gms | German Medical Science

Objective: The disadvantages of the microscope used for the transsphenoidal approach to the sella and the perisellar region include limited vision of anatomical landmarks and limited illumination when fully zoomed which result in a limited area of action confined only to the intrasellar space. Meticulous and gentle dissection within the supra- and parasellar space is not possible. The endoscope brings the light to the target and provides a wide angled view of all the important structures within the sphenoid sinus. We report on our experiences.

Methods: During the last 3 years 131 procedures were carried out in 122 patients using only the endoscope via an endonasal transsphenoidal approach. CT- and MRI-based image guidance was used routinely. We did not use an endoscope holder or irrigation system. Histology included 107 pituitary adenomas, 3 craniopharyngiomas, 3 chordomas, 2 meningiomas and 7 other lesions. The mean age of the patients was 47.9±15.1, min. 4 years.

Results: In 86.8% of the hormone inactive adenomas, radical tumor removal could be achieved. Endocrinological cure was achieved in 58.3%, 80%, 87.5% in somatotroph, adrenocorticotroph, and lactotroph adenomas respectively. A deterioration of pituitary function was observed in 21.8%. Craniopharyngiomas and meningiomas of the tuberculum sellae could be resected completely. Complications consisted of CSF-rhinorrhea (2.5%), permanent visual deterioration (0.8%), intermittent DI (3.4%), permanent DI (1.6%). In adenomas,the duration of hospital stay was 3 to 4 days.

Conclusions: In pituitary adenomas, the complication rate could not be further reduced by the endoscope as compared to the microscopical approach. However, patients discomfort and the duration of the hospital stay could be reduced in most of the patients. The advantages of the endoscope are: Due to the wide angle view, all the important landmarks can be identified. Therefore the opening of the sellar floor can be extended as far as necessary. Direct view into the parasellar and suprasellar space is possible and makes lesions accessible that simply cannot be reached with the microscope. The endoscopic view provides a far better differentitation of pituitary tissue and the pathological lesion. Thus the endoscope is a valuable tool for the removal of complex pituitary adenomas and various skull base lesions that otherwise could be removed only by way of a much more complicated transcranial procedure.