Endoscopie transsphenoidal hypophysectomy

Although surgical approaches to the sellar region (hypophysectomy) traditionally require the use of a microscope, recently rigid endoscopie endonasal surgery has become more common because of advances in optics illumination, and associated instruments, especially when an X-ray or navigation system for hypophysectomy is available. Endoscopie surgery of the sellar region can be performed more safely and effectively nowadays, while providing the surgeon with a view that is superior to that afforded by the microscope. In this report, the usefulness of an endoscope in sellar transsphenoidal surgery was discussed particularly in comparison with that of the microscope. The use of the endoscope was evaluated during recent microsurgeries of eight patients with sellar lesions: three lesions were prolactin (PRL)-secreting adenomas, two were growth hormone (GH)-secreting adenomas, two non-functional adenoma, and one Rathke's cyst. Tumor sizes of these are varied from 7 mm to 30 mm (20 mm in average) in diameter. All tumors were resected all transsphenoidally via the superior nasal meatus in two cases, middle nasal meatus in two cases, and nasal septum in four cases. These approaches provide appropriate exposure of the sella and adequate working space. This technique also reduces the bleeding amount and operating time needed. Therefore endoscopie surgery allowed not only less invasive surgery but also closer inspection and identification of the tumor tissue. For this reason, neurosurgeons and ENT surgeons should co-operate regarding and discuss sellar lesion patients.