi t 20 use of highfield intraoperative magnetic resonance imaging during endoscopic transsphenoidal surgery for functioning pituitary microadenomas and small adenomas located in the intrasellar region. The most common approach is binostril threehand technique which requires a large exposure and subjects. Object endoscopic transsphenoidal surgery is the commonest approach to pituitary tumors. Endoscopic pituitary surgery, also called transsphenoidal endoscopic surgery, is the most common surgery used to remove pituitary tumors. The treatment options for pituitary adenomas include surgery, drugs and radiotherapy.
Pdf pituitary surgery is a continuous evolving speciality of the. We report the experience of endoscopic endonasal transsphenoidal surgery eets for resection of pituitary region tumours at wellington, the central regional referral centre for neurosurgery in new zealand, and discuss the collaborative mentoring. Endoscopic endonasal surgery is burdened by a large learning curve, but after one is proficient, the endoscopic transsphenoidal approach can be a. Endoscopic transnasal transsphenoidal surgery is a minimally invasive procedure where the pituitary tumor is removed by working through the nose. An endoscope is inserted into the nostril towards the base of the tumour at the skull base. Endoscopic endonasal transsphenoidal surgery springerlink. It gives greater lighting hence contributing to the better visualization and depending on the scope used. Computerassisted navigation and intraoperative mri has further improved surgical. Endoscopic pituitary surgery transsphenoidal overview. Transsphenoidal approach in endoscopic endonasal surgery for skull base lesions. Endonasal endoscopic transsphenoidal pituitary surgery. The transsphenoidal route is the surgical approach of choice for most sellar tumors because of the relationship of the sphenoid bone to the nasal cavity below and. The microscope technique removes a large portion of the septum to insert a retractor so that the surgeon can see to the sphenoid sinus and pituitary. Objective there are no published series for the treatment of paediatric cd by etes, and we report our centres preliminary results.
Endoscopic endonasal transsphenoidal surgery request pdf. Understanding the history of the skull base surgery cpt codes and their intended use is important as it sets the stage for accurate coding of eessb procedures. Endoscopic transsphenoidal surgery the iowa clinic. Endoscopic transsphenoidal pituitary adenoma resection. Definition of transsphenoidal surgery nci dictionary of. As endoscopic transsphenoidal surgery becomes more commonplace, and with its increasing complexity with respect to imaging, instrumentation, and endocri. The endoscopic endonasal transsphenoidal approach to the.
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