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Primary Obstruction Of The Fourth Ventricle Outlets: Neuroendoscopic Approach And Anatomic Description Comments
No full textExtended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors. Part 2
No full textOBJECTIVE: The widespread use of the endoscope in transsphenoidal pituitary surgery
has recently contributed to the extension of the approach beyond the tuberculum sellae
and planum sphenoidale for the management of lesions located in the suprasellar
area, either with an endoscope-assisted or purely endoscopic technique. Based on our
previous experience with more than 450 standard endoscopic transsphenoidal operations,
we have retrospectively evaluated the effectiveness of the extended endoscopic
endonasal transsphenoidal approach in the management of lesions mainly located in
the suprasellar area.
METHODS: Between January 2004 and December 2005, 20 consecutive patients underwent
extended endoscopic endonasal transsphenoidal surgery for a total of 21 procedures.
The series consisted of seven pituitary adenomas, seven craniopharyngiomas,
three suprasellar Rathke’s cleft cysts, two tuberculum sellae meningiomas, and one
pilocytic astrocytoma of the chiasm.
RESULTS: Tumor removal, as assessed by postoperative magnetic resonance imaging,
revealed complete removal of the lesion in four out of seven pituitary adenomas, five
out of seven craniopharyngiomas, three out of three Rathke’s cleft cysts, and two out of
two tuberculum sellae meningiomas. One patient (5%) with craniopharyngioma had a
postoperative cerebrospinal fluid leak that required reoperation. The same patient experienced
a sphenoid mycosis, which was treated with medical therapy. Some specific
conditions associated with the anatomy of the surgical route, as well as to the morphology
of the lesion, have resulted to condition the feasibility of the approach.
CONCLUSION: Small and medium sized suprasellar lesions located in the midline,
with or without a limited parasellar extension and without involvement of vascular
structures, seem amenable to be resected through such extended endoscopic transsphenoidal
approach. Improvements in closure techniques and the use of new materials
and surgical glues seem to significantly reduce the postoperative cerebrospinal fluid
leak rate and meningitis
Comment to: Robotic virtual endoscopy: Development of a multidirectional rigid endoscope
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