Endoscopic pituitary surgery: An early experience

被引:188
作者
Jho, HD
Carrau, RL
Ko, Y
Daly, MA
机构
[1] UNIV PITTSBURGH, SCH MED, DEPT NEUROL SURG, PITTSBURGH, PA 15261 USA
[2] UNIV PITTSBURGH, SCH MED, DEPT OTOLARYNGOL, PITTSBURGH, PA 15261 USA
[3] UNIV PITTSBURGH, SCH MED, DIV ENDOCRINOL, PITTSBURGH, PA 15261 USA
来源
SURGICAL NEUROLOGY | 1997年 / 47卷 / 03期
关键词
Cushing's disease; endoscopy; pituitary neoplasms; prolactinoma; sphenoid sinus; transsphenoidal approach;
D O I
10.1016/S0090-3019(96)00452-1
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND As an element of a minimally invasive management approach, we had developed an endonasal endoscopic transsphenoidal technique for the treatment of pituitary tumors. Initially, four patients were operated on via a sublabial, transseptal approach using a fiberoptic rigid endoscope in conjunction with the operating microscope. Encouraged by that experience, our subsequent 11 patients had undergone endonasal endoscopic transsphenoidal surgery without the use of a retractor or speculum. METHODS Our group of patients included nine females and six males, with an age range of 17-88 years (median: 43 years). There were four microadenomas, four intrasellar macroadenomas, three macroadenomas with suprasellar extension, three invasive macroadenomas involving the cavernous sinus with suprasellar extension, and one metastatic adenocarcinoma. RESULTS Thirteen patients with pituitary adenomas experienced resolution of their symptoms postoperatively. One patient with a recurrent prolactinoma responded partially following surgery and subsequently underwent gamma knife radiosurgery. Two patients were treated with post-operative fractionated radiation therapy,on pituitary adenoma in the cavernous sinus, and the other for metastatic adenocarcinoma, respectively. The first patient, treated via an endonasal endoscopic approach for biopsy of the metastatic adenocarcinoma, developed postoperative cerebrospinal fluid (CSF) leak that was successfully managed with endoscopic packing of a fat graft. CONCLUSIONS The endonasal endoscopic transsphenoidal approach facilitates faster postoperative recovery by the avoidance of traditional incision and postoperative nasal packing. It offers a panoramic view of the sphenoid sinus and excellent visualization of the sellar and suprasellar structures with increased illumination and magnification. Such visualization provides the potential for more complete tumor resection, as well as a better chance of preserving pituitary function and avoiding neurovascular injury. (C) 1997 by Elsevier Science Inc.
引用
收藏
页码:213 / 222
页数:10
相关论文
共 18 条
[1]   CURRENT MODES OF TREATMENT OF PITUITARY-TUMORS [J].
ADAMS, CBT ;
BURKE, CW .
BRITISH JOURNAL OF NEUROSURGERY, 1993, 7 (02) :123-127
[2]   INCIDENCE AND MANAGEMENT OF COMPLICATIONS OF TRANS-SPHENOIDAL OPERATION FOR PITUITARY-ADENOMAS [J].
BLACK, PM ;
ZERVAS, NT ;
CANDIA, GL .
NEUROSURGERY, 1987, 20 (06) :920-924
[3]   EXPERIENCE WITH THE DIRECT TRANSNASAL TRANSSPHENOIDAL APPROACH TO THE PITUITARY FOSSA [J].
COOKE, RS ;
JONES, RAC .
BRITISH JOURNAL OF NEUROSURGERY, 1994, 8 (02) :193-196
[4]   THE USE OF THE RIGID ENDOSCOPE IN TRANS-SPHENOIDAL PITUITARY SURGERY [J].
GAMEA, A ;
FATHI, M ;
ELGUINDY, A .
JOURNAL OF LARYNGOLOGY AND OTOLOGY, 1994, 108 (01) :19-22
[5]   A DIRECT TRANSNASAL APPROACH TO THE SPHENOID SINUS [J].
GRIFFITH, HB ;
VEERAPEN, R .
JOURNAL OF NEUROSURGERY, 1987, 66 (01) :140-142
[6]  
GULOT A, 1973, INT C SERIES, V303, P159
[7]  
Hardy J, 1969, Clin Neurosurg, V16, P185
[8]  
HARDY J, 1985, NEUROSURGERY, P889
[9]   ENDOSCOPIC PITUITARY-TUMOR SURGERY [J].
JANKOWSKI, R ;
AUQUE, J ;
SIMON, C ;
MARCHAL, JC ;
HEPNER, H ;
WAYOFF, M .
LARYNGOSCOPE, 1992, 102 (02) :198-202
[10]  
LISTON SL, 1987, J NEUROSURG, V66, P155