Endoscopic endonasal transsphenoidal surgery. Before scrubbing in: tips and tricks.
BACKGROUND
The interest in endoscopic endonasal transsphenoidal surgery for the treatment of sellar and perisellar lesions is growing as a consequence of the results achieved in the past 10 years and of the interest by patients, endocrinologists, and neurosurgeons. Furthermore, the special ability of the endoscope to offer a wider and detailed view of anatomic structures is a major advantage that increases the attention of neurosurgeons who seek less invasive procedures and better results. Most neurosurgeons performing transsphenoidal surgery, however, are not used to endoscopy, and changing from microsurgical to endoscopic technique can be difficult and even discouraging, often because of difficulties in the initial phase of the procedure.


METHODS
With the purpose of helping minimize some of the difficulties, we describe herein useful tips and tricks that mainly concern familiarization with the endoscopic equipment, details of the transsphenoidal anatomy, and endoscopic skills. We stress the steps and details that we judge most important.


CONCLUSIONS
We believe that by following these recommendations neurosurgeons can overcome, or even avoid, the difficulties frequently encountered transsphenoidal surgery, allowing them to safely and efficiently perform endonasal transsphenoidal endoscopic procedures.
Cavallo
Luigi M
LM
Division of Neurosurgery, Department of Neurological Sciences, Università degli Studi di Napoli Federico II, 80131 Naples, Italy.
Dal Fabbro
Mateus
M
Jalalod'din
Hasan
H
Messina
Andrea
A
Esposito
Isabella
I
Esposito
Felice
F
de Divitiis
Enrico
E
Cappabianca
Paolo
P
D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D008866:Microsurgery; D009296:Nasal Cavity / Q000601:surgery; D010900:Pituitary Diseases / Q000601:surgery*; D013100:Sphenoid Bone / Q000601:surgery