Endoscopic pituitary surgery: Techniques, tips and tricks, nuances, and complication avoidance

Sharma, Bhawani S.; Sawarkar, Dattaraj; Suri, Ashish

doi:10.4103/0028-3886.185352

Cited by 17 publications

(12 citation statements)

References 6 publications

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“…Patients with a nonfunctioning adenoma confined to sella in a well-pneumatized sphenoid sinus are the best cases. [6] Preoperative planning with meticulous study of MRI and CT of the patient is of paramount importance. Sphenoid sinus anatomy is specific for each individual like as is the case with finger prints.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] The benefits of endoscope are tangible, however, there are certain disadvantages such as two-dimensional view, limited zoom and focus capability, and the need for two surgeons. [6] More importantly, shifting from microscope to endoscope needs a different set of skills. In this series, we present our experience during the first 83 cases and the lessons learned during this journey.…”

Section: Introductionmentioning

confidence: 99%

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Avoiding complications in endoscopic trans-sphenoidal surgery for pituitary adenoma: A beginner's perspective

et al. 2020

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Introduction: We aimed to analyze the difficulties and complications experienced while as a beginner in endoscopic transnasal transsphenoidal approach for pituitary adenomas. Materials and Methods: We retrospectively analyzed 83 cases done from June 2016 to August 2019. Navigation-guided endoscopic transnasal transsphenoidal approach was used in all the cases. Results: Gross total tumor removal was achieved in 55 (66.26%) patients. We found that gross total resection rate was inversely proportional to Knosp grading, and the extent of resection was found to have a statistically significant correlation with grade of tumor ( P < 0.05). Surgery-related complications were present in 33 of our patients. Nasal complications occurred in six patients: three epistaxis (3.6%) and two hyposmia (2.4%) and one case of septal hematoma (1.2%). Postoperative cerebrospinal fluid leak occurred in six (7.2%) cases, two (2.4%) cases had sinusitis, while two (2.4%) cases had meningitis. There was a very rare case of subarachnoid hemorrhage and one case had sellar hematoma. Endocrinologic complications occurred in 15 (18.07%) patients: anterior pituitary deficiency in five (6.02%) patients, transient diabetes insipidus (DI) in nine (10.84%) patients, and permanent DI in one (1.2%) patient. There was no vascular injury or mortality noted in our study. Conclusion: Endoscopic approach is an effective modality for pituitary surgery; with patience, learning lessons from your own mistakes and by adopting right technique, learning curve can be flattened significantly.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Avoiding complications in endoscopic trans-sphenoidal surgery for pituitary adenoma: A beginner's perspective

et al. 2020

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“…The principal major complications anticipated are vascular injury and orbital and intracranial complications which vary from 1 to 3% ( Table 2). The most frequent immediate complications are CSF leak, intraoperative bleeding, orbital hematoma and injury to brain (27,28). Delayed complications include progressive loss of vision (24) or smell, meningitis, bleeding, synechiae, and infection.…”

Section: Discussionmentioning

confidence: 99%

“…These can be divided into two major categories: (1) Nonendocrinal; and, (2) endocrinal complications- (27,28) (Table 1).…”

Section: Complications and Their Avoidancementioning

confidence: 99%

Trans-nasal Trans-sphenoidal Endoscopic Hypophysectomy

Varshney

2020

ANAMS

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Advances in optics, miniaturization, and endoscopic instrumentation have revolutionized surgery in the past decades. Current progress in the field of endoscopy promises to further this evolution: endoscopic telescopes and instruments have improved upon the optical and technical limitations of the microscope, and require an even less invasive approach to the sella. The minimally invasive endoscopic pituitary surgery is performed through the natural nasal pathway without any incisions and is performed via Trans-nasal Trans-sphenoidal approach. pituitary surgery is traditionally within the realm of the neurosurgeon. However, since the introduction of the endoscopic transnasal transsphenoidal approach to the sella turcica for resection of pituitary adenoma, otolaryngologists have been active partners in the surgical management of these patients. Otolaryngologists have lent their expertise in nasal and sinus surgery, assisting the neurosurgeon with the operation. The otolaryngologist has the advantage of familiarity with the techniques and instruments used to gain exposure of the sella turcica by transnasal approach. Hence, the otolaryngologist provides the exposure, and the neurosurgeon resects the tumour. Such collaboration has resulted in decreased rates of complication and morbidity.We hereby discuss our experience of treating 72 cases of pituitary tumour by endoscopic trans-nasal trans-sphenoidal approach. In our study, conducted from 2005 to 2016, the mean age of patients was 32.5 years (18-56 years), Male and female ratio was 1.3:1.0, MRI was done in all the cases, CT scan was done in 94.44 % cases, 9.72% cases had Intra op./ post op. complications which were managed successfully. Subtotal resection could be done in 6.94% cases, recurrence was seen in 7.46% cases and lumbar drain was required in 4.17 % cases. Average hospital stay was 4.4 days and average surgery time was 120 minutes. Close follow-up was maintained for an average period of 09 months. In our experience of 10 years, adopting the endoscope heightens the surgeons' visualization of pituitary tumors, thus no external incision, no nasal packing and minimal stay with minimal complications. Endoscopic transsphenoidal approach is the less traumatic route to the sella turcica, avoiding brain retraction, and also permitting good visualization, with lower rates of morbidity and mortality.

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“…This technique has the advantages of clear visual field, less blind area, less trauma, flexible observation angle, high total tumor resection rate, rapid recovery after surgery, and others. The endoscopic endonasal approach (EEA) has become the main surgical method for resection of pituitary adenomas [14]. Its excellent postoperative results have shown that this surgical procedure is effective not only for saddle adenomas but also for the giant pituitary adenomas invading the suprasellar region.…”

Section: Introductionmentioning

confidence: 99%

Clinical study of endoscopic treatment of a sellar pituitary adenomas with sellar diaphragm defect

Jin

Wang

2020

BMC Neurol

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Background: Invasive growth of pituitary macroadenomas to the suprasellar region occurs commonly. Pituitary adenomas show varying growth patterns when the sellar diaphragm is absent, and they are often confused with other common tumors in the sellar region. This article explores the clinical features of suprasellar pituitary adenomas with defects of the sellar diaphragm (SPADSD) and evaluates the efficacy of the endoscopic endonasal approach (EEA) for treatment of such tumors. Methods: We performed a detailed examination of records from 19 patients collected prior to surgery. After relevant diseases were excluded, the tumor properties were evaluated according to imaging characteristics. Diagnoses were verified using EEA surgery. The concept of SPADSD was put forward. Postoperative recovery was followed to determine whether EEA is suitable for the treatment of such tumors. Results: In the 19 patients with SPADSD, we found that the tumors were less stressed on the pituitary, and tumors in the suprasellar region often had irregular shapes. During surgery, we took extended supra-saddle approaches and confirmed that unrestricted growth of the tumor was caused by defects in the diaphragm of the sella turcica to the suprasellar region. Recovery was good after surgery, confirming the efficacy of EEA for treatment of these tumors. Conclusion: SPADSD has different clinical features from those of other pituitary tumors and requires careful screening prior to surgery. Endoscopic surgery is the preferred procedure for this type of tumor.

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Endoscopic pituitary surgery: Techniques, tips and tricks, nuances, and complication avoidance

Cited by 17 publications

References 6 publications

Avoiding complications in endoscopic trans-sphenoidal surgery for pituitary adenoma: A beginner's perspective

Avoiding complications in endoscopic trans-sphenoidal surgery for pituitary adenoma: A beginner's perspective

Trans-nasal Trans-sphenoidal Endoscopic Hypophysectomy

Clinical study of endoscopic treatment of a sellar pituitary adenomas with sellar diaphragm defect

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