gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Uninostril (one nostril) approach for endoscopic transnasal transsphenoidal resection of pathologies with sellar origin, but supra- and parasellar extension

Meeting Abstract

  • Rüdiger Gerlach - Klinik für Neurochirurgie, HELIOS Klinikum Erfurt, Germany
  • Almuth Meyer - Klinik für Innere Medizin 2, HELIOS Klinikum Erfurt, Germany
  • Christoph Jacobi - Klinik für Neurochirurgie, HELIOS Klinikum Erfurt, Germany
  • Elisabeth Lamster - Klinik für Innere Medizin 2, HELIOS Klinikum Erfurt, Germany
  • Joachim Klisch - Institut für Neuroradiologie, HELIOS Klinikum Erfurt, Germany
  • Geralf Kellner - Klinik für HNO, HELIOS Klinikum Erfurt, Germany
  • Steffen Rosahl - Klinik für Neurochirurgie, HELIOS Klinikum Erfurt, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1759

DOI: 10.3205/10dgnc230, URN: urn:nbn:de:0183-10dgnc2307

Published: September 16, 2010

© 2010 Gerlach et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Endoscopic surgical procedures have gained wide acceptance in the treatment of sellar lesions. Most surgeons use the four hands two nostrils approach. We hereby report our experiences with the unilateral (one nostril) approach for treatment of (peri)sellar lesions.

Methods: Between December 2008 and 2009 25 consecutive patients (24 adults, 1 child; 9 males) were operated via an uninostril transnasal transsphenoidal approach to treat (peri)sellar pathologies (21 pituitary adenomas, 1 recurrent myopericytoma, 1 recurrent craniopharyngeoma, 1 abscess, 1 Rathke cleft cyst). One lesion was purely intrasellar, all others had a suprasellar (24) or parasellar (7) extension. Complete pre- and postoperative neuroradiological, endocrinological and ophthalmological status was documented in a data base.

Results: In the 2 patients with recurrent lesion and 3 patients with large parasellar extension of an adenoma the subtotal removal of the tumor with decompression of the optic system was accomplished. In all other patients (20) complete removal was achieved. In the patients with the recurrent myopericytoma an accentuated diplopia due to VIth nerve palsy was encountered. 1 patient suffered from postoperative DVT, otherwise no complications occurred. All patients (12) with impaired visual acuity improved. The endocrinological status remained unchanged in 21 patients. Two patients had new endocrinological deficit (1 diabetes insipidus, 1 pituitary insufficiency). Two patients with preoperative partial pituitary insufficiency improved to normal status postoperatively.

Conclusions: The uninostril transnasal transsphenoidal approach is a minimally invasive surgical option to safely and effectively remove sellar lesions with a high patient’s comfort and good clinical and radiological results.