Binasal Endoscopic Approach to the Sellar Region: Experience and Outcome Analysis of 80 Cases

 

 Buy Article Permissions and Reprints

Abstract

A prospective study was performed on 80 cases of different types of sellar lesions during the period between January 2007 and December 2010. The binasal approach was used in all patients. Functioning lesions were diagnosed in 59 patients. The most common secretory tumors were prolactinomas (37 patients) followed by adrenocorticotropic hormone producing tumors (11 patients) and growth hormone producing tumors (11 patients). Nonfunctioning lesions included: 14 pituitary adenomas, 2 chordomas, 2 metastatic lesions (ovarian carcinoma and thyroid carcinoma), and 1 case of sarcoidosis, Rathke's cleft cyst, and craniopharyngioma. Seven nonfunctioning cases developed apoplexy. Among the 59 patients with functioning pituitary lesions, postoperative endocrinological control was achieved in 51 of them (86.5%) 3 months postoperatively with normalization of pituitary functions and complete tumor resection as proved by postoperative magnetic resonance imaging. Postoperative visual field defect improvement was achieved in 15 out of 23 patients (65.2%), including the cases with apoplexy, with complete tumor resection. Postoperative discomfort such as headache, vomiting, or dizziness was minimal and hospitalization period was 2 to 3 days. Postoperative leak continued in one patient in whom revision surgical repair was performed 7 days later. The merits, outcome, and limitations of the approach were discussed.

• References

• 1 Das K, Spencer W, Nwagwu CI , et al. Approaches to the sellar and parasellar region: anatomic comparison of endonasal-transsphenoidal, sublabial-transsphenoidal, and transethmoidal approaches. Neurol Res 2001; 23 (1) 51-54
  CrossrefPubMedGoogle Scholar
• 2 Watson SW, Sinn DP, Neuwelt EA. Dental considerations in the sublabial trans-sphenoidal surgical approach to the pituitary gland. Neurosurgery 1982; 10 (2) 236-241
  CrossrefPubMedGoogle Scholar
• 3 Laws ER, Kanter AS, Jane Jr JA, Dumont AS. Extended transsphenoidal approach. J Neurosurg 2005; 102 (5) 825-827 , discussion 827–828
  CrossrefPubMedGoogle Scholar
• 4 Cappabianca P, Cavallo LM, Colao A, de Divitiis E. Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 2002; 97 (2) 293-298
  CrossrefPubMedGoogle Scholar
• 5 Saeki N, Horiguchi K, Murai H, Hasegawa Y, Hanazawa T, Okamoto Y. Endoscopic endonasal pituitary and skull base surgery. Neurol Med Chir (Tokyo) 2010; 50 (9) 756-764
  CrossrefPubMedGoogle Scholar
• 6 Al-Mefty O, Pravdenkova S, Gragnaniello C. A technical note on endonasal combined microscopic endoscopic with free head navigation technique of removal of pituitary adenomas. Neurosurg Rev 2010; 33 (2) 243-248 , discussion 248–249
  CrossrefPubMedGoogle Scholar
• 7 Schulze F, Bühler K, Neubauer A, Kanitsar A, Holton L, Wolfsberger S. Intra-operative virtual endoscopy for image guided endonasal transsphenoidal pituitary surgery. Int J CARS 2010; 5 (2) 143-154
  PubMedGoogle Scholar
• 8 Jho HD, Carrau RL. Endoscopy assisted transsphenoidal surgery for pituitary adenoma. Technical note. Acta Neurochir (Wien) 1996; 138 (12) 1416-1425
  CrossrefPubMedGoogle Scholar
• 9 Jho HD, Alfieri A. Endoscopic transsphenoidal pituitary surgery: various surgical techniques and recommended steps for procedural transition. Br J Neurosurg 2000; 14 (5) 432-440
  CrossrefPubMedGoogle Scholar
• 10 Koltai PJ, Goufman DB, Parnes SM, Steiniger JR. Transsphenoidal hypophysectomy through the external rhinoplasty approach. Otolaryngol Head Neck Surg 1994; 111 (3 Pt 1) 197-200
  CrossrefPubMedGoogle Scholar
• 11 Gammert C. Rhinosurgical experience with the transseptal-transsphenoidal hypophysectomy: technique and long-term results. Laryngoscope 1990; 100 (3) 286-289
  PubMedGoogle Scholar
• 12 Thomas RF, Monacci WT, Mair EA. Endoscopic image-guided transethmoid pituitary surgery. Otolaryngol Head Neck Surg 2002; 127 (5) 409-416
  CrossrefPubMedGoogle Scholar
• 13 Badie B, Nguyen P, Preston JK. Endoscopic-guided direct endonasal approach for pituitary surgery. Surg Neurol 2000; 53 (2) 168-172 , discussion 172–173
  CrossrefPubMedGoogle Scholar
• 14 Tabaee A, Anand VK, Barrón Y , et al. Endoscopic pituitary surgery: a systematic review and meta-analysis. J Neurosurg 2009; 111 (3) 545-554
  CrossrefPubMedGoogle Scholar
• 15 Schulder M, Sernas TJ, Carmel PW. Cranial surgery and navigation with a compact intraoperative MRI system. Acta Neurochir Suppl (Wien) 2003; 85: 79-86
  PubMedGoogle Scholar
• 16 Laws ER, Kanter AS, Jane Jr JA, Dumont AS. Extended transsphenoidal approach. J Neurosurg 2005; 102 (5) 825-827 , discussion 827–828
  CrossrefPubMedGoogle Scholar
• 17 Schulder M, Sernas TJ, Carmel PW. Cranial surgery and navigation with a compact intraoperative MRI system. Acta Neurochir Suppl (Wien) 2003; 85: 79-86
  PubMedGoogle Scholar
• 18 Knott PD, Batra PS, Citardi MJ. Computer aided surgery: concepts and applications in rhinology. Otolaryngol Clin North Am 2006; 39 (3) 503-522 , ix
  CrossrefPubMedGoogle Scholar
• 19 D'Haens J, Van Rompaey K, Stadnik T, Haentjens P, Poppe K, Velkeniers B. Fully endoscopic transsphenoidal surgery for functioning pituitary adenomas: a retrospective comparison with traditional transsphenoidal microsurgery in the same institution. Surg Neurol 2009; 72 (4) 336-340
  CrossrefPubMedGoogle Scholar
• 20 Goudakos JK, Markou KD, Georgalas C. Endoscopic versus microscopic trans-sphenoidal pituitary surgery: a systematic review and meta-analysis. Clin Otolaryngol 2011; 36 (3) 212-220
  CrossrefPubMedGoogle Scholar