Endoscope or Microscope?

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The authors compare the views afforded by the operating microscope and the endoscope in the direct endonasal extended transsphenoidal approach to the sellar, suprasellar, and parasellar regions.


Five formalin-fixed, silicone-injected adult cadaveric heads were studied. A direct endonasal transsphenoidal approach was performed via the right nostril, pushing aside the nasal septum. The approach was performed with the microscope first, then with the endoscope. For each step (sellar, suprasellar, and clival), the exposure afforded by direct microscopic view was measured and then compared with that obtained using the endoscope. The direct endonasal approach provides a slightly off-midline view. Although the microscope provides an adequate view of the midline structures and part of the contralateral parasellar areas, the addition of the endoscope allows for a more panoramic view and permits widening of the approach in all directions.


An adequate exposure of the sellar, suprasellar, and infrasellar/upper clival regions can be achieved via a simple, direct endonasal approach. From a direct endonasal route, there is a preferential visualization of the structures contralateral to the approach. The endoscope affords a more panoramic view that extends the area covered by the operating microscope.

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    Upper: Diagram summarizing each of the approaches used: transethmoidal (A), transnasal–transsphenoidal (B), and sublabial–transsphenoidal (C). Note the differences in trajectory to the sella and suprasellar region. Inset a: Coronal view of the sella illustrating the zero point along the dorsum sella from which the right and left distances were measured. ICA = internal carotid artery; PC = posterior clinoid. Inset b: Sagittal view of the sella illustrating where the superior and anterior (Ant) distances were measured. Lower: Graph demonstrating the difference in the volume of the area visualized using each approach. Endos = endoscopy; Micros = microscopy. (Figures used with permission from Lippincott, Williams & Wilkins. Originally published in Spencer WR, Das K, Nwagwu C, et al: Approaches to the sellar and parasellar region: anatomic comparison of the microscope vs. endoscope. Laryngoscope 109:791–794, 1999).



Spencer WRDas KNwagwu CWenke ESchaeffer SDMoscatello A: Approaches to the sellar and parasellar region: anatomic comparison of the microscope vs. endoscope. Laryngoscope 109:7917941999


de Divitiis E: Endoscopic transsphenoidal surgery: stone-in-the-pond effect. Neurosurgery 59:5125202006




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