Subscribe to RSS
DOI: 10.1055/s-2002-33457
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662
Comparison of the Exposure Obtained by Endoscope and Microscope in the Extended Trans-Sphenoidal Approach
Publication History
Publication Date:
21 August 2002 (online)
ABSTRACT
Objective: Trans-sphenoidal surgery is often combined with other approaches for the treatment of middle cranial base tumors. By combining a maxillotomy with trans-sphenoidal approach, significantly wider exposure to these regions is gained. However, endoscope-assisted techniques have also been used for sellar and parasellar and upper clival regions. Methods: An extended trans-sphenoidal approach was performed on 10 cadaver heads using the operating microscope and was repeated with a 0-degree endoscope. The mean horizontal and vertical distances were measured and pictured for each technique, and both distances were compared using a parametric paired Student's t-test. Results: The mean horizontal distances in the 10 specimens were 19.5 ± 1.8 mm by microscope and 27.5 ± 2.2 mm by endoscope, and the mean vertical distances were 25.8 ± 1.9 mm by the microscope and 34.5 ± 3.5 mm by the endoscope. Conclusion: The aim of this study was to quantify the amount of exposure obtained with an extended trans-sphenoidal approach and to compare both endoscopic and microscopic techniques. Using the endoscope in conjunction with the operating microscope may provide additional exposure and better access in skull base surgery.
KEYWORDS
Extended trans-sphenoidal approach - microscope - endoscope - skull base surgery
REFERENCES
- 1 Laws Jr E R. Trans-sphenoidal approach to pituitary tumors. In: Schmidek HH, Sweet WH, eds. Operative Neurosurgical Techniques: Indications, Methods, Results, Vol 1. 3rd ed. Philadelphia, PA:WB Saunders 1995: 283-292
- 2 Fahlbusch R, Buchfelder M. The trans-sphenoidal approach to invasive sellar and clival lesions. In: Sekhar LN, Janecka IP, eds. Surgery of Cranial Base Tumors New York, NY: Raven Press 1993: 337-349
- 3 Cawley M C, Tindall G T. Trans-sphenoidal surgery: operative techniques. In: Krisht AF, Tindall GT, eds. Pituitary Disorders Comprehensive Management Baltimore, MD: Lippincott Williams Wilkins 1999: 349-359
- 4 Vates G E, Wilson C B, McDermott M W. Trans-sphenoidal approaches to anterior skull base lesions. Operative Techniques Neurosurg . 1999; 2 191-200
- 5 King W A, Becker D. The trans-sphenoidal approach to pituitary macroadenomas with cavernous sinus extensions. In: Al-Mefty O, Origitano TC, Harkey LH, eds. Controversies in Neurosurgery New York, NY: Thieme 1996: 15-20
- 6 Harrison M J, Al-Mefty O. Skull base approaches for giant invasive pituitary tumors. In: Krisht AF, Tindall GT, eds. Pituitary Disorders Comprehensive Management 1st ed. Baltimore, MD: Lippincott Williams Wilkins 1999: 375-387
- 7 Gamea A, Fathi M, El-Guindy A. The use of rigid endoscope in trans-sphenoidal pituitary surgery. J Laryngol Otol . 1994; 108 19-22
- 8 Helal Z. Combined micro-endo trans-sphenoid excisions of pituitary macroadenomas. Ear Arch Otorhinolaryngol . 1995; 252 186-189
- 9 Jho H D. Endoscopic surgery of pituitary adenomas. In: Krisht AF, Tindall GT, eds. Pituitary Disorders Comprehensive Management 1st ed. Baltimore, MD: Lippincott Williams Wilkins 1999: 389-403
- 10 Auer L M, Auer D P. Virtual endoscopy for planning and simulation of minimally invasive neurosurgery. Neurosurgery . 1998; 43 529-548
- 11 Perneczky A, Fries G. Endoscope-assisted brain surgery: Part 1-Evolution, basic concept, and current technique. Neurosurgery . 1998; 42 219-225
- 12 Moore C E, Ross D A, Marentette L J. Critical pathways in anterior cranial base surgery. Otolaryngol Head Neck Surg . 1999; 121 113-118
- 13 Rabadan A, Contesa H. Transmaxillary transnasal approach to the anterior clivus: a microsurgical anatomic model. Neurosurgery . 1992; 30 473-482
- 14 Fraioli B, Esposito V, Santoro A, Ianetti G, Giuffre R, Cantore G. Transmaxillosphenoidal approach to tumors invading the medial compartment of the cavernous sinus. J Neurosurg . 1995; 82 63-69
- 15 Sabit I, Schaefer S D, Couldwell W T. Extradural extranasal combined transmaxillary trans-sphenoidal approach to the cavernous sinus: a minimally invasive microsurgical model. Laryngoscope . 2000; 110 286-291
- 16 Apuzzo M LJ, Heifetz M D, Weiss M H, Kurze T. Neurosurgical endoscopy using the side-viewing telescope: technical note. J Neurosurg . 1977; 46 398-400
- 17 Sugita K, Hirota T, Tsugane R. Application of nasopharyngeal mirror for aneurysm operation: technical note. J Neurosurg . 1975; 43 244-246
- 18 Bushe K A, Halves E. Modified technique in trans-sphenoidal operations of pituitary adenomas: technical note [in German, abstract]. Acta Neurochir . 1978; 41 163-175
- 19 Spencer W R, Das K, Nwagu C. Approaches to the sellar and parasellar region: anatomic comparison of the microscope versus endoscope. Laryngoscope . 1999; 109 791-799
- 20 Jho H D, Carrau R L. Endoscopic endonasal trans-sphenoidal surgery: experience with 50 patients. J Neurosurg . 1997; 87 44-51
- 21 Cappabianca P, Alfieri A, de Divitis E. Endoscopic endonasal trans-sphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS). Minimal Invasive Neurosurgery . 1998; 41 66-73