Endoscopic Image‐Guided Transethmoid Pituitary Surgery

Thomas, Roy F.; Monacci, William; Mair, Eric A.

doi:10.1067/mhn.2002.129821

Cited by 33 publications

(17 citation statements)

References 17 publications

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“…10,11,15,19,21 There was no need to remove the middle turbinate in any of our cases, which is aligned with the intention of other groups that always seek to preserve the middle turbinate whenever possible. 16,25,27,30,33,36,38 Topical use of cottonoids with adrenalin at 1:1000 may have helped to locate the ostium of the sphenoidal sinus.51 Intense vasoconstriction and decreased mucosal edema resulting from the use of adrenalin facilitate the approach to the sphenoethmoidal recess without the need to remove the middle turbinate partially or totally.…”

Section: Discussionsupporting

confidence: 48%

“…10,12,[17][18][19][20] Those that defend the bilateral approach underline the possibility of conflict between the endoscope and other surgical tools due to lack of space when the approach is done through one nostril only. [21][22][23][24]26 The bilateral transnasal endoscopic approach was used in all of the surgical procedures in this paper. One of the reasons for this choice is the increased comfort in using surgical tools in one nostril and the endoscope in the other.…”

Section: Resultsmentioning

confidence: 99%

“…A mechanical device is used to fixate the endoscope (a mechanical arm or holder); after the sphenoidal sinus is opened, the endoscope is fixated, leaving the neurosurgeon with both hands free to perform the procedure. 7,8,12,17,18,21,22,25,[27][28][29][30][31][32] Other authors prefer not to use an endoscope with a holder 14,15,19,20,24,26 . In the current study we did not use endoscope holders, as one of the most important advantages of the endoscope is its mobility; it can be rapidly repositioned without having to be released and refixated.…”

Section: Discussionmentioning

confidence: 99%

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Acesso endoscópico transnasal aos tumores selares

Santos

Zymberg

Filho

et al. 2007

Rev. Bras. Otorrinolaringol.

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Transsphenoi dal surgery for sellar region tumors is traditionally done only by neurosurgeons. The use of endoscopes has permitted a direct transnasal approach to the sphenoidal sinus, without dissection of the septal mucosa, reducing postoperative morbidity. Aim: The purpose of this study was to assess the technical difficulties, and per and postoperative complications of the otolaryngological management of the endoscopic transnasal approach to the sellar region. Material and Method: 159 patients undergoing sellar region surgery between March 2001 and December 2006 were assessed retrospectively. 91 patients who underwent 95 endoscopic transnasal procedures were included in this study. Study design: a clinical retrospective study. Results: The endoscopic transnasal technique was feasible for every patient, independent of age, anatomical variations, tumor characteristics, tumor etiology, and previous surgical history. There was no need to remove the middle turbinate or septal deviations in any of the cases. The most significant peroperative complication was CSF leak during tumor removal (13.68%). Postoperative complications were: nasal bleeding (8.42%), CSF leak (8.42%), and meningitis (2.19). Conclusion: The transnasal endoscopic approach was accomplished with minimal invasion, preserving nasal structures in all 95 procedures, independent of age, anatomical variations, tumor characteristics,tumor etiology, and previous surgical history.

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Section: Discussionsupporting

confidence: 48%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Acesso endoscópico transnasal aos tumores selares

Santos

Zymberg

Filho

et al. 2007

Rev. Bras. Otorrinolaringol.

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“…The endoscopic endonasal approach avoids transseptal dissection, thus reducing patient discomfort and postoperative pain. The endoscope has increasingly been used in pituitary surgery since the mid 1990s either in conjunction with the microscopic technique (24) or as a pure endoscopic procedure (18,25,26). Especially the better panoramic visualization of sellar, supra-and parasellar anatomy with increased illumination and magnification are recognized as major advantages offered by the endoscopic technique (21,25,27).…”

Section: Introductionmentioning

confidence: 99%

Transsphenoidal pituitary surgery via the endoscopic technique: results in 35 consecutive patients with Cushing’s disease

Netea‐Maier

Lindert²,

Heijer³

et al. 2006

eur j endocrinol

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Objective and design: The endoscopic technique has been recently introduced in the field of transsphenoidal pituitary surgery. This technique allows inspection of sellar, supra-and parasellar structures and removal of the tumor under direct visualization, is minimally traumatic and permits easier reoperations. This is the first report on the results of endoscopic surgery for patients with Cushing's disease. Our aim was to retrospectively analyze the results of pituitary surgery in 35 consecutive patients with Cushing's disease operated in our hospital after the introduction of the endoscopic technique (1998 -2004). Methods: Remission was defined as suppression of plasma cortisol (# 50 nmol/L) after 1 mg dexamethasone overnight determined in the first 3 months after surgery and disappearance of clinical signs and symptoms of hypercortisolism. The patients were followed for an average of 27 months (range 4 to 81 months, median 20 months). Results: Pituitary MRI showed a macroadenoma in 6 patients, a microadenoma in 17 patients and no adenoma in 12 patients. After the initial surgery 27 patients (77%) were in remission. None of the patients had a relapse during follow-up. In the remaining 8 patients hypercortisolemia persisted after surgery. Three of them had a second endoscopic pituitary surgery resulting in remission in two patients. In one patient a second endoscopic pituitary surgery will soon follow. The remaining four patients were treated with radiotherapy postoperatively. Two of them were at the time of data collection in remission. One patient from the remission group had a serious epistaxis and three patients had cerebrospinal fluid leakage, one requiring an external lumbar drain, shortly after surgery. No complications were recorded in the failure group. Postoperatively 34% of all patients required substitution with levothyroxine, 40% required substitution with glucocorticoids, 17% received estrogens or testosterone and 6% still required desmopressin. Conclusions: Endoscopic transsphenoidal pituitary surgery resulted in our series of patients with Cushings disease in an excellent postoperative remission rate. A randomized clinical trial, comparing endoscopic and conventional pituitary surgery in patients with Cushings disease, is needed to determine the pros and cons of both techniques.European Journal of Endocrinology 154 675-684

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“…Также CANS широко применяется при трансна-зальных хирургических вмешательствах на гипофизе [41]. При опухолях, локализация которых связана с ОЧ, благо-даря FESS и CANS в большинстве случаев можно избе-жать краниофациальной резекции, удалив при этом опу-холь единым блоком или частями [6,[42][43][44][45].…”

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