Objective: The evolution of the senior author's (HD Jho) surgical experience on endoscopic endonasal
transsphenoidal pituitary surgery is reviewed in order to introduce a standardized
surgical technique for pituitary endoscopy. Methods: The progressive evolution of the surgical technique and the development of surgical
instrumentation in transsphenoidal endoscopy is reviewed based upon the experience
of more than 150 operations performed by the senior author between the years 1993
and 1998. Results: An endoscope was used to assist visualization during conventional microscopic surgery
in the first four cases (endoscope-assisted microsurgery). Subsequently, endonasal
pituitary endoscopy was performed via a nostril. When the endonasal route was adopted,
it eliminated the use of a transsphenoidal retractor. The use of vasoconstrictors
and any form of nasal packing was discovered to be unnecessary. The inferior margin
of the middle turbinate was such a consistent surgical landmark leading to the sella
that the use of an intraoperative fluoroscopic C-arm was also eliminated. The adoption
of a septal breaker, variously angled suction cannulas and suction-coagulators has
made the operation cleaner, easier and faster. As experience increased, the operation
time progressively shortened and mucosal trauma became minimal. The median patient
hospital stay was one night and postoperative discomfort was noted to be minimal.
Conclusions: The evolution of the senior author's endoscopic pituitary surgery is reported with
a description of our current standardized surgical technique.
Key words:
Acromegaly - Cushing's Disease - Endoscopy - Pituitary Adenoma - Pituitary Gland -
Prolactinoma - Transsphenoidal Surgery
References
Corresponding Author
E-mail:hdjho@neuronet.pitt.edu
