Computerassisted navigation and intraoperative mri has further improved surgical. The transseptal transsphenoidal approach to pituitary. Transsphenoidal hypophysectomy was introduced by cushing in 1910 and reemerged as the standard approach for pituitary tumors with microsurgical technique in the 1960s. Evolution of pituitary surgery and the transsphenoidal approach. Endoscopic endonasal transsphenoidal approach for pituitary fossa. Core techniques in operative neurosurgery 2nd edition pdf. Pdf anatomical workspace study of endonasal endoscopic. If large holes are present in the mucosa, especially if they are anterior, bilateral and adjacent to each other, they are closed at least on one side with 40 chromic suture. In earlier series, complete tumor removal rates have ranged from 45 to 98% for transcranial routes 19,20,22 and from 25 to 100% for the extended transsphenoidal approach.
Transsphenoidal surgery complication avoidance and. 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. It is necessary to create a 56 mm space below the sellar floor for free manipulation of the instruments. The endoscopic endonasal transsphenoidal approach to pituitary tumors is a safe and minimally invasive procedure, which can be employed safely in any of our centers in nepal, equipped. Endoscopic transnasal transsphenoidal surgery is a minimally invasive procedure where the pituitary tumor is removed by working through the nose. Sep 18, 2017 couldwell wt, weiss mh, rabb c, liu jk, apfelbaum ri, fukushima t. Ligia tataranu et al endoscopic endonasal approach 53. Endonasal endoscopic transsphenoidal pituitary surgery for.
The technique of tumor dissection is predicated on preservation of the integrity of the diaphragma, i. Full text get a printable copy pdf file of the complete article 3. Endoscopic transsphenoidal panoramic and detailed view of the intraventricular structures approach. The transsphenoidal approach, either microscopic or endoscopic, has been restricted to intrasellar subdiaphragmatic tumors that extend upward from an enlarged sella turcica, and only partially involve the anteroinferior part of the third ventricle, according to grades i and ii of samiis classification. Sublabial transsphenoidal approach and resection of pituitary tumors suboccipital craniectomy for microvascular decompression of the trigeminal nerve or facial nerve or cerebellopointine angle tumor splitting the sylvian fissure, drilling of the anterior clinoid process and ophthalmic aneurysm clipping.
Case example transphenoidal approach to pituitary tumor return to. These tumors cause hormonal imbalance in the body by either. Transsphenoidal neurosurgery of intracranial neoplasm. Transnasal transsphenoidal approach to the sella pdf transsphenoidal approaches have been used for a century for the resection of.
The first successful resection of a craniopharyngioma was performed through an oronasal approach by a. Microscopic transsphenoidal surgery for pituitary adenomas in. Objective to explore factors influencing the recurrence of patients with cushing s disease after transsphenoidal. The point is that neither the open approach nor the open definitive procedure codes describe a complete procedure. Object the extended transsphenoidal approach, which requires a bone and dural opening through the tuberculum sellae and posterior planum sphenoidale, is increasingly used for the treatment of nonadenomatous suprasellar tumors. Endoscopic transnasal transphenoidal surgery video. The microscopic transsphenoidal operation can be divided into several distinct phases. 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. Additionally, the open skull base surgery codes should not be used in combination with. Guiot g 1973 transsphenoidal approach in surgical treatment 28.
As an alternative, an endonasal approach was adopted for patients who had large nostrils, such as white or. Pdf anesthesia for transsphenoidal pituitary surgery. The transsphenoidal approach is the procedure of choice for with better knowledge of microsurgical anatomy and pituitary adenomas because it offers a lower morbidity and modern microinstrumentation, and introduction of endo mortality 1, 4, 14. The elegant minimally invasive transnasal endoscopic approach to the sella. Even as medical and surgical treatment for pituitary tumors evolves, transsphenoidal surgery remains a mainstay of treatment. Witterick published transsphenoidal approach to the medial petrous apex find, read and cite all the research you need on researchgate. Endoscopic transsphenoidal pituitary surgeryoperative techniques in otolaryngologyhead and neck surgery,volume 22, issue 3,september 2011,pages 206214 list of donors the department of otolaryngology and the university of iowa wish to acknowledge the support of those who share our goal in improving the care of patients we serve. We found no statistically significant differences in complication rate or visual improvement between the two techniques. A team approach allows comprehensive care of both brain and sinusrelated issues before, during, and after surgery. Microsurgical and endoscopic techniques are commonly utilized surgical approaches to pituitary pathologies. In subsequent years, several other authors used such a modified transsphenoidal approach to successfully treat patients with supradiaphragmatic craniopharyngioma 11,17,26,28,31,34,35.
The development of endoscopic techniques for surgery of paranasal sinuses5 awoke the possibility of an endoscopic approach for the pituitary gland. Harvey cushing played an instrumental role in popularizing the endonasal route as it was pioneered by surgeons of his time, including schloffer and halstead. Managing the patient with transsphenoidal pituitary tumor. Patients who undergo transsphenoidal pituitary tumor resection require a multidisciplinary team approach, consisting of a neurosurgeon, an endocrinologist, and nurses. The direct transsphenoidal approach in pituitary adenoma resection under endoscopic assistance is time saving, and safe, with good exposure of operative field. Pituitary adenomas are noncancerous tumors that form in the pituitary gland. Filamentous fungal hyphae growing over mudlike pus discharges are noted inside the sinus. This surgical technique can also be used to remove tumors located in other regions of the skull base. Endoscopic endonasal transsphenoidal approach to pituitary. Transsphenoidal surgery is used to remove tumors of the pituitary gland. The back wall of the sinus covers the pituitary gland. The history and evolution of transsphenoidal surgery. The current literature regarding transsphenoidal surgery for all subtypes of pituitary adenomas and other sellar lesions was examined.
Transnasal transsphenoidal approach to pituitary iowa head. Transsphenoidal approaches for the extracapsular resection of. Sep 01, 2003 since the mid 1980s, the endoscopic transsphenoidal approach to the pituitary gland has been gaining increasing popularity. Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches. Although there is an increasing acceptance of transsphenoidal resection in adults, there are few reports describing this approach in the pediatric population. The endoscopic endonasal transsphenoidal approach is increasingly being used and is. Endoscopic transnasal transsphenoidal pituitary surgery. Pdf endoscopic endonasal transsphenoidal approach to. Igf1, cortisol and 24h urinary free cortisol excretion for patients with. The evolution of the transsphenoidal approaches and. Trends in transsphenoidal surgery have included a shift towards endonasal approaches featuring increasingly direct approaches to the sphenoid. Oct 11, 2020 the direct transsphenoidal approach in pituitary adenoma resection under endoscopic assistance is time saving, and safe, with good exposure of operative field. Transsphenoidal hypophysectomy radiology reference article. We have been using the direct endonasal approach for all pituitary tumors for.
The endonasal endoscopic approach for pituitary tumors is. Transnasal transsphenoidal approach to pituitary transnasal transsphenoidal approach to pituitary see. Initial attempts at transcranial approaches to the pituitary gland in the late 1800s and early 1900s resulted in a mortality rate that was generally considered prohibitive. Microsurgical approaches for transsphenoidal surgery. Transsphenoidal approach to petrous apex oto surgery atlas. Sphenoid sinusitis after transsphenoidal approach is shown in the endoscopic view left side. Ask your surgeons about their training and experience. Transcolumellar approach in transsphenoidal pituitary surgery.
Because of the benign, rapid, and nontraumatizing nature of the extracranial transsphenoidal approach to the base of the skull, this procedure is indicated as the method of choice in nearly all cases of surgery for pituitary fossa and parasellar region access. The transseptal transsphenoidal approach to pituitary tumors. Pdf transsphenoidal approaches in pituitary tumor surgery. This is the most common way to remove pituitary tumors. Transsphenoidal approach in endoscopic endonasal surgery for. The transsphenoidal approach is the procedure of choice for with better knowledge of microsurgical anatomy and pituitary adenomas because it offers a lower morbidity and modern microinstrumentation, and. Isolated fungal sphenoid sinusitis after the authors. Adaptability of the procedure to different sellar lesions. More recently, extended approaches have expanded the indications for transsphenoidal surgery by using different corridors leading to specific target areas. Transsphenoidal approach to the medial petrous apex request pdf. After tumor resection, diaphragmatic opening was seen with intraoperative evidence of csf leak. Various authors have recently reported extensive series on the treatment of craniopharyngiomas using the microscopic supradiaphragmatic transsphenoidal approach 5, 7, 10, 19, 21, 22.
Sublabial transsphenoidal approach and resection of pituitary tumors. Transsphenoidal surgery for pituitary tumours archives. Diabetes insipidus, fluid, pituitary surgery, sodium, syndrome of inappropriate secretion of antidiuretic hormone. With the development of antibiotic drugs and modern microinstrumentation, the transsphenoidal approach became the preferred route for the removal of lesions that were confined to the sella turcica. Nasal symptoms following endoscopic transsphenoidal pituitary. Transsphenoidal surgery for pituitary tumors inpatient. The sublabial approach was the common technique in the late 1960s which was often complicated by numbness of the upper lip and teeth, septal perforation and crust formation7,8. Transsphenoidal means that the surgery is done through the sphenoid sinus, a hollow space in the skull behind the nasal passages and below the brain. Suthakorn, journalopen medicine, year2019, volume14. Jul 08, 2019 the transsphenoidal corridor is accessed by either a transnasal or a sublabial approach. The history and evolution of transsphenoidal surgery in. Fully endoscopic combined transsphenoidal and supraorbital.
Successful transsphenoidal surgery needs expert nursing care for early identification and prompt treatment of pituitary dysfunction and neurosurgical complications. Sublabial approach has been widely used as the standard technique for transsphenoidal pituitary surgery. A neurosurgeon performs transsphenoidal surgery often as a team with an ent ear, nose, and throat surgeon who has specialized training in endoscopic sinus surgery. Pedicled nasoseptal flap hadadbassagasteguy flap protocol click on videos below to active. Transsphenoidal approach in endoscopic endonasal surgery. Pdf endoscopic repair of transsellar transsphenoidal. The recent and rapid diffusion of endoscopy into transsphenoidal surgery 3,4,6,12,24 has led some authors, already experienced in endoscopic pituitary surgery. Transcolumellar approach in transsphenoidal pituitary. The transsphenoidal route is the surgical approach of choice for most sellar tumors because of the relationship of the sphenoid bone to the nasal cavity below and the pituitary gland above.
Sublabial, transseptal, transsphenoidal approach to the. The endoscopic endonasal transsphenoidal approach to pituitary tumors is a safe and minimally invasive procedure, which can be employed safely in any of our centers in nepal, equipped with endoscopic sinus surgery and endoscopically trained ent and neurosurgeons. Chronic rhinosinusitis due to cyanoacrylic glue after. The sublabial transseptal transsphenoidal approach to sellar and.
Subfrontal approach was chosen in 36 cases, anterior interhemispheric fissure approach in 12, pterional approach in 115, transcallosal approach in 20 and transsphenoidal approach in 3. Important considerations regarding the specific approach to the sphenoid are the size of the nose and nostril, the presence of septal deviation or. Extended endoscopic transsphenoidal approach for extrasellar. Transsphenoidal surgery using a high definition video.
The transsphenoidal approach has a number of iterations, including the endonasal rhinoseptoplastic, transnasal septal displacement, transnasal endoscopic, and sublabial transseptal approaches. Open skull base approach code and open skull base definitive procedure code open skull base approach code, global craniotomy code, cranioplasty code, and open skull base secondary repair of dura code ent performs an open skull base approach and open resection of extradural skull base open skull base approach code and open skull base. Use the 4mm outer diameter, 18cm length, 0degree endoscope for the transsphenoidal approach. The transsphenoidal approach is the least traumatic nasal route to the sella turcica, avoids the need for brain retraction, and offers improved visualization of the surgical field. Recent findings endoscopic guidance has improved tumor visualization while minimizing the risk of nasal and dental complications and septal perforation. We encourage use of our illustrations for educational purposes, but permission should be sought before publication or commercial use. Microscopeguided endonasal transsphenoidal approach the. Early postoperative period was uneventful and clinical and histopathologic finding were. Schloffer suggested the use of a transsphenoidal route as a safer, alternative approach to the sella turcica. Hardy j 1969 transsphenoidal microsurgery of the normal and experience, the data are largely descriptive and it is a pathological pituitary. Sublabial transsphenoidal approach and resection of. The endoscopic approach for pituitary tumors is a recent innovation and is said to reduce the nasal trauma associated with transnasal transsphenoidal surgery.
The sublabial, transseptal, transsphenoidal approach is used as described elsewhere. Endoscopic endonasal transsphenoidal approach for pituitary. Sublabial transsphenoidal approach and resection of pituitary. Endoscopic pituitary surgery, transsphenoidal cincinnati. Pdf the extended direct endonasal transsphenoidal approach. Microsurgical approaches for transsphenoidal surgery neupsy key. Endonasal transsphenoidal approach has been a wellestablished method for pituitary gland tumor surgery. The novel transsphenoidal endoscopic approach is strongly taking more place in pituitary surgery, advancing the possibilities of the standard transsphenoidal approach. Feb 05, 2021 the endonasal transsphenoidal approach has evolved during the past century.
Transnasal transsphenoidal approach to pituitary iowa. Halstead of chicago in 1910, shortly after the inception of the transsphenoidal approach for pituitary lesions schloffer, 1907, halstead, 1910. The purpose of this study is to report the outcomes after transsphenoidal surgery in a consecutive series of pediatric patients with craniopharyngiomas treated at a single institution. Although this is a binasal operation, choose the nasal cavity with the most generous working room for the initial portions of the approach. Contemporary indications for transsphenoidal pituitary. The authors present their experiences in using the direct endonasal approach in patients with nonadenomatous suprasellar tumors. Instruments for endoscopic endonasal transsphenoidal surgery. Transsphenoidal surgery is a type of surgery in which an endoscope or 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. 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 than now. Transsphenoidal surgery continues to be the mainstay of surgical treatment for pituitary tumors. In view of these problems, surgeons have been seeking an. After a sublabial approach, the transsphenoidal retractor is removed, the wound is irrigated, and bleeding is controlled. Vivian l smith department of neurosurgery at mcgovern medical school medical school administrative offices 6431 fannin, suite 7.
Outcomes after transshenoidal surgery have improved over time. The transsphenoidal route is the surgical approach of choice for most sellar tumors because. Endoscopic transsphenoidal surgery for the treatment of pituitary sella lesions has been used for the past 10 years. Neurosurgeons must be aware of the indications, risks and alternatives to transsphenoidal pituitary surgery. Get stepbystep, expert guidance on fundamental procedures in neurosurgery both in print and on video. Jul 01, 2001 the transsphenoidal approach is an effective method for treating tumors contained within the sella or extending into the suprasellar cistern. Transsphenoidal approach complications neurosurgery. Traditionally, there are two approaches to endoscopic transsphenoidal surgery for pituitary adenomas. Gralapp retain for all of their original illustrations which appear in this online atlas.
The evolution of the transsphenoidal approaches and their current applications and modifications are discussed. The transsphenoidal resection of pediatric craniopharyngiomas. Endoscopic, endonasal extended transsphenoidal, transplanum. Transsphenoidal hypophysectomy an overview sciencedirect. As a result, this approach has lower morbidity and mortality rates when compared with transcranial procedures 26. Transsphenoidal approach complications for a transsphenoidal approach, no significant differences in surgical outcomes, mortality during the perioperative period or complications were observed between patients younger than 14 years old and similar patients in the general population. The endoscopic endonasal approach offers a more 10.
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