title: The endoscopic endonasal transsphenoidal approach to sellar lesions allows a high radicality: The benefit of angled optics.
abstract: OBJECTIVE
  The endonasal endoscopic approach is currently under investigation for perisellar tumour surgery. A higher resection rate is to be expected, and nasal complications should be minimized. Here, the authors report their technique of transnasal endoscopic neurosurgery with a special reference to the impact of the use of angled optics.
  
  
  METHODS
  Two-hundred-and-seventy-one endoscopic endonasal transsphenoidal procedures were performed for sellar lesions between January 2000 and August 2013. One-hundred-and-twenty-nine patients out of them could be used for analysing the use of angled endoscopes including completed follow up, MR imaging as resection control and documentation of the intraoperative use and benefit of angled optics. Exclusion criteria were: planned incomplete resection or incomplete data set. The surgical technique was carefully analysed; and these cases were followed prospectively.
  
  
  RESULTS
  Standard technique was a mononostril approach with 0° endoscopes. Angled endoscopes were used for assessment of radicality during the tumour resection and at the end of the procedure. In 95 cases (72%), an angled endoscope was used. Remnant tumour was visualized with angled optics in 27 of the 95 cases (28%). In all these cases, remnant tumour tissue was subsequently further removed. Complete resection was seen on MRI FU in 91 of 95 cases (96%) in this subgroup. In the cases without application of angled optics, there was already a sufficient sight via the 0° endoscope (14/34; 42%), or a significant bleeding from the cavernous sinus made the application of an angled endoscope impossible (19/34; 55%). On follow up, MRI revealed radical tumour resection in 93% (120/129). In the subgroup without angled optics use, radicality reached 88% (30/34) in contrast to 96% in the angled optics subgroup. Recurrent tumour growth was observed in four patients (3%).
  
  
  CONCLUSIONS
  The endscopic technique has been shown to be safe and successful with a high radicality and only minor complications. The application of various angled endoscopes allows a look "around the corner" resulting in a potentially higher radicality of tumour resection in endonasal transsphenoidal surgery.
authors.affiliation: Department of Neurosurgery, Saarland University, Homburg, Germany. Electronic address: oertelj@freenet.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Oertel
authors.affiliation: Department of Neurosurgery, Hannover Nordstadt Hospital, Affiliated Hospital Hannover Medical School, Germany.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Gaab
authors.affiliation: Department of Neurosurgery, Saarland University, Homburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Linsler
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010911:Pituitary Neoplasms / Q000601:surgery*; D012658:Sella Turcica / Q000601:surgery*; D013101:Sphenoid Sinus / Q000601:surgery; D055815:Young Adult
keywords: Angled endoscope; Endonasal endoscopic surgery; Endonasal transsphenoidal approach; Pituitary surgery