UI - 20034706
AU - Koren I; Hadar T; Rappaport ZH; Yaniv E
TI - Endoscopic transnasal transsphenoidal microsurgery versus the
sublabial approach for the treatment of pituitary tumors: endonasal
complications.
SO - Laryngoscope 1999 Nov;109(11):1838-40
AD - Department of Otolaryngology, Rabin Medical Center, Beilinson
Campus, Sackler Faculty of Medicine, Tel Aviv University, Petah Tiqva,
Israel.
OBJECTIVE: To evaluate the nasal complications after transnasal
transsphenoidal operations for pituitary tumors, comparing two surgical
techniques: traditional sublabial transseptal and endoscopic transseptal
techniques. STUDY DESIGN: We retrospectively evaluated by self-reported
questionnaire and endoscopic examination the nasal condition of 40
consecutive patients with pituitary tumors: 20 patients had endoscopic
surgery and 20 had surgery with the traditional sublabial technique.
RESULTS: Compared with the traditional technique, the endoscopic approach
was associated with a shorter operative time (about 40 min), shorter
hospitalization time (about half), absence of recurrent epistaxis snoring
and denture problems, and lower incidence of septal perforation,
synechia, and crust formation. Furthermore, loss of nasal tip projection
was found only in the group that had surgery with the sublabial
technique. CONCLUSIONS: Endoscopically guided transseptal transsphenoidal
surgery is simple to perform and time-saving, and it results in fewer
nasal and denture complications than the sublabial technique. At the same
time, it allows the surgeon all the benefits of the binocular microscopic
surgical field that are associated with the traditional approach.
UI - 20186561
AU - Badie B; Nguyen P; Preston JK
TI - Endoscopic-guided direct endonasal approach for pituitary surgery.
SO - Surg Neurol 2000 Feb;53(2):168-72; discussion 172-3
AD - Department of Neurological Surgery, University of Wisconsin School
of Medicine, Madison 53792-3232, USA.
BACKGROUND: Submucosal dissection of the nasal septum is often performed
as part of the transseptal approach to the sella. To evaluate whether
this submucosal dissection is a necessary component of this operation, we
compared the morbidity of a direct transmucosal endonasal approach to
that of the transseptal approach in patients undergoing pituitary
surgery. METHODS: Forty-one consecutive patients undergoing pituitary
surgery from January 1996 to March 1999 were included in this study. The
first 21 patients underwent the standard transseptal operation through
either a sublabial or columellar incision. The latter 20 patients were
operated on through an endoscopically guided, direct endonasal exposure,
without any submucosal dissection of the nasal septum. The operative
morbidity, the duration of surgery, and the length of hospitalization for
each group were compared. RESULTS: The sphenoid sinus exposure obtained
through the endonasal route was comparable with the transseptal approach
and was adequate for resection of most pituitary tumors. Although the
morbidity of the two approaches was similar, patients undergoing the
endonasal operation had less postoperative facial pain. Furthermore, the
endonasal approach significantly decreased the length of the operation
(116 minutes vs. 161 minutes, p = 0.002) and the duration of
hospitalization (3.6 vs. 5.1 days, p = 0.003) as compared with the
transseptal route. CONCLUSIONS: Morbidity of the endonasal approach to
the sphenoid sinus is comparable to that of a conventional transseptal
approach. By eliminating the submucosal dissection, the endonasal
approach reduces postoperative facial discomfort and decreases length of
surgery and hospitalization.
UI - 97182308
AU - Jho HD; Carrau RL
TI - Endoscopy assisted transsphenoidal surgery for pituitary adenoma.
Technical note.
SO - Acta Neurochir (Wien) 1996;138(12):1416-25
AD - Department of Neurological Surgery, University of Pittsburgh School of
Medicine, PA, USA.
AB - Inspired by an experience with endoscopic paranasal sinus surgery, an
endoscope was applied in transsphenoidal pituitary surgery. This
endoscopic transsphenoidal technique has been used in 45 cases of
pituitary adenomas. Using a 4 mm rigid endoscope, the pituitary
adenoma is removed through a nostril. A zero-degree endoscope is used
for micro-adenomas. A combination of a 0-degree endoscope and a
30-degree endoscope is used for macro-adenomas that have extended to
the suprasellar region. Although it is early in our experience with a
small number of patients, the short-term surgical results have been
encouraging with patients' short hospital stay and minimum morbidity.
The endoscopic technique that has evolved with our experience is
described with two cases of pituitary adenomas.
UI - 97221644
AU - Jho HD; Carrau RL; Ko Y; Daly MA
TI - Endoscopic pituitary surgery: an early experience.
SO - Surg Neurol 1997;47(3):213-22; discussion 222-3
AD - Department of Neurological Surgery, University of Pittsburgh School of
Medicine, Pennsylvania, USA.
AB - BACKGROUND: As an element of a minimally invasive management
approach, we had developed an endonasal endoscopic transsphenoidal
technique for the treatment of pituitary tumors. Initially, four
patients were operated on via a sublabial, transseptal approach using
a fiberoptic rigid endoscope in conjunction with the operating
microscope. Encouraged by that experience, our subsequent 11 patients
had undergone endonasal endoscopic transsphenoidal surgery without
the use of a retractor or speculum. METHODS: Our group of patients
included nine females and six males, with an age range of 17-88 years
(median: 43 years). There were four microadenomas, four intrasellar
macroadenomas, three macroadenomas with suprasellar extension, three
invasive macroadenomas involving the cavernous sinus with suprasellar
extension, and one metastatic adenocarcinoma. RESULTS: Thirteen
patients with pituitary adenomas experienced resolution of their
symptoms postoperatively. One patient with a recurrent prolactinoma
responded partially following surgery and subsequently underwent
gamma knife radiosurgery. Two patients were treated with postoperati-
ve fractionated radiation therapy, one for residual pituitary adenoma
in the cavernous sinus, and the other for metastatic adenocarcinoma,
respectively. The first patient, treated via an endonasal endoscopic
approach for biopsy of the metastatic adenocarcinoma, developed
postoperative cerebrospinal fluid (CSF) leak that was successfully
managed with endoscopic packing of a fat graft. CONCLUSIONS: The
endonasal endoscopic transsphenoidal approach facilitates faster
postoperative recovery by the avoidance of traditional incision and
postoperative nasal packing. It offers a panoramic view of the
sphenoid sinus and excellent visualization of the sellar and
suprasellar structures with increased illumination and magnification.
Such visualization provides the potential for more complete tumor
resection, as well as a better chance of preserving pituitary
function and avoiding neurovascular injury.
UI - 97293279
AU - Yaniv E; Rappaport ZH
TI - Endoscopic transseptal transsphenoidal surgery for pituitary tumors.
SO - Neurosurgery 1997;40(5):944-6
AD - Department of Otolaryngology, Rabin Medical Center, Petah Tiqva, Israel.
AB - OBJECTIVE: Transseptal transsphenoidal surgery of pituitary tumors is
a well-established surgical technique. The sublabial approach and the
open rhinoplasty approach are most commonly used. In both cases, the
surgical avenue is along the entire length of the nasal septum,
removing both nasal cartilage and the vomer. Septal perforations and
upper dental anesthesia are frequent complications of the standard
approaches. We describe our initial experience in using the nasal
endoscope for the first stage of the operation. METHODS: A nasal
endoscope was used to open the anterior wall of the sphenoid sinus.
Our initial incision was in the posterior third of the septum,
removing only the vomer. After the sphenoid sinus was opened, we
inserted a speculum and proceeded with the operation with an
operating microscope. After the speculum was in place, it was easier
to proceed with the microscope, which allows binocular vision and
bimanual operation. RESULTS: The procedure was used for our most
recent 14 consecutive patients with pituitary adenomas. No complicat-
ions related to the approach were encountered for any of the patients
in follow-up monitoring. CONCLUSION: The endoscopic transseptal
approach to the sphenoid sinus for pituitary surgery was found to be
easy, time-saving, and without septal or sublabial complications.
UI - 97345772
AU - Jho HD; Carrau RL
TI - Endoscopic endonasal transsphenoidal surgery: experience with 50
patients.
SO - J Neurosurg 1997;87(1):44-51
AD - Department of Neurological Surgery, University of Pittsburgh School of
Medicine, Pennsylvania, USA.
AB - An endoscope was used in transsphenoidal surgery and eventually
replaced the operating microscope as the tool for visualization. This
study focuses on 50 patients (28 females and 22 males) with a median
age of 38 years (range 14-88 years). Initially, four patients
underwent operation via a sublabial-transseptal approach using a
rigid endoscope in conjunction with an operating microscope. The 48
subsequent operations were performed through a nostril using only
rigid endoscopes. Forty-four patients had pituitary adenomas and six
had various other lesions. Thirteen patients had microadenomas, 16
had intrasellar macroadenomas, nine had macroadenomas with suprasell-
ar extension, and six had invasive macroadenomas involving the
cavernous sinus. Seven patients had recurrent pituitary adenomas and
25 had hormone-secreting adenomas (eight patients with Cushing's
disease and 17 patients with prolactinomas). Among the eight patients
with Cushing's disease, seven had resolution of hypercortisolism
clinically and chemically. Of the 17 patients with prolactinomas, 10
improved clinically with normal serum prolactin levels, four improved
clinically with elevated serum prolactin levels, and three had
residual tumors in the cavernous sinus. Among the 19 patients with
nonsecreting adenomas, 16 underwent total resection and three
subtotal resection leaving residual tumor in the cavernous sinus.
Postoperatively, all patients who had undergone endonasal endoscopic
surgery had unobstructed nasal airways with minimal discomfort. More
than half of the patients required only an overnight hospitalization.
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