This is done in a nearly stepbystep fashion, first pointing out the indications of this approach as opposed to conventional pituitary microsurgery and when this approach should be used for the nonadenomatous lesions such as non. Sep 27, 2018 the endonasal transsphenoidal approach has evolved during the past century. Normally an otolaryngologist performs the initial stage of surgery through the nasal cavity and sphenoid. There is fairly solid evidence that for most complications, the incidence rate decreases significantly with increasing experience on the part of the surgeon. Endoscopic pituitary surgery, transsphenoidal cincinnati. If the suprasellar extension is very important, a fullyendoscopic twostaged procedure may be performed, while waiting for the natural descent of the residue 8. Complications of transsphenoidal surgery latest news and. Pure endoscopic endonasal transsphenoidal surgery, with the endoscope used alone throughout the approach to visualize the surgical trajectory and the surgical target area, has been described in detail by jho et al. Left, lateral a and frontal c views of the surgical field during traditional transsphenoidal microsurgery with the nasal speculum. Pickard jd, akalan n, di rocco c, dolenc vv, lobo antunes j, mooij jja, schramm j, sindou m eds advances and technical standards in neurosurgery. Note the difference of viewing angle, which is much wider in the endoscopic technique. The progress of endoscopic techniques for paranasal sinuses surgery 5 revealed the opportunity for an endoscopic pituitary gland.
The endoscopic view is panoramic when compared with the microscopic view. If the suprasellar extension is very important, a fully endoscopic twostaged procedure may be performed, while waiting for the natural descent of the residue 8. As old as surgery is mans need to produce medical instruments specifically dedicated to various techniques. Recently, the endonasal transsphenoidal approach has been widely used as the standard technique for pituitary surgery instead of the sublabial approach.
Endoscopic endonasal transsphenoidal approach springerlink. Endoscopic pituitary surgery transsphenoidal overview. We report our experience of treating pituitary apoplexy using an eea approach. This latter t2weighted image shows the typical inhomogeneous hyperintensity known as thumb sign. Endonasal endoscopic transsphenoidal approach to lesions. Analysis of quality of voice the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Transsphenoidal surgery is a kind of surgery in which surgical instruments are placed into part of the brain by going through the nose and the sphenoid bone. Endoscopic versus microscopic transsphenoidal pituitary.
Transsphenoidal surgery for pituitary adenomas was firstly invented by herman schloffer more than 100 years ago. Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors. May 23, 2004 the spectrum of complications of transsphenoidal surgery is clearly related to the technical aspects of the operation and to the basic aspects of pituitary disease. Recently, the standard endoscopic transsphenoidal approach has been modified in various ways to develop extended endonasal approaches. Of course, microscopic and endoscopic anatomy are basically the same, but the optical.
Jho and carrau further developed the pure endonasal endoscopic surgery of pituitary tumors715. The pure endonasal endoscopic surgery of pituitary tumors was developed by jho and carrau 7, 8. The extended endoscopic endonasal approach for the removal. In the last 2 decades, endoscopic endonasal transsphenoidal surgery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal invasiveness, lower incidence of complications, and lower morbidity and mortality rates compared with traditional approaches. Endoscopic endonasal surgery is burdened by a large learning curve, but after one is proficient, the endoscopic transsphenoidal approach can be a significant addition to the neurosurgeons armamentarium. Neurosurgeons may code for fluoroscopic guidance in addition to any procedure that does not include it in the description. Endoscopic endonasal transsphenoidal surgery springerlink. Endoscopic transsphenoidal surgery etss allows for safe and sufficient resection of sellar lesion tumors. Endoscopic endonasal transsphenoidal approach for pituitary adenomas article pdf available in zhonghua wai ke za zhi chinese journal of surgery 4422. In the field of endoscopic surgery, dedicated instruments are needed not only for neuroendoscopy of the cerebral ventricles, but also for surgery of the cranial base with the use of minimally invasive endoscopic techniques. The first transnasal resection of a pituitary tumor was performed by schloffer in 1907 1. Endoscopic endonasal surgery an overview sciencedirect topics. Apr 01, 2004 subsequently, the authors describe in great detail the endoscopic endonasal transsphenoidal approach to the sella.
In this multiauthor book with numerous color illustrations the main aspects of the endonasal endoscopic approach to the skull base are presented, starting with a clear description of the endoscopic anatomy, the panoramic view afforded by the endoscope and the development of effective instruments and adjuncts. Endonasal endoscopic transsphenoidal approach to lesions of. From this group, 73 consecutive patients with large and giant pituitary adenomas defined as maximum diameter. Microscopic endonasal transsphenoidal surgery in patients. Transsphenoidal approach in endoscopic endonasal surgery for skull base lesions. It is only recently that the use of the endoscope as the sole visualizing tool has been introduced in transsphenoidal pituitary surgery with its favorable related implications and minimal operative trauma. Major reason for developing endoscopic pituitary tumor resection techniques is to minimize intranasal complications and to provide superior visualization. If a neurosurgeon uses fluoroscopic guidance during an endonasal transsphenoidal resection of a pituitary tumor, should i code for the fluoroscopic guidance or only for the endonasal, 61548. Extended endoscopic endonasal approach to the midline. Contains operative video viewer discretion advised. Introduction discussion therefore, after our extensive experience with over 250 patients treated by means of the endoscopic endonasal transsphenoidal approach for pathologies of the sellar region, we describe herein the characteristics of the proper.
Use of an endoscope in transsphenoidal approaches represents a substantial advantage. Endoscopic endonasal transsphenoidal approach request pdf. The aim of this study was to compare and evaluate the outcomes and complications of endoscopic and microscopic transsphenoidal surgery in the. With the rapid evolution of endoscopy, the degree of visualization and surgical maneuverability has improved greatly. The development of endoscopic techniques for surgery of paranasal sinuses5 awoke the possibility of an endoscopic approach for the pituitary gland. Pt is kept on iv antibiotics for 3 days and shifted to oral antibiotics after. Endoscopic endonasal surgery an overview sciencedirect. Endoscopic endonasal skull base approach for parasellar. In an endoscopic endonasal procedure, a rhinotomy for access to the skull base is not performed. Endoscopic endonasal transsphenoidal surgery of 1,166. Endoscopic endonasal transsphenoidal surgery neurosurgery. Instruments for endoscopic endonasal transsphenoidal surgery. Endoscopic transsphenoidal surgery has gradually come to be regarded as a preferred option in the treatment of pituitary adenomas because of its advantages of improved visualization and its minimal invasiveness. Harvey cushing played an instrumental role in popularizing the endonasal route as it was pioneered by surgeons of his time, including schloffer and halstead.
Microscopic endonasal transsphenoidal surgery in patients with small nostril tsutomu kato departments of neurosurgery, hakodate central hospital, hakodate, japan abstract. Acclaimed international experts bring you detailed guidance on natural history, radiologic and clinical aspects, surgical indications, and resection techniques. Stepbystep description endonasal endoscopic pituitary surgery by prof. Nasal resonance change after endoscopic endonasal transsphenoidal skull base surgery. Keywords endoscopic surgery endonasal, transsphenoidal surgery pituitary adenoma pituitary tumors, one of the most frequent intracranial tumors, are clinically classi. Pdf endoscopic endonasal pituitary and skull base surgery. Cureus endoscopic endonasal transsphenoidal treatment of. Coding and reimbursement for endoscopic endonasal surgery. Endoscopic endonasal transsphenoidal approach neupsy key. The endoscopic endonasal transsphenoidal approach is actually widely recommended for sellar lesions, even in the case of cavernous sinus invasion or suprasellar extension. Cushing 2 systematically applied a transsphenoidal approach for sellar lesions. Subsequently, the authors describe in great detail the endoscopic endonasal transsphenoidal approach to the sella. Endoscopic endonasal transsphenoidal approach for pituitary. The outcome of endoscopic endonasal transsphenoidal surgery in 10 patients with pituitary adenomas was compared with that of traditional transnasal transsphenoidal approach tta in 20 subjects.
Extended skull base surgery based on endoscopic endonasal transsphenoidal surgery eetss for various skull base lesions has been reported recently. In this chapter, we describe the planning, procedural steps, tips from our experience, and the pitfalls to avoid to perform a successful. Endoscopic transnasal transsphenoidal surgery mayo clinic. Laws and lanzino, captures all of todays clinical knowledge on the multidisciplinary management of pituitary tumors, with a focus on surgical techniques. This technique was posterior refined and popularized by guiot 3 and hardy 4 with the introduction of the operative microscope the development of endoscopic techniques for surgery of paranasal sinuses 5 awoke the. Transsphenoidal approach in endoscopic endonasal surgery for. Endoscopic endonasal transsphenoidal surgery for growth hormonesecreting pituitary adenomas.
The definitive procedure codes presume an open approach as this was the standard in 1994 when the codes were written. Here we describe the procedures of endoscopic pituitary and skull base surgery in our institute. Endoscopic transsphenoidal surgery can be done with help of a microscope, endoscope, or both. Endoscopic endonasal transsphenoidal surgery using the iarms. Endoscopic endonasal surgery is a minimally invasive technique used mainly in neurosurgery and otolaryngology. Microscopeguided endonasal transsphenoidal approach the. Coding and reimbursement for endoscopic endonasal surgery of. What radiologists and surgeons need to know1 in the last 2 decades, endoscopic endonasal transsphenoidal sur gery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal. Sep 14, 2014 stepbystep description endonasal endoscopic pituitary surgery by prof. Since the first report of successful endonasal endoscopic resection of pituitary adenomas by jankowski et al in 1992, endoscopic endonasal surgery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base 26. The role of the endoscopic transsphenoidal approach in pediatric neurosurgery. Surgical anatomy for extended endoscopic endonasal. The endoscopic technique has been gaining in popularity in recent years. The purpose of this article is to introduce the experience.
It was then developed from transsphenoidal surgery by microscope into endoscopeassisted microscope, and nowadays has progressed to pure endoscopic endonasal surgery 2, 3. In this multiauthor book with numerous color illustrations the main aspects of the endonasal endoscopic approach to the skull base are presented, starting with a clear description of the endoscopic anatomy, the panoramic view afforded by. Transsphenoidal approach in endoscopic endonasal surgery. An endoscope was used in transsphenoidal surgery and eventually replaced the operating microscope as the tool for visualization. Apr 11, 2014 endoscopic transsphenoidal surgery has gradually come to be regarded as a preferred option in the treatment of pituitary adenomas because of its advantages of improved visualization and its minimal invasiveness. Endoscopic surgery is performed through the nose to remove tumors from the pituitary gland and skull base. Postoperative nasal packing was basically not needed in such cases. Extended endoscopic endonasal approach to the midline skull base. Methods the study population consisted of 43 patients. In this minimally invasive surgery, the surgeon works through the nostrils with a tiny endoscope camera and light to remove tumors with long instruments. In this study, the authors report on application of this robotic device to endoscopic endonasal transsphenoidal surgery etss and evaluate their initial experiences. Atlas of endoscopic anatomy for endonasal intracranial surgery. The aim of this study was to compare and evaluate the outcomes and complications of endoscopic and microscopic transsphenoidal surgery in the treatment of pituitary adenomas.
Among the 10 individuals subjected to pure endoscopy. New frontiers in managing clival tumors the extended endoscopic endonasal approach by g. A neurosurgeon or an otolaryngologist, using an endoscope that is entered through the nose, fixes or removes brain defects or tumors in the anterior skull base. A reasoned and balanced dialectic 24 extended endonasal, endoscopic transsphenoidal approach versus craniotomy. Pituitary apoplexy is a rare clinical entity and few cases treated with an endonasal endoscopic approach eea have been reported. Endonasal approach via the sphenoid ostium was carried out for pituitary lesions without the nasal speculum. However, application of eetss without sufficient experience and knowledge of the surgical anatomy may result in severe complications. Endoscopic endonasal transsphenoidal surgery american. This study focuses on 50 patients 28 females and 22 males with a median age of 38 years range 1488 years. New frontiers in managing clival tumors the extended. Pdf endoscopic endonasal transsphenoidal approach for.
Endoscopic endonasal transsphenoidal surgery request pdf. In transnasal transsphenoidal endoscopic surgery, a surgical instrument is placed through the nostril and alongside the nasal septum to access a pituitary tumor. The extended endoscopic endonasal approach for the. Therefore, it is not appropriate to report an existing skull base code for an endoscopic endonasal procedure. Endoscopic endonasal transsphenoidal approach to large and. Nose is not packed after the surgery, no lumbar drain is used even when there is a csf leak. Extended endoscopic endonasal approach to the midline skull. Endoscopic endonasal transsphenoidal surgery using the. Cappabianca has been a leader in this regard and has developed a set of instrumentation specific to this procedure.
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