Microscopeguided endonasal transsphenoidal approach the. A lmost a century ago in 1907, the transnasal transsphenoidal approach to lesions of the sella turcica was first intro. Variations on the standard transsphenoidal approach to the. Transsphenoidal surgery is well established as an effective primary treatment for tumors of the sellar region. We modified the traditional endonasal approach and sellar floor repair and tried to compare the advantages of our procedure to the other traditional. Transsphenoidal surgery for pituitary tumors precare. Transsphenoidal surgery is the mainstay of treatment for most kinds of pituitary adenomas and other sellar masses. On the early postoperative mr scans, 69 patients who underwent transsphenoidal resection and intrasellar packing with fat only showed high signal intensity on the precontrast t1weighted image where the tumor was located figs 1 and 2. The radiologist requires a thorough knowledge of the normal anatomy and the pathological spectrum of this region. The neurosurgeon did 61548 and our physician said he did 30520, 3128750, 31240lt, and 30930. Endoscopic endonasal transsphenoidal approach thieme connect. When the endoscope is used in transsphenoidal surgery, jho and alfieri 2000 recommend first to conduct endoscopeassisted microsurgery, followed by endoscopic sphenoidotomy assisted by a rhinologist, and then to proceed with the endoscopic endonasal transsphenoidal approach 1.
Transsphenoidal approaches to anterior skull base lesions. Endoscopic endonasal transsphenoidal surgery springerlink. Objectives transsphenoidal surgery tss is the preferred method for the excision of pituitary microadenomas in adults. Because of cushings influence in the neurosurgical community, the transsphenoidal approach was virtually abandoned in the united states. These include the transnasal paraseptal, sublabialtransseptal, and paranasal transethmoidal approaches.
The feasibility of a purely endoscopic extended transsphenoidal approach to remove suprasellar lesions has been reported previously, but few cases have been. Fluoroscopy was used in 69 cases and vascular microdoppler with neuronavigation were used in 72 cases. They did a transsphenoidal pituitary tumor together where our physician opened and assisted the neurosurgeon. Pure endoscopic endonasal transsphenoidal surgery has been re cently recommended by jho et al. Pdf anesthesia for transsphenoidal pituitary surgery. It can also be used to biopsy or treat midline skull base lesions from the planum sphenoidale to the clivus.
The use of neuronavigation with vasular microdoppler in. Pdf endoscopic endonasal transsphenoidal approach for. With the development of modern microinstrumentation and the use of the operating microscope, transsphenoidal surgery has proven to be a safe and effective method of. This study was carried out to establish the long term efficacy and safety of tss in children. An overview of transsphenoidal surgery and pituitary irradiation for the primary therapy of. The first report of the transsphenoidal approach for the resection of a pituitary adenoma was made by schloffer in 1907. Endoscopy has obviated the need to resect pituitary tumors through the transcranial corridor. The pituitary gland is attached to the brain and sits behind the bridge of the nose. Endoscopic endonasal transsphenoidal approach request pdf. The transsphenoidal approach has become the preferred route of access to parasellar lesions such as pituitary adenomas, meningiomas, and craniopharyngiomas. Indications for transcranial approach to the pituitary gland large intracranial element of the tumour that is unlikely to be accessible during transsphenoidal surgery, then this approach should be considered. In a transsphenoidal approach, three different routes may be taken to reach the pituitary tumor. Transsphenoidal surgery is the most preferred method in pituitary adenomas disadvantages of transsphenoidal approaches are sellas deeply location, adjacent of carotid artery and 2 dimentions images with flouroscopy 1 22 23.
History of the transsphenoidal endoscopic surgical. It may also go directly through the nostrils or through an incision made on the nasolabial furrow. Tell your surgeon about all medicines you currently take. Transsphenoidal definition of transsphenoidal by medical. Study design a 14 year retrospective analysis was carried out on 23 children 16 boys and seven girls, all less than 18 years of age, who had undergone tss at our centre. Case example transphenoidal approach to pituitary tumor return to. I am with otolaryngology and one of our physicians has done a case with a neurosurgeon. The transsphenoidal approach is contraindicated when the sellar lesion involves the brain 7, 8, cavernous sinus, or middle fossa 1,7,9. It is often a team effort between neurosurgeons and ear, nose, and throat ent surgeons. Preoperative radiographic and clinical factors associated. To evaluate the use of neuronavigation with vascular microdoppler in transsphenoidal pituitary surgery. Sublabial transsphenoidal approach and resection of. Various types of anesthetic techniques have been tried for general anesthesia in patients undergoing an endoscopic approach for transsphenoidal resection of pituitary tumors in order to reduce.
Endoscopic pituitary and skull base surgery anatomy and surgery of. Request pdf endoscopic endonasal transsphenoidal approach clival chordomas are lesions located at the anterolateral aspect of the brainstem, involving the extradural and seldom the intradural. Patients who fail this first approach can be treated either by repeat transsphenoidal surgery, medical therapy, radiotherapy, or, as a final resort, surgical or medical adrenalectomy. The book is a useful addition to the library of all surgeons who deal with skull base cranial surgery, and provides outstanding information and reference sources for complex skull base procedures amenable to the transsphenoidal approach.
Transsphenoidal surgery is a type of surgery in which an endoscope andor surgical instruments are inserted into part of the brain by going through the nose and the sphenoid bone a butterflyshaped bone forming the anterior inferior portion of the brain case into the sphenoidal sinus cavity. Cushing eventually abandoned the transsphenoidal approach, returning to the transcranial method for unknown reasons. Transnasal transsphenoidal approach to pituitary iowa. Pituitary surgery california center for pituitary disorders. For transsphenoidal surgery, there are several alternative approaches to the sphenoid sinus. Neuroendoscopy, nasal cavity surgery, pituitary neoplasm, pituitary adenoma, sphenoid. Transsphenoidal surgery has a lot of risks due to sellas deep.
Important considerations regarding the specific approach to the sphenoid are the size of the nose and nostril, the pres. The indications and the intraoperative technique of absolute alcohol app. Pituitary adenoma, surgical technique, transsphenoidal surgery neurosurgery 51. Pedicled nasoseptal flap hadadbassagasteguy flap protocol click on videos below to active.
Post operative instructions after transsphenoidal surgery this information is intended to answer questions you may have after your tss pituitary surgery. Endoscopic endonasal transsphenoidal approach to large and giant. Background recent advances in surgical techniques have enabled surgeons to approach previously inoperable deepseated lesions of the skull base. However, sellar lesions in children are more difficult to approach because of the smaller size of the pyramidal aperture and because of the limited pneumatization of the sella. The radiology of endoscopic endonasal transsphenoidal.
Surgical approach to pituitary adenoma linkedin slideshare. Initially operations were performed often without any input from endocrinology colleagues, and without preoperative imaging, operative magnification and illumination. There are many kinds of transsphenoidal approach techniques that have been introduced and developed over the past several decades. Transsphenoidal literally means through the sphenoid sinus. Endoscopic endonasal transsphenoidal surgery of 1,166 pituitary. Transpalatal transsphenoidal approach to the sella in children. Over the last century, the transsphenoidal approach has evolved into the firstline method of treatment for sellar as well as select groups of parasellar and suprasellar lesions. Advances in endoscopic skull base surgery have allowed for the resection of larger and more complex pathologies, leading to larger skull base defects, necessitating the development of complex skull base repair techniques. The transseptal transsphenoidal approach to pituitary.
Arrange to have someone drive you home after surgery. It is a surgery performed through the nose and sphenoid sinus to remove pituitary tumors fig. Transnasal transsphenoidal approach to pituitary transnasal transsphenoidal approach to pituitary see. Advances in the understanding of the biology of pituitary tumours, close cooperation between endocrinologists, surgeons and oncologists, and huge advances. Cryptococcal meningitis after transnasal transsphenoidal. Managing the patient with transsphenoidal pituitary tumor resection wen yuan abstract patients who undergo transsphenoidal pituitary tumor resection require a multidisciplinary team approach, consisting of a neurosurgeon, an endocrinologist, and nurses. Followup 6 months mr imaging showed this implanted fat remained with partial resorption. Endoscopic endonasal transsphenoidal surgery of 1,166. The most common complication is diabetes insipidus di, especially in patients with. Managing the patient with transsphenoidal pituitary tumor. Using a microscope or an endoscope, they can navigate through these passages and remove the tumor through the nose without needing to make an incision in face or drill through the skull. Anatomy and surgery of the endoscopic endonasal approach pdf. These procedures include sublabial, transcolumellar, endonasal, and endoscopy assisted approaches. Pdf endoscopic endonasal transsphenoidal approach in the.
Transsphenoidal surgery complication avoidance and. Request pdf endoscopic endonasal transsphenoidal approach the standard endoscopic endonasal transsphenoidal approach to the sella is suitable for the removal of pituitary tumors, both. Endoscopic endonasal transsphenoidal approach for pituitary adenomas. Endoscopic endonasal transsphenoid surgery of pituitary adenoma. The transseptal transsphenoidal approach allows the surgeon to reach lesions located in the middle of the skull base and is widely accepted as the procedure of choice for the surgical treatment of pituitary adenomas with a primary sellar extension. Transsphenoidal hypophysectomy published on apr 1971 by journal of neurosurgery publishing group. Endoscopic transnasal transsphenoidal approach for. Sublabial transsphenoidal approach and resection of pituitary tumors suboccipital craniectomy for microvascular decompression of the trigeminal nerve or facial nerve or cerebellopointine angle tumor splitting the sylvian fissure, drilling of the anterior clinoid process and ophthalmic aneurysm clipping. Endoscopic endonasal transsphenoidal approach in the. Free fulltext pdf articles from hundreds of disciplines, all in one place. The entry point may be through an incision cut made under the upper lip and over the teeth. The direct transsphenoidal approach in pituitary adenoma resection under endoscopic assistance is time saving, and safe, with good exposure of operative field. With transsphenoidal surgery, surgeons approach the pituitary gland through the nose and sphenoid sinus transsphenoidal means through the sphenoid sinus. The journey to its current popularity has been marked by controversy and near abandonment in the late 1920s, followed by its renaissance in the late 1960s.
The transseptal transsphenoidal approach to pituitary tumors. Mcdermott, md the transphenoidal approach to intracranial lesions is most commonly used for pituitary tumors. Pdf transsphenoidal approaches have been used for a century for the resection of pituitary and other sellar tumors. The sublabial transseptal transsphenoidal approach provides excellent exposure for pituitary surgery in adults. Dumbbellshaped tumors constricted at the diaphragm are best approached transcranially 1, 4. Transsphenoidal surgery has evolved much over nearly 100 years. If evidence of significant csf escape during the operation is found, especially during an extended transsphenoidal approach, a lumbar subarachnoid drain should be placed in the patient for several days after the operation.
Here, we report a case of 37yearold male who had cryptococcal meningitis after transnasal transsphenoidal pituitary microsurgery of a relapsing acthsecreting pituitary adenoma. Transsphenoidal surgery can be performed with an endoscope, microscope, or both. Transsphenoidal hypophysectomy was introduced by cushing in 1910 and reemerged as the standard approach for pituitary tumors with microsurgical technique in the 1960s. Transsphenoidal surgery is used to remove tumors of the pituitary gland. However, the advent of endoscopic extended transsphenoidal approach eetsa has expanded its indication to suprasellar craniopharyngiomas. Modified endonasal transsphenoidal approach sciencedirect. Transsphenoidal surgery for pituitary tumours archives. Transsphenoidal approaches to anterior skull base lesions g. At the beginning of our century, in 1906, schloffer was the first to describe an extradural approach to the pituitary gland schloffer 1906, 1907, and thus became a pioneer of numerous similar approaches with the common goal of removing pituitary adenomas without craniotomy, for in those days subfrontal craniotomy caused much greater strain and risk for the patient than now. Pdf to assess the clinical curative effect of the endonasal transsphenoidal approach for removing pituitary adenoma pa under. Transsphenoidal surgery for pituitary tumors is done to remove a tumor on the pituitary gland.
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