Efficacy of Endoscopic Transethmoidal•transsphenoidal Surgery for Pituitary Tumors

DOI PubMed 7 Citations 25 References
  • Haruna Shinichi
    Department of Otorhinolaryngology. The Jikei University School of Medicine
  • Otori Nobuyoshi
    Department of Otorhinolaryngology. The Jikei University School of Medicine
  • Moriyama Hiroshi
    Department of Otorhinolaryngology. The Jikei University School of Medicine
  • Kamio Masami
    Department of Neurosurgery, The Jikei University School of Medicine

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  • 下垂体腫ように対するし骨洞・蝶形骨洞経由内視鏡手術の有用性

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Abstract

Endoscopic transethmoidal•transsphenoidal surgery was performed on 30 patients with pituitary tumors, and the usefulness of this procedure was evaluated. As with conventional endoscopic intranasal surgery, the ethmoidal sinuses were opened and a broad window was created in the ethmoidal sinus from the directions of the middle meacus and the olfactory cleft. Then an endoscopic washing device was attached to a 0° or 3° rigid endoscope and it was immobilized in the left nasal cavity with an endoscope immobilization apparatus. Removal of the tumor was then started from the right side by a bimanual technique. Based on the results, this surgical procedure was judged to be useful for the following reasons (1) it makes it easy to carry out the operative manipulations even in a narrowed nasal cavity, thereby reducing the overall time required for surgery, and (2) it is possible to prevent postoperative deformities of the nasal capity morphology caused by pressure on its lateral wall. In additional, (3) the surgical wound can be observed, and CSF leakage can be repaired immediately after completion of the operation. Corrective surgery can be performed on an outpatient basis early after the initial operation to correct postoperative deformities of the nasal paranasal cavities, which might later cause nasal obstruction or an olfactory disturbance. Finally, (4) employing the route of endoscopic transethmoidal•trapssphenoidal surgery facilitates the Performance of a second operation soon., or even several months, after the first operation. A second operation may be necessary in the event of recurrence of the pituitary tumor complication by chronic sinusitis. <br>On the basis of our experience in the this study, we conclude that our method of endoscopic transethmoidal• transsphenoidal surgery will be useful for reducing invasiveness in the nasal cavities and achieving maximum prevention of postoperative complications. In order to fulfill its potential, neurosurgeons will need to master forceps techniques in the visual field provided by the endoscope and to cooperate with oturhinologists who are skilled in endoscopic techniques.

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