Complication avoidance and management techniques 1st ed. The transfrontal approach was first used by krause in 1905. Post operative instructions after transsphenoidal surgery this information is intended to answer questions you may have after your tss pituitary surgery. At least 90% of pituitary adenomas are being treated by this operation. Endoscopic versus microscopic transsphenoidal mafiadoc. Some anatomic conditions can prevent or hinder use of the extended endonasal approach.
Transsphenoidal surgery is used to remove tumors of the pituitary gland. Cranial microsurgery download ebook pdf, epub, tuebl, mobi. Pedicled nasoseptal flap hadadbassagasteguy flap protocol click on videos below to active. The entry point may be through an incision cut made under the upper lip and over the teeth. Transnasal transsphenoidal approach to pituitary iowa. Core techniques in operative neurosurgery 2nd edition pdf. Transnasal septal displacement approach the transnasal septal displacement procedure or septal pushover is currently our approach of choice for most patients, particularly for reoperative transsphenoidal procedures, in children, and in patients with cushings disease. Web to pdf convert any web pages to highquality pdf files while retaining page layout, images, text and. The radiology of endoscopic endonasal transsphenoidal.
It is often a team effort between neurosurgeons and ear, nose, and throat ent surgeons. It may also go directly through the nostrils or through an incision made on the nasolabial furrow. I am with otolaryngology and one of our physicians has done a case with a neurosurgeon. Since repopularization of the transsphenoidal approach by guiot and thibaut and hardy and wigser 1921, most surgeons have adopted this technique as the primary method for the removal of pituitary adenomas.
Endoscopic endonasal transsphenoidal approach request pdf. Transsphenoidal approach in endoscopic endonasal surgery for. Couldwell wt, weiss mh, rabb c et al 2004 variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches. An additional reason in support of surgery in the management of pituitary lesions. Endoscopic endonasal transsphenoidal approach for pituitary adenomas. Endoscopic, endonasal extended transsphenoidal, transplanum.
When the endoscope is used in transsphenoidal surgery, jho and alfieri 2000 recommend first to conduct endoscopeassisted microsurgery, followed by endoscopic sphenoidotomy assisted by a rhinologist, and then to proceed with the endoscopic endonasal transsphenoidal approach 1. The pituitary fossa, because of its intimate anatomical relationship to the sphenoid sinus, lends itself well to a transsphenoidal surgical approach. Transsphenoidal surgery for pituitary tumors precare. History of pituitary surgery in 1893,caton and paul attempted to explore sella turcica via lateral sub temporal route along with orbital exenteration. We have found this technique for transsphenoidal hypophysectomy to be a simple, reliable, rapid technique for exposing the septum and the floor of the nose. They did a transsphenoidal pituitary tumor together where our physician opened and assisted the neurosurgeon. Endoscopic versus microscopic transsphenoidal pituitary adenoma surgery. Background recent advances in surgical techniques have enabled surgeons to approach previously inoperable deepseated lesions of the skull base. Transsphenoidal literally means through the sphenoid sinus. Free fulltext pdf articles from hundreds of disciplines, all in one place. Listing a study does not mean it has been evaluated by the u. Preoperative radiographic and clinical factors associated. From 1910 to 1925, cushing, combining a number of suggestions made by previous authors, refined the transsphenoidal approach and used it to operate on 231 pituitary tumors, with a mortality rate of 5.
Dumbbellshaped tumors constricted at the diaphragm are best approached transcranially 1, 4. Pdf endoscopic endonasal transsphenoidal approach for. Pdf endoscopic endonasal transsphenoidal approach in the. Endoscopic endonasal transsphenoidal surgery of 1,166. Transnasal transsphenoidal approach to pituitary transnasal transsphenoidal approach to pituitary see. Use pdf download to do whatever you like with pdf files on the web and regain control. Endoscopic endonasal transsphenoidal approach to the sellar region. Get a printable copy pdf file of the complete article 2.
Their diagnosis, both clinical and radiologic, may be difficult. Tell your surgeon about all medicines you currently take. Microscopeguided endonasal transsphenoidal approach the. Transsphenoidal surgery for pituitary tumors is done to remove a tumor on the pituitary gland.
The sphenoid sinus, in turn, has been reached by various transnasal and transsinus routes. As he developed increasing expertise with transcranial surgery, however, cushing reduced his mortality rate to 4. The history and evolution of transsphenoidal surgery. The present study indicates that the endoscopic transsphenoidal approach is safer and more effective than microscopic surgery in the treatment of pituitary adenomas. The book is a useful addition to the library of all surgeons who deal with skull base cranial surgery, and provides outstanding information and reference sources for complex skull base procedures amenable to the transsphenoidal approach. It is a surgery performed through the nose and sphenoid sinus to remove pituitary tumors fig.
Surgical approach to pituitary adenoma linkedin slideshare. We have used this technique in a twoyear period between june 1982 and june 1984 on 14 patients. The feasibility of a purely endoscopic extended transsphenoidal approach to remove suprasellar lesions has been reported previously, but few cases have been. Endoscopic versus microscopic transsphenoidal pituitary. The transsphenoidal approach is the procedure of choice for the removal of tumors of the sella that are still largely confined to this space. The radiologist requires a thorough knowledge of the normal anatomy and the pathological spectrum of this region.
The direct transsphenoidal approach in pituitary adenoma resection under endoscopic assistance is time saving, and safe, with good exposure of operative field. The transsphenoidal approach is contraindicated when the sellar lesion involves the brain 7, 8, cavernous sinus, or middle fossa 1,7,9. The first transnasal resection of a pituitary tumor was performed by schloffer in 1907 1. Transsphenoidal extent of resection study transspher the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Endoscopic endonasal transsphenoidal approach in the. The neurosurgeon did 61548 and our physician said he did 30520, 3128750, 31240lt, and 30930.
Failure to recognize these lesions has in the past led to surgical misadventure, often resulting in meningitis and death. Core techniques in operative neurosurgery, 2nd edition, provides the tools needed to hone existing surgical skills and learn new techniques, helping you minimize risk and achieve optimal outcomes for every procedure. The endonasal transsphenoidal approach has evolved during the past century. Variations on the standard transsphenoidal approach to the.
Topics include transsphenoidal approach, suboccipital transmeatal approach, spinal tumors. Transsphenoidal surgery is a type of surgery in which an endoscope andor surgical instruments are inserted into part of the brain by going through the nose and the sphenoid bone a butterflyshaped bone forming the anterior inferior portion of the brain case into the sphenoidal sinus cavity. Endoscopic endonasal transsphenoidal surgery of 1,166 pituitary. The classic transsphenoidal approach for resection of pituitary. At the beginning of our century, in 1906, schloffer was the first to describe an extradural approach to the pituitary gland schloffer 1906, 1907, and thus became a pioneer of numerous similar approaches with the common goal of removing pituitary adenomas without craniotomy, for in those days subfrontal craniotomy caused much greater strain and risk for the patient. Background cerebrospinal fluid csf leak is a devastating complication after transsphenoidal surgical approach to pituitary adenoma and sellar repair has been postulated as crucial step in this approach. Harvey cushing played an instrumental role in popularizing the endonasal route as it was pioneered by surgeons of his time, including schloffer and halstead. If the inline pdf is not rendering correctly, you can download the pdf file here. Case example transphenoidal approach to pituitary tumor return to. Indications for transcranial approach to the pituitary gland large intracranial element of the tumour that is unlikely to be accessible during transsphenoidal surgery, then this approach should be considered. Pdf to assess the clinical curative effect of the endonasal transsphenoidal approach for removing pituitary adenoma pa under. It is called this because the surgery is done through the nose. Transsphenoidal and transethmoidal encephaloceles radiology. First performed by schloffer over a hundred years ago, the transsphenoidal approach has become the standard approach for the removal of sellar lesions.
Endoscopic transsphenoidal approach to the sella ento key. Endoscopic endonasal transsphenoidal surgery springerlink. Conclusion the pure endoscopic approach is a safe, effi cacious, and minimally invasive technique for the removal of pituitary adenomas. The use of neuronavigation with vasular microdoppler in. Sellar repair in endoscopic endonasal transsphenoidal. Endoscopic endonasal transsphenoidal approach to large and giant pituitary adenomas. Seventy to eighty percent of patients who have abnormal visual fields due to a gonadotroph adenoma in one series experienced improvement following.
The external rhinoplasty approach is such a refinement. Cushing 2 systematically applied a transsphenoidal approach for sellar lesions. Transsphenoidal and transethmoidal encephaloceles are rare but important lesions that cause various signs and symptoms, some characteristic and some misleading. Transsphenoidal surgery an overview sciencedirect topics. To evaluate the use of neuronavigation with vascular microdoppler in transsphenoidal pituitary surgery. Endoscopic pituitary surgery, transsphenoidal cincinnati. Transsphenoidal surgery is the mainstay of treatment for most kinds of pituitary adenomas and other sellar masses. Arrange to have someone drive you home after surgery. Transsphenoidal surgery for pituitary tumors aftercare. Pdf transsphenoidal approaches have been used for a century for the.
Endoscopic endonasal transsphenoidal approach for pituitary adenomas article pdf available in zhonghua wai ke za zhi chinese journal of surgery 4422. Transsphenoidal surgery complication avoidance and. The manuscript also ponders on intracranial tumors and transnasaltranssphenoidal approach to the pituitary gland. This technique was posterior refined and popularized by guiot 3 and hardy 4 with the introduction of the operative microscope the development of endoscopic techniques for surgery of paranasal sinuses 5 awoke the. The purpose of this article is to describe an operative. In this study, we describe our experience regarding sellar repair in pure endoscopic endonasal approach in 240 patients with pituitary adenoma. Request pdf endoscopic endonasal transsphenoidal approach the standard endoscopic endonasal transsphenoidal approach to the sella is suitable for the removal of pituitary tumors, both. It is essentially suitable for all intra, supraand parasellar lesions provided that a sufficiently. The role of the radiologist in surgical planning for endoscopic endonasal transsphenoidal. Introduction the transsphenoidal approach to the pituitary fossa was first proposed by giordano in 1897. Download cranial microsurgery or read online books in pdf, epub, tuebl, and mobi format. Pdf anesthesia for transsphenoidal pituitary surgery.
Get stepbystep, expert guidance on fundamental procedures in neurosurgery both in print and on video. Transsphenoidal surgery almost always results in a decrease in adenoma size figure 18. With the development of modern microinstrumentation and the use of the operating microscope, transsphenoidal surgery has proven to be a safe and. Managing the patient with transsphenoidal pituitary tumor resection wen yuan abstract patients who undergo transsphenoidal pituitary tumor resection require a multidisciplinary team approach, consisting of a neurosurgeon, an endocrinologist, and nurses. Fluoroscopy was used in 69 cases and vascular microdoppler with neuronavigation were used in 72 cases. Endoscopic endonasal transsphenoidal surgery of 1166. Advances in endoscopic skull base surgery have allowed for the resection of larger and more complex pathologies, leading to larger skull base defects, necessitating the development of complex skull base repair techniques. Managing the patient with transsphenoidal pituitary tumor. The historical evolution of transsphenoidal surgery. In a transsphenoidal approach, three different routes may be taken to reach the pituitary tumor. The transsphenoidal route is the surgical approach of choice for most sellar tumors. Endoscopic transsphenoidal approach to the pituitary fossa. The pituitary gland is attached to the brain and sits behind the bridge of the nose. The most common surgery that is done on the pituitary is transsphenoidal surgery.
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