UI - 20034706 AU - Koren I; Hadar T; Rappaport ZH; Yaniv E TI - Endoscopic transnasal transsphenoidal microsurgery versus the sublabial approach for the treatment of pituitary tumors: endonasal complications. SO - Laryngoscope 1999 Nov;109(11):1838-40 AD - Department of Otolaryngology, Rabin Medical Center, Beilinson Campus, Sackler Faculty of Medicine, Tel Aviv University, Petah Tiqva, Israel. OBJECTIVE: To evaluate the nasal complications after transnasal transsphenoidal operations for pituitary tumors, comparing two surgical techniques: traditional sublabial transseptal and endoscopic transseptal techniques. STUDY DESIGN: We retrospectively evaluated by self-reported questionnaire and endoscopic examination the nasal condition of 40 consecutive patients with pituitary tumors: 20 patients had endoscopic surgery and 20 had surgery with the traditional sublabial technique. RESULTS: Compared with the traditional technique, the endoscopic approach was associated with a shorter operative time (about 40 min), shorter hospitalization time (about half), absence of recurrent epistaxis snoring and denture problems, and lower incidence of septal perforation, synechia, and crust formation. Furthermore, loss of nasal tip projection was found only in the group that had surgery with the sublabial technique. CONCLUSIONS: Endoscopically guided transseptal transsphenoidal surgery is simple to perform and time-saving, and it results in fewer nasal and denture complications than the sublabial technique. At the same time, it allows the surgeon all the benefits of the binocular microscopic surgical field that are associated with the traditional approach. UI - 20186561 AU - Badie B; Nguyen P; Preston JK TI - Endoscopic-guided direct endonasal approach for pituitary surgery. SO - Surg Neurol 2000 Feb;53(2):168-72; discussion 172-3 AD - Department of Neurological Surgery, University of Wisconsin School of Medicine, Madison 53792-3232, USA. BACKGROUND: Submucosal dissection of the nasal septum is often performed as part of the transseptal approach to the sella. To evaluate whether this submucosal dissection is a necessary component of this operation, we compared the morbidity of a direct transmucosal endonasal approach to that of the transseptal approach in patients undergoing pituitary surgery. METHODS: Forty-one consecutive patients undergoing pituitary surgery from January 1996 to March 1999 were included in this study. The first 21 patients underwent the standard transseptal operation through either a sublabial or columellar incision. The latter 20 patients were operated on through an endoscopically guided, direct endonasal exposure, without any submucosal dissection of the nasal septum. The operative morbidity, the duration of surgery, and the length of hospitalization for each group were compared. RESULTS: The sphenoid sinus exposure obtained through the endonasal route was comparable with the transseptal approach and was adequate for resection of most pituitary tumors. Although the morbidity of the two approaches was similar, patients undergoing the endonasal operation had less postoperative facial pain. Furthermore, the endonasal approach significantly decreased the length of the operation (116 minutes vs. 161 minutes, p = 0.002) and the duration of hospitalization (3.6 vs. 5.1 days, p = 0.003) as compared with the transseptal route. CONCLUSIONS: Morbidity of the endonasal approach to the sphenoid sinus is comparable to that of a conventional transseptal approach. By eliminating the submucosal dissection, the endonasal approach reduces postoperative facial discomfort and decreases length of surgery and hospitalization. UI - 97182308 AU - Jho HD; Carrau RL TI - Endoscopy assisted transsphenoidal surgery for pituitary adenoma. Technical note. SO - Acta Neurochir (Wien) 1996;138(12):1416-25 AD - Department of Neurological Surgery, University of Pittsburgh School of Medicine, PA, USA. AB - Inspired by an experience with endoscopic paranasal sinus surgery, an endoscope was applied in transsphenoidal pituitary surgery. This endoscopic transsphenoidal technique has been used in 45 cases of pituitary adenomas. Using a 4 mm rigid endoscope, the pituitary adenoma is removed through a nostril. A zero-degree endoscope is used for micro-adenomas. A combination of a 0-degree endoscope and a 30-degree endoscope is used for macro-adenomas that have extended to the suprasellar region. Although it is early in our experience with a small number of patients, the short-term surgical results have been encouraging with patients' short hospital stay and minimum morbidity. The endoscopic technique that has evolved with our experience is described with two cases of pituitary adenomas. UI - 97221644 AU - Jho HD; Carrau RL; Ko Y; Daly MA TI - Endoscopic pituitary surgery: an early experience. SO - Surg Neurol 1997;47(3):213-22; discussion 222-3 AD - Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA. AB - BACKGROUND: As an element of a minimally invasive management approach, we had developed an endonasal endoscopic transsphenoidal technique for the treatment of pituitary tumors. Initially, four patients were operated on via a sublabial, transseptal approach using a fiberoptic rigid endoscope in conjunction with the operating microscope. Encouraged by that experience, our subsequent 11 patients had undergone endonasal endoscopic transsphenoidal surgery without the use of a retractor or speculum. METHODS: Our group of patients included nine females and six males, with an age range of 17-88 years (median: 43 years). There were four microadenomas, four intrasellar macroadenomas, three macroadenomas with suprasellar extension, three invasive macroadenomas involving the cavernous sinus with suprasellar extension, and one metastatic adenocarcinoma. RESULTS: Thirteen patients with pituitary adenomas experienced resolution of their symptoms postoperatively. One patient with a recurrent prolactinoma responded partially following surgery and subsequently underwent gamma knife radiosurgery. Two patients were treated with postoperati- ve fractionated radiation therapy, one for residual pituitary adenoma in the cavernous sinus, and the other for metastatic adenocarcinoma, respectively. The first patient, treated via an endonasal endoscopic approach for biopsy of the metastatic adenocarcinoma, developed postoperative cerebrospinal fluid (CSF) leak that was successfully managed with endoscopic packing of a fat graft. CONCLUSIONS: The endonasal endoscopic transsphenoidal approach facilitates faster postoperative recovery by the avoidance of traditional incision and postoperative nasal packing. It offers a panoramic view of the sphenoid sinus and excellent visualization of the sellar and suprasellar structures with increased illumination and magnification. Such visualization provides the potential for more complete tumor resection, as well as a better chance of preserving pituitary function and avoiding neurovascular injury. UI - 97293279 AU - Yaniv E; Rappaport ZH TI - Endoscopic transseptal transsphenoidal surgery for pituitary tumors. SO - Neurosurgery 1997;40(5):944-6 AD - Department of Otolaryngology, Rabin Medical Center, Petah Tiqva, Israel. AB - OBJECTIVE: Transseptal transsphenoidal surgery of pituitary tumors is a well-established surgical technique. The sublabial approach and the open rhinoplasty approach are most commonly used. In both cases, the surgical avenue is along the entire length of the nasal septum, removing both nasal cartilage and the vomer. Septal perforations and upper dental anesthesia are frequent complications of the standard approaches. We describe our initial experience in using the nasal endoscope for the first stage of the operation. METHODS: A nasal endoscope was used to open the anterior wall of the sphenoid sinus. Our initial incision was in the posterior third of the septum, removing only the vomer. After the sphenoid sinus was opened, we inserted a speculum and proceeded with the operation with an operating microscope. After the speculum was in place, it was easier to proceed with the microscope, which allows binocular vision and bimanual operation. RESULTS: The procedure was used for our most recent 14 consecutive patients with pituitary adenomas. No complicat- ions related to the approach were encountered for any of the patients in follow-up monitoring. CONCLUSION: The endoscopic transseptal approach to the sphenoid sinus for pituitary surgery was found to be easy, time-saving, and without septal or sublabial complications. UI - 97345772 AU - Jho HD; Carrau RL TI - Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. SO - J Neurosurg 1997;87(1):44-51 AD - Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA. AB - An endoscope was used in transsphenoidal surgery and eventually replaced the operating microscope as the tool for visualization. This study focuses on 50 patients (28 females and 22 males) with a median age of 38 years (range 14-88 years). Initially, four patients underwent operation via a sublabial-transseptal approach using a rigid endoscope in conjunction with an operating microscope. The 48 subsequent operations were performed through a nostril using only rigid endoscopes. Forty-four patients had pituitary adenomas and six had various other lesions. Thirteen patients had microadenomas, 16 had intrasellar macroadenomas, nine had macroadenomas with suprasell- ar extension, and six had invasive macroadenomas involving the cavernous sinus. Seven patients had recurrent pituitary adenomas and 25 had hormone-secreting adenomas (eight patients with Cushing's disease and 17 patients with prolactinomas). Among the eight patients with Cushing's disease, seven had resolution of hypercortisolism clinically and chemically. Of the 17 patients with prolactinomas, 10 improved clinically with normal serum prolactin levels, four improved clinically with elevated serum prolactin levels, and three had residual tumors in the cavernous sinus. Among the 19 patients with nonsecreting adenomas, 16 underwent total resection and three subtotal resection leaving residual tumor in the cavernous sinus. Postoperatively, all patients who had undergone endonasal endoscopic surgery had unobstructed nasal airways with minimal discomfort. More than half of the patients required only an overnight hospitalization.
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