gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

The endoscopic transsphenoidal binostril approach for surgical treatment of pituitary adenomas

Der endoskopische transsphenoidale Zugang zur Resektion von Hypophysentumoren

Meeting Abstract

Suche in Medline nach

  • corresponding author R. Reisch - Klinik für Neurochirurgie, Universitätsklinikum Mainz
  • C. Charalampaki - Klinik für Neurochirurgie, Universitätsklinikum Mainz
  • A. Perneczky - Klinik für Neurochirurgie, Universitätsklinikum Mainz

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc11.05.-07.08

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0204.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Reisch et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

To describe our first experiences with the endoscopic transsphenoidal binostril approach for surgical treatment of intra- and suprasellar pituitary adenomas.

Methods

Between January and September 2004, we have performed 29 endoscopic procedures for non-recurrent pituitary adenomas using WOLF and Aesculap pituitary endoscopes. According to a biportal-binostril technique, the sphenoid sinus was exposed from both sides through the apertura sinus sphenoidalis, without using a nasal retractor. There were 11 micro- and 18 macroadeomas, none of the tumours showed parasellar infiltration into the cavernous sinus. There were 11 hormonal active tumours (in 5 cases STH-adenoma, in 3 cases prolactinoma and in 3 cases ACTH-adenoma) and 18 inactive tumours. 20 patients showed partial or complete pituitary insufficiency, 13 patients showed preoperative visual deficits. One of the patients suffered from an acute onset of diplopia. Postoperative endocrinological investigations were performed 6 weeks after surgery, the tumour resection was controlled 3 months postoperatively using MRI studies.

Results

Using 0° and 30° endoscopes, the intra- and suprasellar tumour removal could be successfully controlled. Postoperative MRI showed complete tumour removal in 10 of 11 microadenomas (91%) and in 15 of 18 macroadenomas (83%). Treating microadenomas, none of the patients revealed additional hormonal deficits, treating macroadenomas one patent suffered from further pituitary insufficiency (5%); 8 of 11 hormonal active tumours could be successfully treated (73%). Three months postoperatively, 11 of 13 patients showed improvement of visual function (85%), none of the patients suffered from increased visual deficits. The patient with preoperative diplopia showed complete remission.

Conclusions

After a comprehensive cadaver study and after a learning curve of 5 clinical cases, the endoscopic binostril approach offered safe and sufficient transsphenoidal exposure of micro- and macroadenomas of the pituitary gland. The minimum traumatization of the nasal cavity without nasal retractor, the optical advantages of the endoscopic visualization in anatomical orientation and tumour removal and the early postoperative improvement of the patients without nasal packing are obvious advantages of the endoscopic binostril technique.