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

Image-guided endoscopic pituitary surgery through nostril

Meeting Abstract

  • corresponding author A. Kuge - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan
  • T. Kayama - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan
  • S. Saito - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan
  • S. Sato - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan
  • A. Kuroki - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan
  • M. Saino - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan
  • K. Sakurada - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan

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.01.05

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2006/06dgnc161.shtml

Veröffentlicht: 8. Mai 2006

© 2006 Kuge 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: In 1965, Dr. Hardy introduced transsphenoidal surgery for pituitary adenomas. On the other hand, the , endoscope has been used for nasal surgery since the early 20th century. However endoscopic pituitary surgery started in the last 10 years, because instrumental development was needed for the application of the endoscope to pituitary surgery. At present, we achieve various technical and instrumental innovations. In this paper, we present our strategy and our results with image-guided endoscopic pituitary surgery through the nostril.

Methods: In the MRI era, we gained experience with 176 cases of pituitary adenomas operated via the trans-sphenoidal approach. Of these, 82 cases were operated using the operative microscope, and 94 cases were operated using the endoscope only. Endoscopic pituitary surgery through the nostril was performed using three special instruments and techniques to make the best use of the endoscope. (1) newly designed surgical instruments, (2) Draining system to keep the operative fields dry and clear, (3) Navigation system for good orientation.

Results: Endoscopic pituitary surgery was less invasive than the operation with a microscope. Moreover, total removal ratio by endoscopic surgery (67.0%) was higher than that of microscopic surgery (59.8%). Endoscopes with various angle tips madde it possible to remove the tumors at blind angles. Navigation systems contributed to the safety of the operation. There is no difference in the morbidity between microsurgery and endoscopic surgery in spite of higher total removal ratio (there is no morbidity in both groups).

Conclusions: Endoscopic pituitary surgery is less invasive because it approaches through the nostril opening. Tumor extending to the suprasellar/lateral regions can be removed under direct endoscopic visualization. Surgical results of this method are better than those of classical microscopic trans-sphenoidal surgery. The application of image guided systems has made this approach much safer and surer. The use of a rigid endoscope for trans-sphenoidal surgery has many advantages, and the surgical results are favorable.