gms | German Medical Science

Objective: The 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. Here, the authors report their technique of transnasal endoscopic neurosurgery and results with angled optics.

Method: One hundred thirty two patients received endoscopic endonasal transsphenoidal procedures for pituitary adenomas between October 2005 and November 2012. Procedures were video recorded. These cases were prospectively followed. The surgical technique was carefully analyzed.

Results: Standard technique was mononostril approach with 0° optics. 30° and – after availability – 45° optics were used for assessment of radicality. In 95 cases (72%) an angled optic were used. In the other cases there was already a sufficient sight (43%) or a significant bleeding of the cavernous sinus (55%). Remnant tumor was visualized with angled optics in 27 cases (28%). On follow-up MRI revealed radical tumour resection in 120 cases (91%). Recurrent tumour growth was observed in five patients (3.7%).

Conclusions: In comparison with other literature reports, the results are comparable or even better with respect to surgical radicality. 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.