title: Endoscopic endonasal transsphenoidal surgery: a mentoring surgical model.
abstract: BACKGROUND
  We report the experience of endoscopic endonasal transsphenoidal surgery (EETS) for resection of pituitary region tumours at Wellington, the central regional referral centre for neurosurgery in New Zealand, and discuss the collaborative mentoring surgical model that enhanced the learning experience.
  
  
  METHODS
  Between January 2007 and June 2009, a total of 47 operations on 46 patients were performed and reviewed retrospectively. All patients had perioperative clinical assessment, hormonal profile and magnetic resonance imaging studies for residual/recurrent disease. The collaborative model utilized two neurosurgeons with experience in the microsurgical resection of pituitary tumours: an endoscopic skull base fellowship trained rhinologist and an endoscopic skull base rhinologist with more experience who visited twice a year from Adelaide, Australia.
  
  
  RESULTS
  The pathology results included: 30 non-functioning pituitary adenomas, 10 secreting pituitary adenomas, 3 meningiomas, 1 chordoma, 1 anterior skull base adenocarcinoma and 1 clival prostate metastasis. Complete tumour resection was intended and achieved in 38 cases. All 10 patients with secreting adenomas achieved improvement of hormonal profile. Nineteen out of 27 cases demonstrated improvement of vision. Perioperative complications included one epistaxis, three cerebrospinal fluid fistulae, one delayed chronic subdural haematoma and one persistent diabetes insipidus.
  
  
  CONCLUSIONS
  Our results highlight the value of a collaborative mentoring surgical model for a single centre adopting the endoscopic transsphenoidal technique and demonstrate that excellent EETS outcomes can be achieved in a smaller endoscopic skull base unit in Australasia during the learning phase.
authors.affiliation: Department of Neurosurgery, Wellington and Wakefield Hospitals Endoscopic Sinus and Skull Base Surgery, Wakefield Hospital, Wellington, New Zealand.
authors.forename: Joseph Y M
authors.initials: JY
authors.lastname: Yang
authors.forename: Ingrid
authors.initials: I
authors.lastname: De Ruiter
authors.forename: Andrew
authors.initials: A
authors.lastname: Parker
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Wormald
authors.forename: Simon
authors.initials: S
authors.lastname: Robinson
authors.forename: Agadha
authors.initials: A
authors.lastname: Wickremesekera
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000236:Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002817:Chordoma / Q000601:surgery; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D008611:Mentors; D008875:Middle Aged; D017145:Models, Educational; D057605:Natural Orifice Endoscopic Surgery / Q000193:education* / Q000379:methods; D009369:Neoplasms / Q000601:surgery*; D009520:New Zealand; D010911:Pituitary Neoplasms / Q000601:surgery; D011183:Postoperative Complications; D011471:Prostatic Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000601:surgery; D016896:Treatment Outcome