[Videoendoscopic endonasal-transsphenoidal surgery of pituitary adenomas from a rhinological viewpoint]

Abstract

Introduction: Videoendoscopic endonasal-transsphenoidal pituitary surgery is a modern minimally invasive surgical technique, which requires interdisciplinary cooperation between ENT and neurosurgery.

Patients and methods: Between December 2006 and July 2008, 25 patients (13 male, 12 female, average age 55 years old) suffering from pituitary adenomas were operated on with the abovementioned method. All operations were done four-handed with the ENT surgeon carrying out the sphenoidectomy and the neurosurgeon the adenomectomy. An optoelectronic system (Vector Vision) was used for navigation using CT and MRI scans that were fused together.

Results: Of the patients 21 suffered from a macroadenoma and 3 from a microadenoma. Primary surgery was carried out on 22 patients and 3 underwent recurrence surgery. The adenoma could be resected without any intraoperative complications in all cases. In five cases postoperative liquorrhoea occurred, which in one case was combined with a pneumocephalus due to strong nose blowing and revision surgery was required in three cases. Oculomotor nerve palsy due to neuroborreliosis was observed in one case on the third postoperative day, which receded completely under antibiotics within 1 week. Navigation worked well in all cases, thus there was no need for a C-bow. Additional functional endoscopic sinus surgery (FESS) was necessary in one case due to nasal polyposis. The endoscopic panorama view was advantageous because of the possibility to view the operation cavity. The changeover from microscopic to endoscopic techniques was performed due to the interdisciplinary approach without an intensive learning phase.

Conclusions: The newly developed videoendoscopic endonasal pituitary surgery as an interdisciplinary operation between neurosurgery and rhinosurgery by means of modern navigation systems proved to be an excellent method.