Endoscopic Transsphenoidal Pituitary Surgery

Dr.Saied AlhabashENT Department –Red Crescent

HospitalNeurosurgery Department-

Damascus Hospital

ESBS• Endoscopic Pituitary Surgery is step 1 or 2

from learning curve of the ESBS(Endoscopic Skull Base Surgery).

• ESBS now is considered one of the most reliable routs for the treatment of some skull base tumors.

Pituitary Lesions• Medication• Surgery craniotomy sublabial microscopic transseptal endoscopic transsphenoidal• Gamma knife• Observation

Many surgeries in the world moves to the

endoscopic rout

Transnasal transsphenoidal endoscopic excision is a reasonable

alternative to the traditional method of sellar mass excision.

Analysis of transnasal endoscopic versus transseptal microscopic approach for excision of pituitary tumors.

Higgins TS ,Courtemanche C ,Karakla D ,Strasnick B , Singh RV ,Koen JL , Han JK.

Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.

In our experience, fully endoscopic transsphenoidal surgery for functioning

pituitary adenomas leads to a better endocrinologic outcome for noninvasive

macroadenomas compared to the traditional microsurgical technique.

However, morbidity with the endoscopic technique was higher in terms of the rate of

postoperative CSF leaks.Fully endoscopic transsphenoidal surgery for functioning pituitary adenomas: a retrospective comparison with traditional transsphenoidal microsurgery in the same institution.

'D Haens J , Van Rompaey K ,Stadnik T ,Haentjens P ,Poppe K ,Velkeniers B.Department of Neurosurgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, B-1090 Brussels, Belgium. jean.dhaens@uzbrussel.be

Transsphenoidal pituitary surgery has evolved over the past several decades, because advances

in technology have been the catalyst for minimally invasive surgeries. Less invasive

approaches, such as the transnasal approach with endoscopic resection of tumor and the completely endoscopic .technique have less morbidity and a shorter hospital stay than

traditional sublabial approaches. Continued follow-up is needed to confirm long-term benefits

and similar recurrence rates.Comparison of techniques for transsphenoidal pituitary surgery.

Neal JG , Patel SJ ,Kulbersh JS ,Osguthorpe JD , Schlosser RJ.Departments of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.

The results were comparable with those of the best microsurgical series regarding endosellar lesions, but tumor removal was notably superior when dealing with tumors having an extrasellar extension. The

improvement may be explained by the excellent vision of the deep surgical fields due to the endoscope and by the extreme flexibility of the surgical trajectory, mainly due to the absence of the divaricator, giving access to the ramifications of the tumor, otherwise

difficult to reach.

The endoscopic versus the traditional approach in pituitary surgery. Frank G ,Pasquini E ,Farneti G ,Mazzatenta D ,Sciarretta V , Grasso V ,

Faustini Fustini M.Center of Surgery for Pituitary Tumors, Department of Neuroscience, Bellaria Hospital, Bologna, Italy. Giorgio.Frank@ausl.bologna.it

An adequate exposure of the sellar, suprasellar, and infrasellar/upper clival

regions can be achieved via a simple, direct endonasal approach. From a direct

endonasal route, there is a preferential visualization of the structures contralateral to the approach. The endoscope affords a more panoramic view that extends the

area covered by the operating microscope.Comparison between the microscope and endoscope in the direct endonasal extended transsphenoidal approach: anatomical study.

Catapano D ,Sloffer CA , Frank G ,Pasquini E ,'D Angelo VA ,Lanzino G.Department of Neurosurgery, Microsurgical Laboratory, Illinois Neurological Institute, University of Illinois College of Medicine at Peoria, Illinois 61637, USA.

The paraseptal transsphenoidal approach to the sella turcica using the telescope is at least as

effective as the conventional transseptal approach using the operating microscope only. It provides a wide access to the pituitary fossa and

an optimal vision of the critical areas. The absence of postoperative nasal packing

improves significantly the comfort of the patient during the first postoperative hours.

Endoscopic and microscopic paraseptal transsphenoidal approach to the sella turcica.Eloy P ,Watelet JB ,Donckier J ,Gustin T ,Gaudon IP ,Collet S ,Rombaux P ,

Gillard C , Bertrand B.Department of Otorhinolaryngology, Head and Neck Surgery, UCL Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium. philippe.eloy@orlo.ucl.ac.be

• It is now accepted that Endoscopic Transnasal Transsphenoidal Hypophysectomy is a good choice for the the pituitrary adenomas even spread to the perisellar region because of:

1-The ability to see in many angles which makes the endoscope go to dead areas could not be accessible with the assistance of microscope, then the recurrence rate becomes lower with endoscope.

2-The ability of histological differnciation is very high with the new generation of cameras(HD) ,that make us to define the normal tissue .

Mono CCD Three CCD

3-The complications are very rare specially which correlate with the nasal septum, because no need to translocate it ,or incise it.

•Two nostril approach

• Free-hand endoscope

Why Endoscope• Endoscope opens hidden parts• The manipulation of endoscope is better than

microscope• The speed revolution of technology made

magnificent picture with very high differnciation

• Minimally invasive

ESBSEndoscopic Skull Base Surgery

We can use the endoscope now to treat more complicated entities in the skull base like cordoma ,craniopharyngoma and petroclival cysts.

Advantages Of ESBS

• Reduces the impact on the patient

• Lessens the morbidity

• Reduces the length of stay in many cases

Technical Equipment• Endoscopic set:

Endoscpopes(0/30) Monitor(medical) Camera (HD) Xenon light Instruments Recorder Suitable Powered Instrumentation

• Other equipments: Pneumatic Holder Navigation System CUSA MR intraoperative

a

Team Spirit

Disadvantages

• Complicated instruments• Clock –Gear Mechanism

MacroadenomaSupasellar extension

Knowledge Is Power