Background: Craniocervical chordoma representing a challenge for surgeons. The endoscopic transoral approach is used for treatment. Additional exposure is required. However, its benefits are not sufficiently addressed. Aim: To evaluate the use of endoscopy in the transoral approach and the benefits of additional exposure in cases of craniocervical chordomas. Patients and Methods: in this study, 12 patients had a confirmed diagnosis of chordoma after histopathological examination due to the presence of craniocervical destructive lesions. The author performed all surgical cases using a microscopic transoral approach in 6 patients, an endoscopic-assisted microscopic transoral approach in 3 patients, and a purely endoscopic transoral approach in 3 patients. Eight patients required posterior cervical fusion according to the extent of instability. Preoperative and postoperative data were collected, including radiological examination and clinical status data. Results: in this study, 12 patients were evaluated clinically and radiologically. It was found that the use of endoscopic assistance in the microscopic transoral approach, or the use of the purely endoscopic transoral approach, added greater angles of exposure of the tumors that could not be reached when using a microscope alone. This led to greater tumor removal and excision with the same precautions and safety for the patient using these approaches compared with the use of the microscopic approach alone. The use of endoscopy alone minimized the incision of the posterior pharyngeal wall and led to good healing, which is an important goal in this field and additional angles of view. Conclusion:The use of endoscopy either for assistance in the microscopic transoral approach or alone led to the safe implementation and greater extent of tumor removal and excision. We recommend the use of endoscopy in such cases.

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Background: The most important goal in endoscopic pituitary surgery is bloodless field with better visualization under hemodynamic stability and good analgesia to improve the outcome, the current study was performed to evaluate the intraoperative anesthetic and postoperative analgesic effects of bilateral sphenopalatine ganglion block(SPGB)as adjuvant to general anesthesia in endoscopic transsphenoidal resection of pituitary adenoma. Patients and methods: Thirty patients(ASA I-II)aged 22-55 years, randomly assigned into two equal groups. After stabilization of general anesthesia, the patients received bilateral sphenopalatine ganglion block with 2ml of either2% lidocaine: 1:200000 epinephrine (SPGB group) or sterile normal saline (control group). Mean arterial blood pressure was maintained at 60-70mmHg by using nitroglycerine. Intraoperative MAP and heart rate, Nitroglycerine and propranolol consumption, blood loss, average category scale, emergence time were recorded. Also, pre and postoperative plasma B-endorphin, VAS and time of the first request for analgesia, the total dose of meperidine consumption in the first 24hours postoperatively, patient's satisfaction and postoperative complication were recorded. Results: Sphenopalatine ganglion block group showed decrease in blood loss(P<0.001), ACS(P<0.01), nitroglycerine consumption(P<0.0001)and emergence time(P< 0.001). At PACU, visual analog pain score were lower in SPGB at 0,1,6(P<0.001), there were a high difference between two groups in B-endorphin levels(P<0.001)and also in dose of meperidine, % of patients needs analgesia and patients satisfaction(P<0.002), Conclusion: Use of sphenopalatine ganglion block with general anesthesia is a safe and effective technique, it contributes in adequate intra and postoperative analgesia needed for stabilization of hemodynamics with less blood loss, improving the quality of surgical field instead of controlled hypotensive technique during endoscopic endo-nasal trans-sphenoidal hypophysectomy.

Background: Advances in the era of modern micro-neurosurgery enabled a reduction of surgical invasiveness and brain retraction which has been defined as minimally invasive or keyhole surgery. Sinonasal endoscopy has brought radical changes in the concepts of pathophysiology and treatment of sinonasal aliments as well as surgical techniques. Aim of the Study: To compare between the use of endoscopic and microscopic trans-sphenoidal approach in resection of growth hormone-secreting pituitary adenomas with Suprasellar Extension. Patients and Methods: This is a prospective study. It had been conducted upon 20 patients having growth hormone secreting pituitary adenoma admitted to Neurosurgery department in Alzar University hospitals and Nasr City Insurance hospital from 2015 to 2018, divided into 2 groups; group A (10 cases) underwent endoscopic endonasal trans-sphenoidal pituitary adenoma resection, while group B (10 cases) operated upon using the standard microscopic trans-sphenoidal pituitary adenoma resection. The inclusion criteria were included: All patients with growth hormone secreting pituitary adenomas showing manifestations of acromegaly, mass effect or hormonal disturbance. Results: This study showed that improvement in outcome was higher in endoscopic group opposed to microscopic group (100% vs. 71% improved headache, 80% vs. 60% visual improvement, 75% vs. 20% fundus improvement and 60% vs. 30% field improvement). Conclusion: We concluded that fully endoscopic procedure result in improved rates of complete tumor removal and a reduced incidence of complications, when compared to the microscopic approach.

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