Endoscopic endonasal transsphenoidal surgery: experience with 50 patients

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✓ 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 suprasellar extension, and six had invasive macroadenomas involving the cavernous sinus. Seven patients had recurrent pituitary adenomas and 25 had hormonesecreting 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.

Article Information

Address reprint requests to: Hae-Dong Jho, M.D., Ph.D., Department of Neurological Surgery, Presbyterian University Hospital, Suite B-400, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213.

© AANS, except where prohibited by US copyright law.

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    Coronal (left) and sagittal (right) preoperative MR images obtained in a 33-year-old man who developed a visual disorder with a recurrent pituitary adenoma. The patient had previously undergone sublabial, transseptal, transsphenoidal resection of the pituitary adenoma twice, followed by conventional fractionated radiation treatment.

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    Upper: Schematic drawing showing an endonasal endoscopic approach to the sella. No septal or alar incision is required. No speculum or retractor is used. Center and Lower: Intraoperative photographs. Center: An endoscope is held in the surgeon's nondominant hand until an anterior sphenoidotomy is performed. Lower: Once the anterior sphenoidotomy is completed, the endoscope is mounted to an endoscope holder. This will provide the surgeon with a steady video image in addition to freeing both hands to maneuver surgical instruments simultaneously.

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    Upper: Endoscopic view using a rigid endoscope with a 30°-angled lens after resection of the tumor shown in Fig. 1, demonstrating the bilateral optic nerves and optic chiasm. Lower: A close-up view revealing the optic system and the anterior cerebral arteries behind the arachnoidal membrane.

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    Coronal (left) and sagittal (right) postoperative MR images obtained in the patient described in the legend for Fig. 1, showing complete resection of the tumor and decompression of the optic system.

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    Left: Sagittal MR image showing a craniopharyngioma at the sellar and suprasellar regions. The pituitary stalk was sectioned proximal to the origin of a craniopharyngioma. Right: Endoscopic view showing the optic nerves, optic chiasm, and stump of the pituitary stalk (30°-angled lens).

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