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Endoscopic transsphenoidal approach



Little is known about the long-term effects of either transnasal transsphenoidal endoscopic approach (TTEA) or expanded endonasal approach (EEA).

A study assessed the long-term impact of endoscopic skull base surgery on olfaction, sinonasal symptoms, mucociliary clearance time (MCT), and quality of life (QoL). Patients with pituitary adenomas underwent TTEA (n = 38), while patients with other benign parasellar tumours who underwent an EEA with vascularised septal flap reconstruction (n = 17) were enrolled in this prospective study between 2009 and 2012. Sinonasal symptoms (Visual Analogue Scale), subjective olfactometry (Barcelona Smell Test-24, BAST-24), MCT (saccharin test), and QoL (short form SF-36, rhinosinusitis outcome measure/RSOM) were evaluated before, and 12 months after, surgery. At baseline, sinonasal symptoms, MCT, BAST-24, and QoL were similar between groups. Twelve months after surgery, both TTEA and EEA groups experienced smell impairment compared to baseline. Moreover, EEA (but not TTEA) patients reported increased posterior nasal discharge and longer MCTs compared to baseline. No significant changes in olfactometry or QoL were detected in either group 12 months after surgery. Over the long-term, expanded skull base surgery, using EEA, produced more sinonasal symptoms (including loss of smell) and longer MCTs than pituitary surgery (TTEA). EEA showed no long-term impact on smell test or QoL 1).

Case series


Guo-Dong et al., performed a retrospective review of 100 pituitary tumor patients treated by endoscopic endonasal transsphenoidal surgery (ETS) and 147 patients treated by microscopic transsphenoidal surgery (MTS) from January 2007 to July 2014. The tumors were stratified by Knosp classification and modified Hardy classification, and tumor gross total resection (GTR)/remission rate, visual improvement rate, complications, operation time, intraoperative bleeding and length of hospital stay were compared between ETS and MTS.

The GTR rate decreased with increasing Knosp grades for both ETS and MTS, with the rates of 93.3%, 87.5%, 71.4%, 58.8% for ETS and 82.8%, 92.0%, 70.7%, 36.0% for MTS in resecting Knosp grades 0, I, II, and III tumors, respectively. The visual improvement rates increased with increasing Hardy grades, which was 66.7% and 45.5% for Hardy grade B lesion, 72.2% and 71.4% for grade C lesion, and 88.9% and 78.9% for grade D lesion treated by ETS and MTS, respectively. No significant differences were observed for GTR rate, visual outcome and complication rate between ETS and MTS, while ETS resulted in more intraoperative blood loss, longer operative time, and shorter hospital stay than MTS.

These data conclude that, compared with MTS, ETS needs longer operation time and results in more intraoperative blood loss, but appears to achieve higher GTR rate for Knosp grade III pituitary tumors 2).

In 28 patients via entirely endoscopic endonasal transsphenoidal approach with the help of special-designed instruments; performed the procedure bloodlessly within limited time. The skill emphasized bilateral nostrils and four hands technique which was as delicate as possible not to scratch nasal mucosa or injure nasal frame. The special instruments included curette with suction, monopolar electrotome and bipolar coagulation forceps with suction, powered surgical equipments (Diamond Bur, Irrigation Tubing for Blades and Burs for nasal endoscopic surgery). Among 28 patients, there were 16 total resections, 8 subtotal resections, 3 partial resections, and 1 only biopsy due to excessive bleeding and hard nature. Of 19 patients with preoperative visual impairment, 12 patients had postoperative improvement in visual acuity and visual field. All the procedures were finished within 60 to 90 min. Complications seldom occurred except transient diabetes insipidus, especially no nasal-related signs or complications but 1 had epistaxis. The full endoscopic transsphenoidal surgery is a promising approach for pituitary adenoma resection. Multidisciplinary collaboration will lead to optimal cure for the patients. New technique and special-designed instruments can facilitate greatly this procedure 3).

Rioja E, Bernal-Sprekelsen M, Enriquez K, Enseñat J, Valero R, de Notaris M, Mullol J, Alobid I. Long-term outcomes of endoscopic endonasal approach for skull base surgery: a prospective study. Eur Arch Otorhinolaryngol. 2015 Dec 19. [Epub ahead of print] PubMed PMID: 26688432.
Guo-Dong H, Tao J, Ji-Hu Y, Wen-Jian Z, Xie-Jun Z, Jian G, Zhen L, Tai-Peng J, Jian-Jun D, Yong-Zhong G, Wenlan L, Wei-Ping L. Endoscopic Versus Microscopic Transsphenoidal Surgery for Pituitary Tumors. J Craniofac Surg. 2016 Sep 29. PubMed PMID: 27748726.
Fan YP, Lv MH, Feng SY, Fan X, Hong HY, Wen WP, Li HB. Full Endoscopic Transsphenoidal Surgery for Pituitary Adenoma-emphasized on Surgical Skill of Otolaryngologist. Indian J Otolaryngol Head Neck Surg. 2014 Jan;66(Suppl 1):334-40. doi: 10.1007/s12070-011-0317-4. Epub 2011 Nov 12. PubMed PMID: 24533411.
endoscopic_transsphenoidal_approach.txt · Last modified: 2017/08/08 13:19 by administrador