Artikel
Endoscope-assisted microscopic endonasal transsphenoidal pituitary surgery
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Autoren
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K. Kurisu
- Department of Neurosurgery, Hiroshima University Hospital
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A. Tominaga
- Department of Neurosurgery, Hiroshima University Hospital
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K. Eguchi
- Department of Neurosurgery, Hiroshima University Hospital
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T. Sakoguchi
- Department of Neurosurgery, Hiroshima University Hospital
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K. Arita
- Department of Neurosurgery, Kagoshima University Hospital
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: To evaluate the efficacy and demonstrate the decreased invasiveness of endoscope-assisted microscopic endonasal transsphenoidal pituitary surgery (TSS) compared to former microscopic TSS.
Methods: After 2003, we have performed endoscope-assisted microscopic endonasal TSS in 71 patients (62 pituitary adenomas and 9 Rathke’s cleft cysts). We make a mucosal incision along the joint of nasal septum cartilage and bony septum of the vomer and dissect nasal mucosa to reach the anterior wall of the sphenoid sinus. After this procedure using a smaller speculum, we proceed in the same manner as with TSS. We use a rigid type endoscope with an angle of 30 and 70 degrees to get a lateral (cavernous sinus) and superior (hypothalamic) view.
Results: In cases of 27 hormone inactive adenomas, total removal was achieved in 22 cases. In 21 GHomas, normalization of GH level was obtained after removal in 13 cases (12 cases in 13 Knosp 0-2 grades). In 10 PRLomas, 9 cases were normalized after operation (all normalized in 9 Knosp 0-2 grades). No side effect was observed in these 71 cases.
Conclusions: 1) Endonasal TSS is a less invasive approach and needs shorter operating time. 2) Under endonasal TSS, we need an endoscope to get wide operating view in the blind corner underthe microscope. 3) The advantage of endoscope-assisted microscopic TSS has a higher accuracy in the management of complicated situations such as massive bleeding and high consistency of the tumor, etc.
