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Endoscopic Endonasal Transsphenoidal Approach: Outcome Analysis of 100 Consecutive Procedures
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2002
Year
Pituitary TumorsEndoscopic SurgeryConsecutive ProceduresInvasive Surgical TechniqueOpen ProcedureEndocrine SurgeryEndonasal SurgerySurgeryEndoscopic Sinus SurgeryClivus ChordomaInterventional EndoscopySkull Base SurgeryMedicineOrthopaedic SurgerySkull Base
The endoscopic endonasal transsphenoidal approach is a minimally invasive technique developed over the past decade for pituitary tumor removal. From January 1997 to November 1999, 100 consecutive pituitary tumor patients underwent endoscopic endonasal surgery using Jho's technique with 0°, 30°, 45°, and 70° rigid endoscopes (18–30 cm, 4 mm diameter) secured to a holder. Total tumor removal was achieved in 51 of 87 adenomas, subtotal in 20, partial in 16, and all four craniopharyngiomas were completely resected; the approach was less traumatic, effective, and associated with fewer complications, a shorter average hospital stay of two days for 40 patients, and reduced costs, though the small series and short follow‑up limit definitive conclusions.
The endoscopic endonasal transsphenoidal approach has been proposed in the past decade as a minimally invasive surgical technique for the removal of pituitary tumors. From January 1997 to November 1999, 100 consecutive patients with pituitary tumors underwent endoscopic endonasal surgery, according to Jho's technique. We employed 0 degrees, 30 degrees, 45 degrees, and 70 degrees rigid endoscopes, 18 - 30 cm in length, 4 mm in diameter with an outer sleeve for irrigation and secured to a holder. Among the 87 pituitary adenomas, tumor removal was total in 51, subtotal (> 80 %) in 20 and partial in 16 cases. Four craniopharyngiomas were totally removed and an intra-suprasellar arachnoid cyst was emptied; a biopsy was performed in the two patients with a clivus chordoma. The two cases of sphenoid sinusitis were cured by surgery, the three patients with spontaneous CSF rhinorrhea were successfully treated and the residual nasal meningocele was removed. The endoscopic endonasal transsphenoidal approach appeared to be less traumatic than the traditional microsurgical approach, was very effective, and was characterized by a reduced number of complications. However, the relatively small series together with the short follow-up do not allow us to draw definitive conclusions. The post-operative reduction in hospital stay (two days in 40 of 100), significantly reduced the cost of patient's management.