Abstract
The excellent visualization and minimally invasive approach employed in endoscopic endonasal procedures has now revolutionized the pituitary surgery, replacing the transnasal microscopic technique worldwide. However, it involves major shift in hand-eye co-ordination from static 3 dimensional images of microscope to 2 dimensional endoscopic images hence demands training and inter-disciplinary approach. Here we present our experiences in learning and developing a safe endonasal transsphenoidal endoscopic approach to resect pituitary adenomas. This prospective study was jointly conducted in the departments of ENT and Neurologicals surgery Kathmandu Medical College, Nepal, from September 2014 to August 2016. The endoscopic approach to the sphenoid sinus was performed by an Otolaryngologist and ablative surgery by Neurosurgeon. The ease of procedure, intra operative challenges, surgical cure, post-operative cerebro spinal fluid (CSF) leaks and postoperative complaints were analyzed. Sixteen consecutive patients with pituitary adenoma (macro adenoma=13, micro adenoma =3) were analyzed. There were three intraoperative CSF leak, managed successfully. Two patients developed transient diabetes insipidus and surgical cure rate was 90%. No case had to be switched over to traditional microscopic route due to technical failure. There was no mortality. The endoscopic endonasal transsphenoidal approach to pituitary tumors is a safe and minimally invasive procedure, which can be employed safely in any of our centers in Nepal, equipped with endoscopic sinus surgery and endoscopically trained ENT and Neurosurgeons. A multi disciplinary approach provides good access, greater tumor excision and excellent postoperative follow up.
Highlights
The mainstay of treatment of pituitary adenoma is the surgery
All the consecutive patients who were diagnosed with pituitary adenoma and gave written informed consent for endoscopic endonasal trans-sphenoidal surgery were enrolled in the study
A 18 mm long 0° rigid nasal endoscope was used to perform diagnostic nasal endoscopy and introduced via the paraseptal route, medial to middle turbinate to localize the sphenoid sinus ostium which was located about 1-1.5 cm above the choana
Summary
The mainstay of treatment of pituitary adenoma is the surgery. Currently the direct endoscopic endonasal transsphenoidal approach has gained popularity. We like-minded ENT and Neurosurgeons designed this study to assess whether endoscopic endonasal pituitary surgery is safe and feasible in our setup and to study the benefits of a multi disciplinary approach. Up panoramic view and allows more complete tumor METHODS removal as illumination is close to the target It involves endoscopic equipments as well as expertise in This prospective study was jointly conducted in the dehandling tissues in such closed corridors. The excellent visualization and minimally invasive approach employed in endoscopic endonasal procedures has revolutionized the pituitary surgery, replacing the transnasal microscopic technique worldwide. It involves major shift in hand-eye co-ordination from static 3 dimensional images of microscope to 2 dimensional endoscopic images demands training and inter-disciplinary approach. We present our experiences in learning and developing a safe endonasal transsphenoidal endoscopic approach to resect pituitary adenomas
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