Endoscopic endonasal approach to pituitary adenomas
Epublication WebSurg.com, Mar 2012;12(03). URL: http://websurg.com/doi/lt03ensolari001
The endoscopic endonasal approach is a continuously evolving speciality of modern neurosurgery, which requires precise anatomical knowledge, technical skills and integrated appreciation of the pathology to be treated. This technique is a minimally invasive approach that allows the surgeon to deal with several diseases, especially entire skull base obviating brain retraction. The endoscopic endonasal approach offers some advantages arising from the use of the endoscope itself: a superior close-up view of the relevant anatomy and an enlarged working angle with an increased panoramic vision within the surgical area. Indeed, it offers the opportunity to safely and effectively visualize the surgical field, which as a result provides a corridor through the nasal cavity to reach the brain with its neurovascular structures. Most pituitary adenomas can be managed and removed through a standard transsphenoidal approach either microscopically or endoscopically. More recently, the introduction of the endoscope in the extended endoscopic endonasal approach has made this technique more popular, and today this technique can be considered suitable for the removal of lesions extending beyond the sellar area such as parasellar, suprasellar and/or retrosellar spaces. We have been using the endoscopic endonasal technique since 1997 on more than 1000 patients, aiming to remove first sellar lesions and more recently skull base lesions applying the so-called extended endonasal approach. We report our experience through a step-by-step depiction of the surgical techniques to access the different compartments, detailing the anatomy as seen from the endonasal perspective, focusing on dangerous landmarks, describing possible complications and techniques used to manage this kind of lesions.