Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Mahmoud Messerer; Giulia Cossu; Mercy George; Roy Thomas Daniel

doi:10.3791/55896

Approche endoscopique Endonasal Trans-sphénoïdal : Chirurgie mini-Invasive pour les adénomes de l...

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JoVE Journal Neuroscience

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Approche endoscopique Endonasal Trans-sphénoïdal : Chirurgie mini-Invasive pour les adénomes de l’hypophyse

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07:43 min

January 17, 2018

DOI: 10.3791/55896-v

Mahmoud Messerer¹, Giulia Cossu¹, Mercy George², Roy Thomas Daniel¹

¹Department of Neurosurgery,University Hospital of Lausanne, ²Department of Otorhinolaryngology,University Hospital of Lausanne

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Overview

This paper describes the endoscopic endonasal approach to the sella turcica, focusing on the surgical technique for pituitary adenoma removal. The method aims for gross total resection while minimizing invasiveness.

Key Study Components

Area of Science

Neurosurgery
Endoscopic techniques
Pituitary adenoma treatment

Background

The endoscopic transnasal approach is a minimally invasive technique.
It allows for maximum tumor resection.
Neurosurgeons may face a learning curve transitioning from microscope to endoscope.
General anesthesia and neuro navigation are essential for the procedure.

Purpose of Study

To achieve gross total removal of pituitary adenomas.
To normalize hormone levels in secreting tumors.
To relieve visual and oculomotor symptoms in nonsecreting tumors.

Methods Used

Endoscopic endonasal approach to access the sella turcica.
Identification of sellar anatomy using neuro navigation.
Patient positioning and anesthesia protocols.
Maximizing tumor resection through a panoramic view provided by the endoscope.

Main Results

The technique facilitates total removal of pituitary tumors.
Minimally invasive approach reduces recovery time.
Improved outcomes in hormone normalization and symptom relief.
Enhanced visualization aids in surgical precision.

Conclusions

The endoscopic endonasal approach is effective for pituitary adenoma removal.
Training in endoscopic techniques is crucial for neurosurgeons.
This method offers significant advantages over traditional approaches.

Frequently Asked Questions

What is the endoscopic endonasal approach?

It is a minimally invasive surgical technique used to access the sella turcica for pituitary tumor removal.

What are the benefits of this approach?

It allows for maximum tumor resection with reduced recovery time and fewer complications.

Is there a learning curve for surgeons?

Yes, surgeons trained primarily in microscope techniques may need additional training to master endoscopic methods.

What are the anesthesia requirements?

General anesthesia and oral tracheal intubation are required for the procedure.

How does neuro navigation assist in the surgery?

Neuro navigation helps identify sellar anatomy accurately, facilitating tumor access.

What outcomes can be expected from this surgery?

Patients can expect normalization of hormone levels and relief from visual and oculomotor symptoms.

Le but de cet article est de décrire les différentes étapes de l’approche endonasale endoscopique de la selle turcique.

L’objectif global de cette intervention chirurgicale est d’obtenir une ablation totale et grossière d’un adénome hypophysaire par une approche transnasale endoscopique. La technique chirurgicale facilite l’ablation totale des tumeurs hypophysaires pour normaliser les niveaux d’hormones dans les tumeurs séparatrices et pour soulager les symptômes visuels et oculomoteurs dans les tumeurs non sécrétrices. Le principal avantage de cette technique est qu’elle est peu invasive tout en permettant une résection tumorale maximale, principalement en raison de la vue panoramique fournie par l’endoscope.

Il peut y avoir une courbe d’apprentissage pour l’utilisation des techniques d’endoscope pour les neurochirurgiens qui ont été principalement formés pour effectuer avec un microscope. Après une anesthésie générale et une intubation trachéale orale, avec le patient en position couchée, positionnez la tête dans un support de tête et fixez la bande pour la neuronavigation magnétique autour de la tête. L’identification de l’anatomie sellaire à l’aide de points de repère connus, qui est également confirmée par la neuronavigation, permet d’accéder à la tumeur dans le sellaire, les citernes suprasellaires et les sinus caverneux de manière bilatérale.

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