[Endoscopic, posterior transseptal pituitary surgery--learning curve of the surgical technique and equipment in 61 operations].
BACKGROUND
The removal of hypophyseal tumor by transsphenoidal pituitary surgery using microsurgical instruments was first performed over 100 years ago. Operating techniques for this surgery are constantly being renewed, first by using a microscope and later on with the use of an endoscop. The authors provide an overview of the minimal invasive posterior transseptal-transsphenoidal aproach with the combined utilization of classical techniques with the assistance of the endoscop.


METHODS
Sixty-one patients (33 female, 28 male, 21-84 yrs) were treated for sellar region tumor resection using an endonasal transsphenoidal aproach with the help of an endoscope. Follow ups were performed within 2-21 months.


RESULTS
Total tumor resection was successful in 91.8%, and partial resection in 8.2% of the patients. The rate of complications using the endoscopic method was not higher compared to that of the classical microscopic method. There was no major bleeding in any of the cases. Adverse events such as minor epistaxis occurred in 4.9%, transitional diabetes insipidus in 6.5%, inraoperative CSF leak in 16.67%, postoperative CSF leak in 11.5% and meningitis in 8.2% of the patients. After the operation the pathological hormonal production stoped in all patients except in two patients who were acromegalic. However their GH level normalized and they did not require further treatment, the IGF-1 still remained high.


CONCLUSIONS
The success of the surgical treatment is based on both, the proficient pre- and postoperative endocrinological care, and the minimal invasive surgical technique. The endoscope was used partially or continuously during the operation for better visualization of the operation field in multiple angles (30 degrees, 45 degrees). It was useful in differentiating between normal and tumorous glandular tissue, and also offered an enhanced view of the intrasellar (via hydroscopy) and parasellar region. Moreover the endoscopic method is able to decrease the operating time, reduce blood loss. In different stages of the surgery, depending on the anatomical and pathological situation, switching back and forth from microscope to endoscope technique, gives us the benefit of a clearer view in each situation.
Szegedi Tudományegyetem, Idegsebészeti Klinika, 6721 Szeged, Semmelweis u. 6.
Zsolt
Z
Bella
Béla
B
Fülöp
Eva
E
Csajbök
Sándor
S
Magony
Zsuzsa
Z
Valkusz
Szilvia
S
Herczegh
József
J
Jóri
Mihály
M
Bodosi
Jeno
J
Czigner
Barzó
B
Pái
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology; D003919:Diabetes Insipidus / Q000209:etiology; D004844:Epistaxis / Q000209:etiology; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008581:Meningitis / Q000209:etiology; D008875:Middle Aged; D044582:Neuroendoscopes; D044583:Neuroendoscopy / Q000009:adverse effects / Q000193:education* / Q000295:instrumentation / Q000379:methods*; D009666:Nose / Q000601:surgery; D010904:Pituitary Gland, Posterior / Q000473:pathology / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D013101:Sphenoid Sinus / Q000601:surgery