[Minimally invasive surgery of the pituitary and the sellar region].
BACKGROUND
New minimal invasive neurosurgical approaches for the treatment of diseases in the sellar and perisellar regions (superciliary and paraseptal approach, perioperative ACTH measurements, application of endoscopes and neuronavigation) were introduced by the author. The modified surgical techniques were applied by the author successfully in the treatment of more than 1000 cases, of which the data of 746 patients were analysed and the results are presented.


RESULTS
The results of the clinical studies concerning superciliary and paraseptal approaches were as follows: length of the operations and, loss of blood were decreased, the patients needed shorter anesthesia and the treatment cost became lower. The approaches were performed without hair cutting with excellent cosmetic results leading to easier resocialisation of the patients. In the group of the patients operated on through the superciliary approach postoperative vasospasm developed in significantly lower rate, the number of days spent in the intensive care unit decreased and the rate of patients on discharge in good clinical condition were higher. The study on perioperative plasma ACTH simultaneous measurements with rapid and standard methods revealed first in the literature that, during anaesthesia in patients with ACTH producing adenoma the plasma ACTH level changed individually. There was no difference between arterial and venous plasma ACTH concentration in the same patient and the ACTH concentration in the bleedings from the peripituitary bony structures are individually variable, representing the network of the venous outflow of the pituitary. The decrease in the plasma ACTH concentrations in the peripheral venous samples two hours after operation and next morning proved the radical removal of the adenoma. The differences between concentrations in the left and right sides indicate the intrapituitary lateralization of the adenoma. The study on the usefulness of neuroendoscopy and neuronavigation in the author's hand revealed the advantages and disadvantages of these new neurosurgical instruments.


CONCLUSIONS
With the advent of the minimal invasive methods in surgery of the pituitary and the sellar region the mortality end the morbidity of the operations decreased.
Czirják
Sándor
S
Országos Idegsebészeti Tudományos Intézet, Budapest.
D000236:Adenoma / Q000097:blood / Q000601:surgery*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002533:Cerebral Angiography; D002648:Child; D003422:Critical Care; D005260:Female; D006801:Humans; D007016:Hypophysectomy / Q000379:methods*; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D047748:Pituitary ACTH Hypersecretion / Q000097:blood / Q000601:surgery*; D010902:Pituitary Gland / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000097:blood / Q000601:surgery*; D012658:Sella Turcica / Q000601:surgery*; D016896:Treatment Outcome
D000324:Adrenocorticotropic Hormone