Progress and Achievements of Endoscopic Endonasal Transsphenoidal Surgery

For the past 11 years we gained a great experience in treating over 5,000 patients by endoscopic endonasal transsphenoidal approach. The majority of patients had pituitary adenomas (p.a.) (85%). The other tumors were represented by different pathologies: craniopharyngiomas (more 500 pts), chordomas, meningiomas, gliomas, cancers, arachnoid cysts etc. Use of endoscopic technique permitted us to considerably broaden indications for transsphenoidal surgery. In particular, this approach allowed removal of p.a. with a small-size sella, adenomas with different secondary nodes, p.a. with a narrow neck between their superior and basal parts, and giant pituitary tumors (over 60 mm). Introduction of endoscopic technologies into daily practice permitted to evacuate tumors via anterior extended transsphenoidal approach which earlier could be hardly accessed by a transcranial approach: suprasellar and intraventricular craniopharyngiomas, anterior scull base meningiomas, chiasmal and III ventricular gliomas and other suprasellar tumors. Lateral extended transsphenoidal approach allows safety removal tumors invading cavernous sinus (especially when medial displacement internal carotid artery)—p.a., chordomas, trigeminal and oculomotors nerves schwannomas. Via posterior extended transsphenoidal approach is available the removal clivus chordomas invading in posterior fossae, clivus meningiomas, some ventral brainstem tumors, clipping aneurism of Basilar artery. A modified method was used for a multilayer hermetic closure using auto- and allotransplant of major postoperative skull base defects and prevention of postoperative CSF leakage.