Efficacy Of Endoscopic Endonasal Approach Research Articles

Comparing the efficacy of endoscopic endonasal versus microscopic transsphenoidal approach for the management of sellar and suprasellar tumors: a systematic review and meta-analysis protocol

Abstract Managing sellar and suprasellar tumors is challenging due to their diverse origins and proximity to critical structures. The transsphenoidal surgical approach has become the preferred method, evolving from transcranial attempts to reduce morbidity. Microscopic transsphenoidal techniques have been refined over time, with endoscopic endonasal surgery emerging as a significant advancement. Due to the multifaceted nature of these approaches, the complexities of the pathology and the paucity of data from specific regions, understanding the prevalence, characteristics and management outcomes of sellar and suprasellar tumors is crucial for informing healthcare practices and resource allocation. This study aims to collate evidence-based insights into the efficacy of the endoscopic endonasal approach compared with the microscopic transsphenoidal approach as a surgical intervention for sellar and suprasellar tumors, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for 2020. To source pertinent information, we will rely on four primary central databases: PubMed, EMBASE, SCOPUS and the Cochrane Central Register of Controlled Trials. The primary outcome measure will be the surgical outcome’s effectiveness in achieving tumor resection and preserving pituitary function. The study protocol is duly registered with the International Prospective Register of Systematic Reviews (PROSPERO), with no requirement for ethical approval as it exclusively relies on previously published research. We aim to publish our findings in scientific journals and present the abstract at conferences to guide clinical practice. PROSPERO Registration Number: CRD42023461972: available via https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023461972.

Endoscopic endonasal management of skull base defects in pediatric patients

PurposeSkull base defects in children may be the result of congenital anomalies or trauma. They often present as cerebrospinal fluid (CSF) rhinorrhea, meningitis, brain abscess or nasal obstruction. Surgical intervention is predominantly the treatment of choice. Our goal is to assess the efficacy of endoscopic endonasal approach in treating skull base defects in pediatric patients. Material and methodsIn this retrospective study we identified 38 patients (mean age 8.7 ± 5.6 years old, ranging 2 months-18 years) who underwent endoscopic endonasal repair of skull base defects, between March 2010 and February 2020. Patients who had skull base reconstruction after tumor resection, those who were lost to follow-up or did not sign the consent forms were excluded from the study. ResultsThe clinical indications for endoscopic endonasal repair were trauma (n = 24, 63.1%) and congenital defects (n = 14, 36.9%). Congenital skull base defects included basal meningoencephalocele (n = 5, 35.7%) and frontoethmoidal defects (n = 9, 64.3%). Mean follow up time was 32 ± 29.04 months, ranging 2–103 months. Fat graft (alone or in combination) was the most commonly used material to repair the skull base defects. Thirty-seven patients (97%) showed successful results after endoscopic endonasal surgery and were symptom free. ConclusionThe endoscopic endonasal repair of CSF leak and skull base defects proved to be safe and feasible with 97% success rate.

The safety and efficacy of endoscopic endonasal approach in the treatment of recurrent craniopharyngioma: A protocol for systematic review and meta-analysis.

Background:Craniopharyngioma is the most challenging brain tumor with a high recurrence rate. Some scholars have shown that endoscopic endonasal approach (EEA) can achieve a higher total tumor resection rate and significantly reduce the incidence of complications and mortality. However, there is still no consensus on the surgical approach for recurrent craniopharyngioma. The purpose of this study is to evaluate the safety and efficacy of EEA in the treatment of recurrent craniopharyngioma.Methods:We will search 7 electronic databases (PubMed, EMBASE, Web of Science, the Cochrane Library, PsycINFO, AMED, Scopus) to collect related randomized controlled trials (RCTs). The resection rate, recurrence rate and progression-free survival rate will be regarded as the primary outcome, and the incidence of complications will be regarded as the secondary outcome. Endnote Software X9.0 will be used to filter articles, Review Manager Software 5.2 and STATA software 16.0 will be used for analysis and synthesis.Results:We will integrate existing studies to assess the safety and efficacy of EEA in the treatment of recurrent craniopharyngioma.Conclusion:Our study will provide EEA as an effective and safe treatment for recurrent craniopharyngioma.Registration number:International Prospective Register of Systematic Reviews (PROSPERO): CRD42020199860

Clinical study of endoscopic treatment of a sellar pituitary adenomas with sellar diaphragm defect

BackgroundInvasive growth of pituitary macroadenomas to the suprasellar region occurs commonly. Pituitary adenomas show varying growth patterns when the sellar diaphragm is absent, and they are often confused with other common tumors in the sellar region. This article explores the clinical features of suprasellar pituitary adenomas with defects of the sellar diaphragm (SPADSD) and evaluates the efficacy of the endoscopic endonasal approach (EEA) for treatment of such tumors.MethodsWe performed a detailed examination of records from 19 patients collected prior to surgery. After relevant diseases were excluded, the tumor properties were evaluated according to imaging characteristics. Diagnoses were verified using EEA surgery. The concept of SPADSD was put forward. Postoperative recovery was followed to determine whether EEA is suitable for the treatment of such tumors.ResultsIn the 19 patients with SPADSD, we found that the tumors were less stressed on the pituitary, and tumors in the suprasellar region often had irregular shapes. During surgery, we took extended supra-saddle approaches and confirmed that unrestricted growth of the tumor was caused by defects in the diaphragm of the sella turcica to the suprasellar region. Recovery was good after surgery, confirming the efficacy of EEA for treatment of these tumors.ConclusionSPADSD has different clinical features from those of other pituitary tumors and requires careful screening prior to surgery. Endoscopic surgery is the preferred procedure for this type of tumor.

Clinical analysis of endoscopic endonasal approach for removal of sellar tumors

Objective:To investigate the safety and efficacy of endoscopic endonasal approach for removal of sellar tumors. Method: The clinical data of 18 patients with sellar tumors undergoing endoscopic endonasal surgery were analyzed retrospectively. This series consisted of ten pituitary adenomas, five craniopharyngiomas, three meningiomas. The headache, visual improvement, endocrine, extent of resection and surgical complications were evaluated. Result:Total removal was achieved in 14 patients (77.8%), almost total removal was achieved in one patient of pituitary adenoma with two craniopharyngiomas (16.7%), and one patient with the subtotal removal of craniopharyngioma (5.6%) received gamma knife therapy. Overall, 18 patients with headache got improved obviously; 15 patients presented with visual and view impairment, All of them, vision and view were improved or even recovered to normal following surgery; There were 2 new cases of postoperative diabetes insipidu; 5(27.8%) patients had hyposmia after operation; 1 patient (5.6%) with adenoma suffered cerebrospinal fluid rhinorrhea, the second operation was successful. The follow-up lasted 12-84 months, no tumor recurrence was identified by MRI examination, and no patient died. Conclusion:The endoscopic endonasal approach is feasible and safe for the treatment of tumors in the sellar region. With advantages of clear vision, better exposure, without brain retraction, and preservation of vascular and neurological function. Skilled endoscopic technique and reliable skull base reconstruction are important to ensure success of surgery.