gms | German Medical Science

Objective: The direct endonasal endoscopic approach is currently under investigation for perisellar tumour surgery. A higher resection rate is to be expected and nasal complications should be minimized. However, the reported results with this technique are diverging. Here, the authors report their technique of transnasal endoscopic neurosurgery after 215 procedures.

Methods: Between October 2000 and September 2011, 215 patients (102 males, 113 females, mean age 58yrs [range 21–83 yrs] received endoscopic endonasal transsphenoidal procedures for perisellar lesions. In 151 cases procedures were video recorded. These cases were prospectively followed. The surgical technique was carefully analyzed. Special attention was paid to the application of various optics, necessity to switch to the microscope, complications, surgical radicality, symptoms relieve and postsurgical nasal complaints.

Results: In all but two cases, a nasal speculum was used. Standard technique was mononostril approach. All procedures were performed with the 0° optics. 30° and – after availability – 45° optics were used for assessment of radicality. Mean surgical time scored 111 min (range 57–220 min). In 106 cases (70.1%) radical tumor resection was intended at surgery. On follow-up (2 weeks to 2 years; mean 1.04 year), MRI revealed radical tumour resection in 94 out of 104 cases (90.3%). Preoperative visual deficits improved in 108 of 123 cases (87.8%); a worsening was recorded in one 55 year-old woman (0.6%). Recurrent tumour growth was observed in five younger patients (3.3%). There was no mortality. There were three cases of meningitis (1.9%) and 7 cases of CSF leakage (4.6%). One case required subsequent surgical closure of the fistula (0.6%). One case demonstrated postoperatively a transient VI nerve palsy. Three patients (1.9%) complained postoperatively of nasal congestion or reduced nasal air flow, however no complaints were considered to be severe.

Conclusions: In comparison with other literature reports, the results are comparable or even better with respect to surgical radicality. But, the very low rate of nasal complains is particularly remarkable. The technique has been shown to be safe and successful with a high radicality and only minor complications. In contrast to microsurgery, the various optics allow a look "around the corner" to allow a radical tumor removal. In contrast to the nasolabial approach, only minimal nasal complaints were reported.