- Email: [email protected]
Microendoscopic transseptal transsphenoid excision of pituitary macroadenomas
International Congress Series 1240 (2003) 435 – 436
Microendoscopic transseptal transsphenoid excision of pituitary macroadenomas Mohamed Zaki Helal*,1 Ain Shams University, Cairo 11471, Egypt
Keywords: Transsphenoid approach; Pituitary macroadenomas; Video demonstration
1. Purpose The transsphenoid approach is the standard approach to the sella and parasellar region of the skull base. The transseptal and the endonasal sphenoidotomy routes are direct midline direct midline approaches and therefore safer than oblique approaches such as the transethmosphenoid approach. In this video demonstration, the superiority of the transseptal route over the endonasal sphenoidotomy route is highlighted. The advantage of combined use of endoscopes and microscope is also documented. The purpose of this video presentation is to discuss the operative details of the procedure.
2. Methods In all patients with pituitary macroadenomas, the transseptal transsphenoid approach was used under optimal visualization and illumination, using both angled endoscopes and the microscope. With the endoscopic technique, most of the surgical steps are performed. The endoscopic view provides superior perception of anatomy, and therefore avoidance of possible complications. The microscopic view with its magnification and antireflective nature of its lens system provides superior perception of tissue fine details and with its stable operative view is suitable for in focus free bimanual delicate manipulation of
* Department of ORL, Faculty of Medicine, Ain Shams University, 28 Othman Ibn Afan Str., Heliopolis, Cairo 11361, Egypt. Tel.: +20-2-2142942; fax: +20-2-2142942. E-mail addresses: [email protected], [email protected], [email protected] (M.Z. Helal). 1 Home address: 57 Helmi Hassan Ali Str., 8th District, Nasr City, PO Box 7037, Cairo 11471, Egypt. Tel.: +20-2-2737804; fax: +20-2-2871542. 0531-5131/ D 2003 International Federation of Otorhinolaryngological Societies (IFOS). All rights reserved. doi:10.1016/S0531-5131(03)01046-X
436
M.Z. Helal / International Congress Series 1240 (2003) 435–436
midline structures such as in dissection of tumor capsule from dura, cavernous sinuses and arachnoid.
3. Results Since 1989, a total of 354 pituitary macroadenomas underwent selective adenomectomy with preservation of the normal glandular tissues using this technique.
4. Conclusions The transseptal approach is superior to endonasal sphenoidotomy approach in preserving nasal anatomy, mucosa and function. It is an extramucosal route respecting nasal mucosa, preserving middle turbinate and permitting better control of possible CSF leaks. It also provides easy manipulation of instruments and the combined use of microscopes and endoscopes.
Microendoscopic transseptal transsphenoid excision of pituitary macroadenomas Mohamed Zaki Helal*,1 Ain Shams University, Cairo 11471, Egypt
Keywords: Transsphenoid approach; Pituitary macroadenomas; Video demonstration
1. Purpose The transsphenoid approach is the standard approach to the sella and parasellar region of the skull base. The transseptal and the endonasal sphenoidotomy routes are direct midline direct midline approaches and therefore safer than oblique approaches such as the transethmosphenoid approach. In this video demonstration, the superiority of the transseptal route over the endonasal sphenoidotomy route is highlighted. The advantage of combined use of endoscopes and microscope is also documented. The purpose of this video presentation is to discuss the operative details of the procedure.
2. Methods In all patients with pituitary macroadenomas, the transseptal transsphenoid approach was used under optimal visualization and illumination, using both angled endoscopes and the microscope. With the endoscopic technique, most of the surgical steps are performed. The endoscopic view provides superior perception of anatomy, and therefore avoidance of possible complications. The microscopic view with its magnification and antireflective nature of its lens system provides superior perception of tissue fine details and with its stable operative view is suitable for in focus free bimanual delicate manipulation of
* Department of ORL, Faculty of Medicine, Ain Shams University, 28 Othman Ibn Afan Str., Heliopolis, Cairo 11361, Egypt. Tel.: +20-2-2142942; fax: +20-2-2142942. E-mail addresses: [email protected], [email protected], [email protected] (M.Z. Helal). 1 Home address: 57 Helmi Hassan Ali Str., 8th District, Nasr City, PO Box 7037, Cairo 11471, Egypt. Tel.: +20-2-2737804; fax: +20-2-2871542. 0531-5131/ D 2003 International Federation of Otorhinolaryngological Societies (IFOS). All rights reserved. doi:10.1016/S0531-5131(03)01046-X
436
M.Z. Helal / International Congress Series 1240 (2003) 435–436
midline structures such as in dissection of tumor capsule from dura, cavernous sinuses and arachnoid.
3. Results Since 1989, a total of 354 pituitary macroadenomas underwent selective adenomectomy with preservation of the normal glandular tissues using this technique.
4. Conclusions The transseptal approach is superior to endonasal sphenoidotomy approach in preserving nasal anatomy, mucosa and function. It is an extramucosal route respecting nasal mucosa, preserving middle turbinate and permitting better control of possible CSF leaks. It also provides easy manipulation of instruments and the combined use of microscopes and endoscopes.