Minim Invasive Neurosurg 2006; 49(1): 20-24
DOI: 10.1055/s-2005-919148
Original Article
© Georg Thieme Verlag Stuttgart · New York

A Minimally Invasive Endoscopic Transsphenoidal Approach with an Endonasal Septal Pushover Technique by Using a Modified Nasal Speculum

N.  Nakao1 , K.  Nakai1 , T.  Itakura1
  • 1Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
Further Information

Publication History

Publication Date:
20 March 2006 (online)

Abstract

Whereas the endoscopic endonasal transsphenoidal approach has been applied in patients with pituitary lesions as a potentially efficacious and less invasive surgical technique, the sinonasal step of a series of the surgical procedures is generally not well known to neurosurgeons. This is one of the reasons why the endoscopic technique has not been fully been adopted as a routine surgical procedure approaching towards the sella. The present paper describes the technical details of a purely endoscopic approach using an endonasal septal pushover technique. We also present a newly designed nasal speculum specialized for this endoscopic endonasal technique. As compared to the endoscopic endonasal approach previously reported, the surgical procedure required for sphenoidotomy with the aid of the modified speculum was simplified and thereby less time-consuming. This technique has been performed in 40 patients with several types of pituitary lesions. All patients recovered rapidly without significant rhinological complications. Despite a limited number of cases, our experience suggests that this simplified endoscopic technique could encourage a more routine use of endoscopes in the endonasal approach for pituitary lesions.

References

  • 1 Cappabianca P, Cavallo L M, Colao A M, de Divitiis E. Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas.  J Neurosurg. 2002;  97 293-298
  • 2 Cappabianca P, Cavallo L M, Colao A M, Del Basso De Caro M, Esposito F, Cirillo S, Lombardi G, de Divitiis E. Endoscopic endonasal transsphenoidal approach: Outcome analysis of 100 consecutive procedures.  Minim Invas Neurosurg. 2002;  45 1-8
  • 3 Cappabianca P, Cavallo L M, de Divitiis E. Endoscopic endonasal transsphenoidal surgery.  Neurosurgery. 2004;  55 933-941
  • 4 Jho H-D, Carrau R L. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients.  J Neurosurg. 1997;  87 44-51
  • 5 Jho H-D, Carrau R L. Endoscopic transsphenoidal surgery. In: Schmidek HH (eds). Schmidek & Sweet Operative Neurosurgical Techniques: Indications, Methods, and Results, 4th edn. Philadelphia: WB Saunder, Vol 1 2000: 385-397
  • 6 Griffith H B, Veerapen R. A direct transnasal approach to the sphenoid sinus. Technical note.  J Neurosurg. 1987;  66 140-142
  • 7 Nakao N, Nakai K, Itakura T. Updating of neuronavigation based on images intraoperatively acquired with a mobile computerized tomographic scanner: Technical note.  Minim Invas Neurosurg. 2003;  46 117-120
  • 8 Giustina A, Barkan A, Casanueva F F, Cavagnini F, Frohman L, Ho K, Veldhuis J, Wass J, Werder K von, Melmed S. Criteria for cure of acromegaly: A consensus statement.  J Clin Endocrinol Metab. 2000;  85 526-529
  • 9 Cooke R S, Jones R AC. Experience with the direct transnasal transsphenoidal approach to the pituitary fossa.  Br J Neurosurg. 1994;  8 193-196
  • 10 Zada G, Kelly D F, Cohan P, Wang C, Swerdloff R. Endonasal transsphenoidal approach for pituitary adenomas and sellar lesions: assessment of efficacy, safety, and patient impressions.  J Neurosurg. 2003;  98 350-358
  • 11 Cappabianca P, Alfieri A, Thermes S, Buonamassa S, de Divitiis E. Instruments for endoscopic endonasal transsphenoidal surgery.  Neurosurgery. 1999;  45 392-396

Naoyuki Nakao, M. D. 

Department of Neurological Surgery · Wakayama Medical University

811-1 Kimiidera

Wakayama 641-0012

Japan

Phone: +81/734/41-0609

Fax: +81/734/47-1771 ·

Email: nnakao@wakayama-med.ac.jp