Endonasal Endoscopic Transsphenoidal Technique of Sellar Lesions Resection

Authors: V. Masopust;  D. Netuka;  V. Beneš
Authors‘ workplace: Neurochirurgická klinika 1. LF UK, IPVZ a ÚVN Praha
Published in: Cesk Slov Neurol N 2008; 71/104(6): 704-710
Category: Short Communication


Endoscopic endonasal technique of sellar lesions resection became an alternative treatment option to microsurgical procedure in the last decade. Authors evaluate their experience with endoscopic procedures.

Altogether, 121 endoscopic endonasal surgeries in 93 patients were performed at author’s institution in years 2006 and 2007. Altogether, 101 procedures were performed in patients with pituitary adenoma, 20 in patients with other sellar lesions. Binostral technique was used in the last 93 procedures.

30-days mortality was 0% in this series, 30-days morbidity was 1.1% (in one case postoperative unilateral amaurosis). Altogether, reoperation due to postoperative cerebrospinal leak was indicated in 9.6% cases (nine patients).

Endoscopic technique is a relevant alternative to microsurgical technique. Endoscopic technique offers significant variability of procedures. Postoperative cerobrospinal leakage is the major complication after expanded endoscopic procedures. Further studies are needed to clarify whether endoscopic technique achieves better results than microsurgical technique or the same results. Authors are convinced about superiority of endoscopic technique.

Key words:
sellar lesion – endoscopic endonasal resection – pituitary adenoma – surgical treatment


1. Lindholm J. A century of pituitary surgery: Schloffer‘s legacy. Neurosurgery 2007; 61(4): 865–867.

2. Cohen-Gadol AA, Liu JK, Laws ER jr. Cushing‘s first case of transsphenoidal surgery: the launch of the pituitary surgery era. J Neurosurg 2005; 103(3): 570–574.

3. Liu JK, Das K, Weiss MH, Laws ER jr, Couldwell WT. The history and evolution of transsphenoidal surgery. J Neurosurg 2001; 95(6): 1083–1096.

4. Fusek I, Černý E. Transsphenoidal operation of hypophyseal tumors. J Neurosurg Sci 1977; 21, 159–160.

5. Fusek I, Černý E. Naše zkušenosti s indikacemi transsfenoidálních operací nádorů tureckého sedla. Cesk Neurol Neurochir 1978; 41(2): 107–114.

6. Fusek I. Chirurgické léčení nádorů tureckého sedla transsfenoidálním přístupem. Praha: Avicenum 1986.

7. Cappabianca P, Alfieri A, de Divitiis E. Endoscopic endonasal transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS). Minim Invasive Neurosurg 1998; 41(2): 66–73.

8. Cappabianca P, Alfiery A, de Divitiis E, Tschabitscher M. Atlas of Endoscopic Anatomy for Endonasal Intracranial Surgery. New York: Springer-Verlag 2001: 134.

9. Cappabianca P, Alfiery A, Thermes S, Buonamassa S, de Divitiis E. Instruments for endoscopic endonasal transsphenoidal surgery. Neurosurgery 1999; 45(2): 392–396.

10. de Divitiis E, Cappabianca P. Endoscopic endonasal transspehenoidal surgery. In: Pickard JD et al (eds). Advances and Technical Standards in Neurosurgery. 27th ed. New York: Springer-Verlag 2002: 137–177.

11. Jho HD, Carrau RL. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 1997; 87(1): 44–51.

12. Cavallo LM, Messina A, Gardner P, Esposito F, Kassam AB, Cappabianca P et al. Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations. Neurosurg Focus 2005; 19(1): E5.

13. de Divitiis E, Cappabianca P, Cavallo LM. Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesion. Neurosurgery 2002; 51(3): 669–707.

14. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 2005; 19(1): E3

15. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus 2005; 19(1): E4

16. Kassam A, Gardner P, Snyderman C, Mintz A, Carrau R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus 2005; 19(1): E6.

17. Dusick JR, Esposito F, Mattozo CA, Chaloner C, McArthur DL, Kelly DF. Endonasal transsphenoidal surgery: the patient‘s perspective-survey results from 259 patients. Surg Neurol 2006; 65(4): 332–341.

18. Ludecke DK, Abe T. Transsphenoidal microsurgery for newly diagnosed acromegaly: a personal view after more than 1,000 operations. Neuroendocrinology 2006; 83(3–4): 230–239.

19. Nimsky C, von Keller B, Ganslandt O,Fahlbusch R. Intraoperative high‑field magnetic resonance imaging in transsphenoidal surgery of hormonally inactive pituitary macroadenomas. Neurosurgery 2006; 59(1): 105–114.

20. Shou XF, Li SQ, Wang YF, Zhao Y, Jia PF, Zhou LF. Treatment of pituitary adenomas with a transsphenoidal approach. Neurosurgery 2005; 56(2): 249–256.

21. Náhlovský J, Česák J, Látr I, Čáp J, Žižka J, Krajina A. Komplikace transsfenoidálních operací u našich nemocných – příčiny, řešení. Cesk Slov Neurol N 2004; 67/100(2): 112–119.

22. Sameš M, Vachata P, Saur K, Budíková M.Přímý transnazální miniinvazivní přístup pro mikrochirurgickou resekci adenomů hypofýzy. Cesk Slov Neurol N 2005; 68/101(5): 338–342.

23. Snyderman C, Kassam A, Carrau R, Mintz A, Gardner P, Prevedello DM. Acquisition of surgical skills for endonasal skull base surgery: a training program. Laryngoscope 2007; 117(4): 699–705.

24. Elias WJ, Chadduck JB, Alden TD, Laws ER jr. Frameless stereotaxy for transsphenoidal surgery. Neurosurgery 1999; 45(2): 271–277.

25. Fahlbush R, Ganslandt O, Buchfelder M, Schott W, Nimsky C. Intraoperative magnetic resonance imaging during transsphenoidal surgery. J Neurosurg 2001; 95(3): 381–390.

26. Martin CH, Schwartz R, Jolesz F, Black PM. Transspehenoidal resection of pituitary adenomas in an intraoperative MRI unit. Pituitary 1999; 2(2): 155–162.

27. Nimsky C, Ganslandt O, Kober H, Buchfelder M, Fahlbusch R. Intraoperative magnetic resonance imaging combined with neuronavigation: a new concept. Neurosurgery 2001; 48(5): 1082–1091.

28. Cappabianca P, Briganti F, Cavallo LM, de Divitiis E. Pseudoaneurysm of the intracavernous carotid artery following endoscopic endonasal trans‑spehenoidal surgery treated by endovascular approach. Acta Neurochir (Wien) 2001; 143(1): 95–96.

29. Cappabianca P, Cavallo LM, Mariniello G,de Divitiis O, Romero AD, de Divitiis E. Easy sellar reconstuction in endoscopic endonasal transsphenoidal surgery with polyester-silicone dural substitute and fibrin glue: technical note. Neurosurgery 2001; 49(2): 473–476.

30. de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O. Tuberculum sellae meningiomas: high route or low route? A series of 51 consecutive cases. Neurosurgery 2008; 62(3): 556–563.

31. de Divitiis E, Cappabianca P, Cavallo LM, Esposito F, de Divitiis O, Messina A. Extended endoscopic transsphenoidal approach for extrasellar craniopharyngiomas. Neurosurgery 2007; 61 (5 Suppl 2): 219–227.

32. Fortes FS, Carrau RL, Snyderman CH, Kassam A, Prevedello D, Vescan A et al. Transpterygoid transposition of a temporoparietal fascia flap: a new method for skull base reconstruction after endoscopic expanded endonasal approaches. Laryngoscope 2007; 117(6): 970–976.

33. Fortes FS, Carrau RL, Snyderman CH, Prevedello D, Vescan A, Mintz A et al. The posterior pedicle inferior turbinate flap: a new vascularized flap for skull base reconstruction. Laryngoscope 2007; 117(8): 1329–1332.

34. Snyderman CH, Kassam AB, Carrau R, Mintz A. Endoscopic Reconstruction of Cranial Base Defects following Endonasal Skull Base Surgery. Skull Base 2007; 17(1): 73–78.

35. Ray BS. Intracranial hypophysectomy. J Neurosurg 1968; 28(2): 180–186.

36. Buchfelder M, Kreutzer J. Transcranial surgery for pituitary adenomas. Pituitary. In press 2008.

37. Youssef AS, Agazzi S, van Loveren HR. Transcranial surgery for pituitary adenomas. Neurosurgery 2005; 57(1 Suppl): 168–175.

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