Abstract
BackgroundTranssphenoidal surgery (TSS) is an increasing preferred treatment for sella lesions. In a university teaching hospital, the novel endoscopic TSS was adopted with ongoing resident teaching. We evaluated a single institutional series of preliminary comparisons of transseptal microscopic with endoscopic TSS.MethodsA retrospective data analysis included 37 patients and 19 patients who underwent microscopic and endoscopic TSS, respectively. The demographic characteristics of the patients, intra-operative analyses, morbidity, mortality and visual assessments were included in this analysis.ResultsThe study included 31 men and 25 women, and median age at surgery was 49 years old (range 14–70 years old). There were no differences between the rates of cerebrospinal fluid (CSF) fistula, sinus complications, anterior pituitary hormone deficiency and diabetes insipidus between the groups. Total length of stay and intensive care unit stay were similar between the groups. Patients who underwent endoscopic TSS were at significantly increased risk of epistaxis (P = 0.010), respiratory event (P = 0.014) and post-operative visual deterioration prior to discharge (P = 0.032).ConclusionEndoscopic TSS is a promising procedure that allows sufficient visualisation of the surgical field and adequate tumour removal. It is comparable to microscopic TSS but has a higher complication rate notably due to steep learning curve required to gain the expertise.
Highlights
MethodsThe minimally invasive extra-cerebral approach to the sellar and suprasellar region is becoming more attractive and has regained much interest among neurosurgeons
Illustration of endoscopic Transsphenoidal surgery (TSS). (A) A T2W and T1 postgadolinium MRI brain shows a sella and suprasellar lesion in a 45-year-old male who presented with worsening headache and bitemporal hemianopia
The tumour was seen extending into the sphenoid sinus. (B–C) Depictions of the operating theatre (OT) arrangement, with the otorrhinolaryngologist and neurosurgeon standing by the patient. (D) Upon insertion of the endoscope, the tumour was seen protruding through the sphenoid sinus. (E) The sphenoid phase with the visualised tumour. (F) The sellar phase after removal of the tumour with visualised diaphragmatic sella. (G–H) Sellar reconstruction was performed with a sandwich of oxidised cellulose plus gelatin sponge, layered with tissue glue www.mjms.usm.my 65
Summary
MethodsThe minimally invasive extra-cerebral approach to the sellar and suprasellar region is becoming more attractive and has regained much interest among neurosurgeons. In the 1960s, Guiot met a visiting fellow from Montreal, Canada called Jules Hardy, who became much interested in this technique. He brought back the knowledge and continued performing operations using preoperative encephalography and intra-operative radiofluoroscopy. His frustration at the time was due to the limited visualisation of the tumour, causing incomplete tumour removal. This frustration became the light of his solution and, in 1965, he became the first surgeon to use an operating microscope, microscopic TSS [6, 7]. We evaluated a single institutional series of preliminary comparisons of transseptal microscopic with endoscopic TSS
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