Endoscopic Anatomy Along the Transnasal Approach to the Pituitary Gland and the Surrounding Structures
“The nasal route is impracticable and can be never otherwise”, Dandy, 1945 [2 ]. This assumption of one of the greatest neurosurgeons of the 20th century proved to be wrong. The idea of reaching the pituitary along the preformed route through the nose and
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Springer-Verlag Wien GmbH
Prof. Dr. Enrico de Divitiis Prof. Dr. Paolo Cappabianca Department of Neurosurgery, University "Federico II", Naples, Italy
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© 2003 Springer-Verlag Wien Originally published by Springer-Verlag Wien New York in 2003 Softcover reprint of the hardcover 1st edition 2003
SPIN: 10910740
With 172 partly coloured Figures
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ISBN 978-3-7091-7225-4 ISBN 978-3-7091-6084-8 (eBook) DOI 10.1007/978-3-7091-6084-8
FOREWORD Edward R. Laws
Pituitary tumors and other lesions of the sellar area are common and important neurosurgical problems. Approximately one third of primary brain tumors treated surgically are pituitary lesions and, in the United States, about 19% of operations for primary brain tumors are done transsphenoidally. Autopsy studies in the otherwise healthy general population demonstrate that approximately 20% of adults harbor a small pituitary adenoma, most of which are clinically insignificant. Pituitary lesions present with a wide spectrum of clinical manifestations, including headache, progressive visual loss, progressive hypopituitarism manifest as fatigue and sexual disfunction, and hyperactive syndromes that include Cushing's disease, acromegaly, and Nelson's Syndrome. Occasionally pituitary lesions will invade laterally into the cavernous sinus producing diplopia, or facial numbness and pain. By far the most common lesion in the pituitary area is a benign pituitary adenoma, and most of the other lesions that present here (craniopharyngiomas, meningiomas, etc.) are likewise benign lesions with an excellent prognosis if they are suitably treated with surgical management and occasionally with adjunctive medical or radiotherapeutic, including radiosurgical, procedures (Table 1). Table 1. Evolution of adjunctive therapy for pituitary therapy 1902 1909 1912 1919 1939 1950 1950 1960 1960 1962 1965 1966 1969 1972 1985 1990 1995 1995
Roentgenograms Radiotherapy Radium Therapy Blood Transfusion Antibiotics Corticosteroids Fractionated Radiotherapy Interstitial Radiotherapy Proton Beam Therapy Radiosurgery Nuclear Imaging Videofluoroscopy Operating Microscope CT Scan PET Scan, SPECT, MRI Ultrasonic Imaging Neuronavigation Intraoperative MRI
The complexi
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