A Simplified Direct Endonasal Approach for Transsphenoidal Surgery

Abstract

Having the experience of more than 4 000 hypophysectomy operations (150 cases per year on the average) by the senior author, initially performed via an intracranial, then a transseptal approach, now a direct endonasal approach, as a minimal invasive technique, is introduced to reduce the complications and for better comfort of the patient. It is the least traumatic route to the sella turcica, it avoids brain retraction, and it provides excellent visualization of the pituitary gland and lesions related to that structure. The brilliant increased vision of the surgical target offered by the endoscope can enable a more effective removal of the lesion, followed by superior clinical results and a reduction in the incidence of complications.

transsphenoidal - endonasal - hypophysectomy - endoscopic

References

• 1 Kabil MS, Eby JB, Shahinian HK. Fully endoscopic endonasal vs. transseptal transsphenoidal pituitary surgery.  Minim Invas Neurosurg. 2005;  48 348-354
• 2 Jarrahy R, Suh R, Berci G. et al . Endoscopic pituitary surgery: an in vivo model for transnasal transsphenoidal hypophysectomy. Endoscopic pituitary surgery.  J Laparoendosc Adv Surg Tech A. 1999;  9 211-219
• 3 Melmed S. The Pituitary. London, UK Wiley-Blackwell Publications 2002 Section 3, Chapter 10: 409
• 4 Roudkin A, Zawadzki T, Wojatacha M. et al . Endoscopic transasal transsphenoidial treatment of pathology of the sellar region.  Minim Invas Neurosurg. 2005;  48 101-107
• 5 Liu JK, Orland R, Apfelbaum RI. et al . Novel closure technique for the endonasal transsphenoidal approach.  J Neurosurg. 2004;  100 161-164
• 6 Liu JK, Cohen-Gadol AA, Laws Jr ER. et al . Harvey Cushing and Oskar Hirsch: early forefathers of modern transsphenoidal surgery.  J Neurosurg. 2005;  103 1094-1104
• 7 Vrionis FD, Saatman D, Sorenson J. et al . Microscopic paraseptal sphenoidotomy approach for pituitary tumors.  Cancer Control. 2002;  9 223-231

Correspondence