Mononostril endoscopic endonasal approach for pituitary surgery
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HOW I DO IT - PITUITARIES
Mononostril endoscopic endonasal approach for pituitary surgery Bertrand Baussart 1
&
Agnes Declerck 2 & Stephan Gaillard 1
Received: 3 June 2020 / Accepted: 16 August 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Most surgical teams currently consider that endoscopy has become the “gold standard” technique for the transsphenoidal approach to pituitary surgery. Pituitary adenomas are commonly benign tumours and should benefit from the least invasive approach. Method In Foch Hospital, from 2006 to 2020, 2835 patients with pituitary adenomas were treated with a mononostril endoscopic endonasal approach. Here we describe the fine details of the nasal, sphenoidal and sellar steps of this technique. Conclusion Complete preservation of the nasal corridor, luxation of the nasal septum and tailored sellar bone resection are essential for safe resection of pituitary adenomas. Keywords Pituitary surgery . Endoscopy . Endoscopic endonasal approach . Tailored sellar opening
Relevant surgical anatomy The transsphenoidal approach is commonly used for surgical resection of pituitary adenomas. The technical advances under microscopy were developed by Guiot and Hardy [5, 6, 10], and the transition from microscopic to endoscopic surgery occurred in the late 1990s, on the basis of efficiency and the spectacular increase in visual field [1, 7, 8]. Many techniques have been described previously [1, 2, 4]. A total of 2835 patients with pituitary adenomas were treated in our department via a mononostril endoscopic endonasal approach. Some anatomical key points should be noted before starting. Several anatomical variations are spotted on preoperative magnetic resonance imaging (MRI) imaging. Special attention must be paid to the degree of sphenoid sinus
pneumatization. Most of the sphenoid septations must be removed to expose the entire sellar area. The direction of each septation, towards the midline or the cavernous sinus, is a useful surgical landmark during sella exposure, particularly in a non-well-pneumatized sinus (presellar or conchal types). A carotid artery procidence must be identified. Anatomically, we would like to highlight three key steps: the complete respect of the nasal corridor, the luxation of nasal septum in order to convert the initial paramedian approach into a true median approach and the selective tailored sellar opening.
Description of the technique Positioning
This article is part of the Topical Collection on Pituitaries Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04542-z) contains supplementary material, which is available to authorized users. * Bertrand Baussart [email protected]; [email protected] 1
Department of Neurosurgery, Foch Hospital, 40 rue Worth, 92150 Suresnes, France
2
Department of Anesthesiology, Foch Hospital, 40 rue Worth, 92150 Suresnes, France
The patient is placed in a semi-sitting position with the head secured in a horseshoe head hold
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