Endoscopic approach to the pituitary lesions: contemporary method and review of the literature.
The present status of endoscopic transsphenoidal surgery is introduced and reviewed. The difference between endoscopic and microscopic transsphenoidal surgery is explained and also the characteristics of the transnostril approach is mentioned. The advantages of endoscopic surgery are (1) good anatomical orientation with wider view, (2) tumors at the dead angle can be removed under the direct visualization, and (3) the patients can drink, eat and even brush their teeth just after surgery. Short hospital stay and even day-surgery could be possible when a patient is carefully selected. The disadvantages and the limitation of endoscopic surgery have been solved and improved with several new instruments and ideas. Moreover, we have made use of the surgical simulation with the three-dimensional (3-D) CT virtual navigation endoscopic image and the navigation system with the ENT application and the SureTrak of the Stealth Station. There is no need for head fixation with a Mayfield clamp or a C-arm intraoperative fluoroscopic image. This image guidance enabled a correct and smooth approach even in those patients with complicated and abnormal anatomical structures by prior surgery such as for sinusitis. The sellar floor can be safely and correctly opened even in patients with conchal type sphenoid sinus using a navigation system that helps to understand the locations of the cavernous sinus and the internal carotid arteries. The overall result by endoscopic transsphenoidal surgery is as good as or better than that by the traditional microscopic transsphenoidal surgery.
Kuroki
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Department of Neurosurgery, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan. akuroki@med.id.yamagata-u.ac.jp
Kayama
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T
D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015175:Prolactinoma / Q000601:surgery*; D013101:Sphenoid Sinus / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods