gms | German Medical Science

57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. bis 14.05.2006, Essen

The role of the endoscopic visualization in the transsphenoidal surgery of pituitary adnomas with supra- and parasellar extension

Die Rolle der endoskopischen Bildgebung in der transsphenoidalen Chirurgie von Hypophysenadenomen mit supra- und parasellärer Ausbreitung

Meeting Abstract

Suche in Medline nach

  • corresponding author R. Reisch - Neurochirurgische Universitätsklinik Mainz
  • A. Perneczky - Neurochirurgische Universitätsklinik Mainz

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSO.01.03

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2006/06dgnc159.shtml

Veröffentlicht: 8. Mai 2006

© 2006 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 the importance of endoscopic visualization in transsphenoidal surgery of extended supra- and parasellar pituitary adenomas.

Methods: During an 18-month period up to June 2005, we have performed 80 pure endoscopic procedures using an endonasal transsphenoidal biportal approach. According to this technique, the sphenoid sinus was exposed through both nostrils, without using a nasal retractor. There were 34 micro- and 46 macroadeomas, 13 patients had recurrent tumors. 28 patients had hormonally active tumors. The tumor showed marked suprasellar extension in 21 cases and a parasellar infiltration into the cavernous sinus in 7 cases. In this group of 28 patients, 25 showed partial or complete hormonal insufficiency of the pituitary gland, 5 patients had hormonally active tumors (in 4 cases STH-adenoma, in 1 case prolactinoma).18 patients showed preoperative visual deficits, 3 patients suffered from diplopia due to oculomotor (2 cases) or abducens palsy.

Results: Endoscopic visualization allowed exquisite intraoperative anatomical orientation, increased light intensity in the deep-seated surgical field with an extended viewing angle and clear depiction of surgical details in a close-up position. Using 0° and 30° endoscopes, the tumor removal could be effectively controlled especially in hidden parts of the surgical field. This increased optical control on tumor removal was particularly useful in the case of supra- and parasellar tumor extension. In this group of patients, postoperative MRI showed complete tumor removal in 16 of 21 macroadenomas with suprasellar extension and in 5 of 7 tumors with parasellar infiltration. 3 of the 5 patients with active tumors could be successfully treated with surgical therapy. Three months after the operation, 16 of 18 patients showed improvement of visual function, none of the patients suffered from increased visual deficits. Patients with preoperative diplopia showed complete remission.

Conclusions: The endoscopic binostril approach offers a safe and satisfactory transsphenoidal exposure of pituitary adenomas. The endoscopic visualization allows clear anatomical orientation and increased control over tumor removal, especially in the case of marked tumor growth with supra- or parasellar extension. The minimal traumatization of the nasal cavity without using a nasal retractor and the early postoperative improvement of the patients without nasal packing are additional advantages of the endoscopic binostril technique.