Endoscopic Endonasal Hemisphenoidotomy for Resectionof Pituitary Lesions Confined to the Sella:Report of 3 Cases and Technical Note

The authors report use of a minimally invasive endoscopic procedure, unilateral endonasal hemisphenoidotomy, for removal of lesions contained in the sella. The entire procedure was performed through a single nostril with the use of an endoscope. A unilateral endonasal hemisphenoidotomy (1.5 cm × 1.5 cm) was performed and was sufficient to expose the sellar floor for successful removal of adenomas confined to the sella in three patients. Neither outfracturing the midline septum nor exposure of the opposite sphenoid ostium was necessary for adequate visualization, tumor exposure, or instrument maneuverability. There was, however, a learning curve required in order to become facile and efficient with the equipment. All lesions were completely resected. When compared to a bilateral endoscopic endonasal sphenoidotomy as practiced by us, the operative time was reduced and the length of stay was 1 - 2 days. There was less operative trauma, patients appeared to experience less pain immediately postoperatively, and their satisfaction was very high. In conclusion, for resection of this group of intrasellar tumors, the hemisphenoidotomy procedure proved to be less invasive and traumatic, more simple, and faster than the standard bilateral endoscopic sphenoidotomy.

Key words

Endonasal - Endoscopic - Transsphenoidal - Hemisphenoidotomy - Pituitary - Minimally Invasive

References

• 1 Black P M, Zervas N P, Candia G L. Incidence and management of complications of transsphenoidal operation for pituitary adenomas.  Neurosurgery. 1987;  20 920-924
• 2 Cappabianca P, Alfieri A, de Divitiis E. Endoscopic endonasal transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS).  Minimally Invasive Neurosurgery. 1998;  41 66-73
• 3 Cooke R S, Jones R AC. Experience with the direct transnasal transsphenoidal approach to the pituitary fossa.  British Journal of Neurosurgery. 1994;  8 193-196
• 4 Cushing H. Intracranial tumors: Notes upon a series of two-thousand verified cases with surgical mortality percentages pertaining thereto. Springfield: Charles C Thomas 1932
• 5 Cushing H. Transsphenoidal methods of access. In: The Pituitary Body and Its Disorders, Ed.: Cushing, H Philadelphia: Lippincott Co. 1912: 296-303
• 6 Cusimano M D, Fenton R S. A technique for endoscopic pituitary tumor removal. AANS ORG/Journals/OnLine July 1996
• 7 Gamea A, Fathi M, El-Guindy A. The use of the rigid endoscope in transsphenoidal pituitary surgery.  The Journal of Laryngology and Otology. 1994;  108 19-22
• 8 Griffith H B, Veerapen R. A direct transnasal approach to the sphenoid sinus.  J Neurosurgery. 1987;  66 140-142
• 9 Hardy J. Transsphenoidal microsurgery of the normal and pathological pituitary.  Clin Neurosurg. 1969;  16 185-217
• 10 Helal M V. Combined micro-endoscopic trans-sphenoid excisions of pituitary macroadenomas.  Eur Arch Otorhinolaryngol. 1995;  252 186-189
• 11 Jankowski R, Auque J, Simon C et al. Endoscopic pituitary tumor surgery.  Laryngoscope. 1992;  102 198-202
• 12 Jho H D, Carrau R L. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients.  J Neurosurg. 1997;  87 44-51
• 13 Jho H D, Carrau R, Ko Y. Endoscopic pituitary surgery. In: Neurosurgical operative atlas, Ed.: Rengachary S, Wilkens R Baltimore: Williams and Wilkins 1996 5: 1-12
• 14 Perneczky A, Fries G. Endoscopic assisted brain surgery: Part one - evolution, basic concept, and current technique.  Neurosurgery. 1998;  42 219-225
• 15 Renn W H, Rhoton A L. Microsurgical anatomy of the sellar region.  J Neurosurg. 1975;  43 288-298
• 16 Rhoton A L, Harris F S, Renn W H. Microsurgical anatomy of the sella region and cavernous sinus.  Clinical Neurosurgery. 1977;  24 54-85
• 17 Rodziewicz G S, Kelly R T, Kellman R M, Smith M V. Transnasal endoscopic surgery of the pituitary gland. Technical Note.  Neurosurgery. 1996;  39 189-193
• 18 Sethi D, Pillay P K. Endoscopic management of lesions of the sella turcica.  J Laryngol Otol. 1995;  109 956-962
• 19 Wurster C F, Smith D E. The endoscopic approach to the pituitary gland.  Letter Arch Otolaryngol Head Neck Surg. 1994;  120 164
• 20 Yaniv E, Rappaport V H. Endoscopic transseptal transsphenoidal surgery for pituitary tumors.  Neurosurgery. 1997;  40 944-946

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