ORIGINAL ARTICLES   

Journal of Neurosurgical Sciences 1999 June;43(2):85-92

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: English

Endoscopic endonasal transsphenoidal approach to the sellar region. Technical evolution of the methodology and refinement of a dedicated instrumentation

Alfieri A.

Department of Neurosurgery, “Federico II” University School of Medicine, Naples, Italy

Back­ground. Endo­scop­ic treat­ment of hydro­ceph­a­lus ­has in ­time ­acquired a pri­mary posi­tion in Neu­ro­sur­gery. ­Today endos­co­py ­can be ­employed in ­the ­vast major­ity of neu­ro­sur­gi­cal pro­ce­dures in ­the real­iza­tion of ­the so-­called endo­scope-assist­ed micro­neu­ro­sur­gery. On ­the ­basis of ­the encour­ag­ing ­results ­obtained by ­Jho ­and Car­rau, ­the ­authors ­report ­the ­pros ­and ­cons of ­the ­new endo­scop­ic endo­na­sal tech­nique.
Meth­ods. An endo­scop­ic endo­na­sal trans­sphe­noid­al ­approach to ­the sel­la ­was per­formed in 50 ­patients: 33 ­females ­and 17 ­males, of ­age includ­ed ­between 16 ­and 76 ­years; 45 ­were affect­ed by pitui­tary aden­o­mas (9 ­micro ­and 36 mac­ro; 10 ­were recur­renc­es), 3 by cran­i­oph­a­ryn­gio­mas, 2 by cli­val chor­do­mas. ­The ­new instru­men­ta­tion ­was real­ized ­through ­straight devic­es ­with a han­dle shift­ed 10-30 ­degrees hor­i­zon­tal­ly. ­The pos­sible dan­ger to ­the ­nasal struc­tures is ­reduced ­not ­only by ­the elim­i­na­tion of ­the bay­o­net-­like ­shape ­but ­also by hid­ing ­the ­cutting extrem­ity in ­the han­dle.
­Results. ­The advan­tag­es of ­this tech­nique ­have ­been rep­re­sent­ed by an easi­er ­access to ­the ­lesion, espe­cial­ly in recur­rent ­tumors, a ­more com­plete exci­sion of volu­mi­nous neo­plasms, a ­decrease of ­ENT ­post-sur­gi­cal com­pli­ca­tions ­and a reduc­tion of hos­pi­tal­iza­tion ­times ­and ­costs. ­The ­main lim­its ­have ­been ­the reduc­tion of ­field ­depth ­and ­the ­lack of ade­quate instru­men­ta­tion.
Con­clu­sions. In ­this pecu­liar sur­gery ­the ­absence of prop­er instru­ments ­has to be over­come ­because: a) ­there is ­less ­room to ­work, b) a con­flict ­between ­the ­hands of ­the sur­geon ­and ­the endo­scope ­may ­occur, c) ­the ­blind intro­duc­tion of ­the instru­ments in ­the nos­tril ­may ­cause dam­age to ­the ­nasal struc­tures. ­The ­secret ­for ­the suc­cess of ­the endo­scop­ic endo­na­sal trans­sphe­noid­al tech­nique is to ­create ­the opti­mal con­di­tions, in ­order to ­avoid improp­er manoeu­vres ­that ­may ­cause poten­tial dan­gers.