Download PDF
J Neurol Surg B Skull Base 2013; 74(03): 146-154
DOI: 10.1055/s-0033-1338258
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Endonasal Transsphenoidal Approach to Sellar Lesions: A Detailed Account of Our Mononostril Technique

Stefan Linsler
1   Department of Neurosurgery, Saarland University, Homburg, Germany
,
Michael Robert Gaab
2   Department of Neurosurgery, Hannover Nordstadt Hospital, affiliated with Hospital Hannover Medical School, Hannover, Germany
,
Joachim Oertel
1   Department of Neurosurgery, Saarland University, Homburg, Germany
› Author Affiliations
Further Information

Publication History

09 March 2012

24 December 2012

Publication Date:
19 March 2013 (online)

    Permissions and Reprints

Abstract

Objective The endonasal endoscopic approach is currently under investigation for perisellar tumor surgery. A higher resection rate is to be expected and nasal complications should be minimized. Here, the authors report their technique of transnasal endoscopic neurosurgery after 218 procedures.

Methods Between October 2000 and September 2011, 210 patients received 218 endoscopic endonasal transsphenoidal procedures for perisellar lesions. Procedures were video recorded. The surgical technique was carefully analyzed. These cases were prospectively followed.

Results Standard technique was mononostril approach with 0-degree optics. 30-degree and—after availability—45-degree optics were used for assessment of radicality. On follow-up, magnetic resonance imaging revealed radical tumor resection in 94 out of 104 cases (90.3%). Recurrent tumor growth was observed in five younger patients (2.2%). There was no mortality and a low complication rate. Three patients (1.4%) complained postoperatively of nasal congestion or reduced nasal air flow; however, no complaints were considered to be severe.

Conclusion In comparison with other literature reports, the results are comparable or even better with respect to surgical radicality. The very low rate of nasal complaints is particularly remarkable. The technique has been shown to be safe and successful with a high radicality and only minor complications.

Keywords

endoscopy - mononostril - endonasal transsphenoidal approach - sellar lesions
 

  • References

  • 1 Kanter AS, Dumont AS, Asthagiri AR, Oskouian RJ, Jane Jr JA, Laws Jr ER. The transsphenoidal approach. A historical perspective. Neurosurg Focus 2005; 18 (4) e6
    PubMedGoogle Scholar
  • 2 Adams CB, Burke CW. Current modes of treatment of pituitary tumours. Br J Neurosurg 1993; 7 (2) 123-127
    CrossrefPubMedGoogle Scholar
  • 3 Ciric I, Ragin A, Baumgartner C, Pierce D. Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 1997; 40 (2) 225-236 , discussion 236–237
    CrossrefPubMedGoogle Scholar
  • 4 Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M. Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 1999; 90 (2) 237-250
    Google Scholar
  • 5 Hardy J. Transphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg 1969; 16: 185-217
    PubMedGoogle Scholar
  • 6 Laws EJ. Transsphenoidal approach to pituitary tumours. In: Schmidek HH, Sweet WH, , eds. Operative Neurosurgical Techniques: Indications, Methods and Results. 3rd ed. Philadelphia: WB Saunders; 1995: 283-292
    Google Scholar
  • 7 Schroeder HW, Oertel J, Gaab MR. Endoscopic aqueductoplasty in the treatment of aqueductal stenosis. Childs Nerv Syst 2004; 20 (11–12) 821-827
    CrossrefPubMedGoogle Scholar
  • 8 Schroeder HW, Oertel J, Gaab MR. Incidence of complications in neuroendoscopic surgery. Childs Nerv Syst 2004; 20 (11–12) 878-883
    CrossrefPubMedGoogle Scholar
  • 9 Schroeder HW, Oertel J, Gaab MR. Endoscope-assisted microsurgical resection of epidermoid tumors of the cerebellopontine angle. J Neurosurg 2004; 101 (2) 227-232
    CrossrefPubMedGoogle Scholar
  • 10 Schroeder HW, Oertel J, Gaab MR. Endoscopic treatment of cerebrospinal fluid pathway obstructions. Neurosurgery 2007; 60 (2) (Suppl. 01) 44-51
    PubMedGoogle Scholar
  • 11 Oertel JM, Mondorf Y, Baldauf J, Schroeder HW, Gaab MR. Endoscopic third ventriculostomy for obstructive hydrocephalus due to intracranial hemorrhage with intraventricular extension. J Neurosurg 2009; 111 (6) 1119-1126
    CrossrefPubMedGoogle Scholar
  • 12 Mortini P, Roberti F, Kalavakonda C, Nadel A, Sekhar LN. Endoscopic and Microscopic Extended Subfrontal Approach to the Clivus: A Comparative Anatomical Study. Skull Base 2003; 13 (3) 139-147
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Fischer G, Stadie A, Reisch R , et al. The keyhole concept in aneurysm surgery: results of the past 20 years. Neurosurgery 2011; 68 (1, Suppl Operative): 45-51 , discussion 51
    PubMedGoogle Scholar
  • 14 Cappabianca P, Cavallo LM, Esposito F, De Divitiis O, Messina A, De Divitiis E. Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery. Adv Tech Stand Neurosurg 2008; 33: 151-199
    PubMedGoogle Scholar
  • 15 Zada G, Cappabianca P. Raising the bar in transsphenoidal pituitary surgery. World Neurosurg 2010; 74 (4–5) 452-454
    CrossrefPubMedGoogle Scholar
  • 16 Naftel RP, Reed GT, Kulkarni AV, Wellons JC. Evaluating the Children's Hospital of Alabama endoscopic third ventriculostomy experience using the Endoscopic Third Ventriculostomy Success Score: an external validation study. J Neurosurg Pediatr 2011; 8 (5) 494-501
    CrossrefPubMedGoogle Scholar
  • 17 Cappabianca P, Alfieri A, Colao A , et al. Endoscopic endonasal transsphenoidal surgery in recurrent and residual pituitary adenomas: technical note. Minim Invasive Neurosurg 2000; 43 (1) 38-43
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Cappabianca P, Cavallo LM, Colao A , et al. Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg 2002; 45 (4) 193-200
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 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
  • 20 Cappabianca P, Cavallo LM, de Divitiis O, Solari D, Esposito F, Colao A. Endoscopic pituitary surgery. Pituitary 2008; 11 (4) 385-390
    CrossrefPubMedGoogle Scholar
  • 21 Cappabianca P, Cavallo LM, Esposito F, de Divitiis E. Endoscopic endonasal transsphenoidal surgery: procedure, endoscopic equipment and instrumentation. Childs Nerv Syst 2004; 20 (11–12) 796-801
    CrossrefPubMedGoogle Scholar
  • 22 Conrad J, Philipps M, Oertel J. High-definition imaging in endoscopic transsphenoidal pituitary surgery. Am J Rhinol Allergy 2011; 25 (1) e13-e17
    CrossrefPubMedGoogle Scholar
  • 23 Jho HD. Endoscopic transsphenoidal surgery. J Neurooncol 2001; 54 (2) 187-195
    Google Scholar
  • 24 Jho HD, Carrau RL. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 1997; 87 (1) 44-51
    CrossrefPubMedGoogle Scholar
  • 25 Jho HD, Alfieri A. Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations. Minim Invasive Neurosurg 2001; 44 (1) 1-12
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Spencer WR, Levine JM, Couldwell WT, Brown-Wagner M, Moscatello A. Approaches to the sellar and parasellar region: a retrospective comparison of the endonasal-transsphenoidal and sublabial-transsphenoidal approaches. Otolaryngol Head Neck Surg 2000; 122 (3) 367-369
    CrossrefPubMedGoogle Scholar
  • 27 Zada G, Kelly DF, Cohan P, Wang C, Swerdloff R. Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions. J Neurosurg 2003; 98 (2) 350-358
    CrossrefPubMedGoogle Scholar
  • 28 Sheehan MT, Atkinson JL, Kasperbauer JL, Erickson BJ, Nippoldt TB. Preliminary comparison of the endoscopic transnasal vs the sublabial transseptal approach for clinically nonfunctioning pituitary macroadenomas. Mayo Clin Proc 1999; 74 (7) 661-670
    CrossrefPubMedGoogle Scholar
  • 29 Sharma K, Tyagi I, Banerjee D, Chhabra DK, Kaur A, Taneja HK. Rhinological complications of sublabial transseptal transsphenoidal surgery for sellar and suprasellar lesions: prevention and management. Neurosurg Rev 1996; 19 (3) 163-167
    CrossrefPubMedGoogle Scholar
  • 30 Shou XF, Li SQ, Wang YF, Zhao Y, Jia PF, Zhou LF. Treatment of pituitary adenomas with a transsphenoidal approach. Neurosurgery 2005; 56 (2) 249-256 , discussion 249–256
    CrossrefPubMedGoogle Scholar
  • 31 Cappabianca P, de Divitiis E. Endoscopy and transsphenoidal surgery. Neurosurgery 2004; 54 (5) 1043-1048 , 1048–1050
    CrossrefPubMedGoogle Scholar
  • 32 Oertel JGM. Endoscopic endonasal transsphenoidal approach for pituitary lesions: results after 77 procedures with special reference to geriatric patients. In, Klug N(ed) 2004; :Abstract 55
    PubMedGoogle Scholar
  • 33 Fahlbusch R, Ganslandt O, Buchfelder M, Schott W, Nimsky C. Intraoperative magnetic resonance imaging during transsphenoidal surgery. J Neurosurg 2001; 95 (3) 381-390
    CrossrefPubMedGoogle Scholar
  • 34 Thomale UW, Stover JF, Unterberg AW. The use of neuronavigation in transnasal transsphenoidal pituitary surgery. Zentralbl Neurochir 2005; 66 (3) 126-132 , discussion 132
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Cappabianca P, Cavallo LM, Esposito F, Valente V, De Divitiis E. Sellar repair in endoscopic endonasal transsphenoidal surgery: results of 170 cases. Neurosurgery 2002; 51 (6) 1365-1371 , discussion 1371–1372
    CrossrefPubMedGoogle Scholar
  • 36 Cavallo LM, de Divitiis O, Aydin S , et al. Extended endoscopic endonasal transsphenoidal approach to the suprasellar area: anatomic considerations—part 1. Neurosurgery 2007; 61 (3, Suppl): 24-33 , discussion 33–34
    CrossrefPubMedGoogle Scholar
  • 37 Nasseri SS, Kasperbauer JL, Strome SE, McCaffrey TV, Atkinson JL, Meyer FB. Endoscopic transnasal pituitary surgery: report on 180 cases. Am J Rhinol 2001; 15 (4) 281-287
    CrossrefPubMedGoogle Scholar
  • 38 Cappabianca P, Decq P, Schroeder HW. Future of endoscopy in neurosurgery. Surg Neurol 2007; 67 (5) 496-498
    CrossrefPubMedGoogle Scholar
  • 39 Cavallo LM, Cappabianca P, Galzio R, Iaconetta G, de Divitiis E, Tschabitscher M. Endoscopic transnasal approach to the cavernous sinus versus transcranial route: anatomic study. Neurosurgery 2005; 56 (2, Suppl): 379-389 , discussion 379–389
    CrossrefPubMedGoogle Scholar
  • 40 Cavallo LM, Dal Fabbro M, Jalalod'din H , et al. Endoscopic endonasal transsphenoidal surgery. Before scrubbing in: tips and tricks. Surg Neurol 2007; 67 (4) 342-347
    CrossrefPubMedGoogle Scholar
  • 41 Cavallo LM, de Divitiis O, Aydin S , et al. Extended endoscopic endonasal transsphenoidal approach to the suprasellar area: anatomic considerations—part 1. Neurosurgery 2008; 62 (6) (Suppl. 03) 1202-1212
    PubMedGoogle Scholar
  • 42 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
  • 43 Jho HD. Endoscopic pituitary surgery. Pituitary 1999; 2 (2) 139-154
    CrossrefPubMedGoogle Scholar
  • 44 Cappabianca P, Cavallo LM, Esposito F, De Divitiis E. Craniopharyngiomas. J Neurosurg 2008; 109 (1) 1-3 , reply 3–5
    PubMedGoogle Scholar
  • 45 Cappabianca P, Cavallo LM, de Divitiis E. Endoscopic endonasal transsphenoidal surgery. Neurosurgery 2004; 55 (4) 933-940 , discussion 940–941
    CrossrefPubMedGoogle Scholar