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Skull Base 2002; 12(3): 119-124
DOI: 10.1055/s-2002-33457
ORIGINAL ARTICLE

Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Comparison of the Exposure Obtained by Endoscope and Microscope in the Extended Trans-Sphenoidal Approach

Funda Batay1 , Emre Vural2 , Aykut Karasu1 , Ossama Al-Mefty1
  • 1Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
  • 2Department of Otolaryngology Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Publication History

Publication Date:
21 August 2002 (online)

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ABSTRACT

Objective: Trans-sphenoidal surgery is often combined with other approaches for the treatment of middle cranial base tumors. By combining a maxillotomy with trans-sphenoidal approach, significantly wider exposure to these regions is gained. However, endoscope-assisted techniques have also been used for sellar and parasellar and upper clival regions. Methods: An extended trans-sphenoidal approach was performed on 10 cadaver heads using the operating microscope and was repeated with a 0-degree endoscope. The mean horizontal and vertical distances were measured and pictured for each technique, and both distances were compared using a parametric paired Student's t-test. Results: The mean horizontal distances in the 10 specimens were 19.5 ± 1.8 mm by microscope and 27.5 ± 2.2 mm by endoscope, and the mean vertical distances were 25.8 ± 1.9 mm by the microscope and 34.5 ± 3.5 mm by the endoscope. Conclusion: The aim of this study was to quantify the amount of exposure obtained with an extended trans-sphenoidal approach and to compare both endoscopic and microscopic techniques. Using the endoscope in conjunction with the operating microscope may provide additional exposure and better access in skull base surgery.

KEYWORDS

Extended trans-sphenoidal approach - microscope - endoscope - skull base surgery

REFERENCES

  • 1 Laws Jr E R. Trans-sphenoidal approach to pituitary tumors. In: Schmidek HH, Sweet WH, eds. Operative Neurosurgical Techniques: Indications, Methods, Results, Vol 1. 3rd ed. Philadelphia, PA:WB Saunders 1995: 283-292
    Google Scholar
  • 2 Fahlbusch R, Buchfelder M. The trans-sphenoidal approach to invasive sellar and clival lesions. In: Sekhar LN, Janecka IP, eds. Surgery of Cranial Base Tumors New York, NY: Raven Press 1993: 337-349
    Google Scholar
  • 3 Cawley M C, Tindall G T. Trans-sphenoidal surgery: operative techniques. In: Krisht AF, Tindall GT, eds. Pituitary Disorders Comprehensive Management Baltimore, MD: Lippincott Williams Wilkins 1999: 349-359
    Google Scholar
  • 4 Vates G E, Wilson C B, McDermott M W. Trans-sphenoidal approaches to anterior skull base lesions.  Operative Techniques Neurosurg . 1999;  2 191-200
    PubMedGoogle Scholar
  • 5 King W A, Becker D. The trans-sphenoidal approach to pituitary macroadenomas with cavernous sinus extensions. In: Al-Mefty O, Origitano TC, Harkey LH, eds. Controversies in Neurosurgery New York, NY: Thieme 1996: 15-20
    Google Scholar
  • 6 Harrison M J, Al-Mefty O. Skull base approaches for giant invasive pituitary tumors. In: Krisht AF, Tindall GT, eds. Pituitary Disorders Comprehensive Management 1st ed. Baltimore, MD: Lippincott Williams Wilkins 1999: 375-387
    Google Scholar
  • 7 Gamea A, Fathi M, El-Guindy A. The use of rigid endoscope in trans-sphenoidal pituitary surgery.  J Laryngol Otol . 1994;  108 19-22
    PubMedGoogle Scholar
  • 8 Helal Z. Combined micro-endo trans-sphenoid excisions of pituitary macroadenomas.  Ear Arch Otorhinolaryngol . 1995;  252 186-189
    PubMedGoogle Scholar
  • 9 Jho H D. Endoscopic surgery of pituitary adenomas. In: Krisht AF, Tindall GT, eds. Pituitary Disorders Comprehensive Management 1st ed. Baltimore, MD: Lippincott Williams Wilkins 1999: 389-403
    Google Scholar
  • 10 Auer L M, Auer D P. Virtual endoscopy for planning and simulation of minimally invasive neurosurgery.  Neurosurgery . 1998;  43 529-548
    PubMedGoogle Scholar
  • 11 Perneczky A, Fries G. Endoscope-assisted brain surgery: Part 1-Evolution, basic concept, and current technique.  Neurosurgery . 1998;  42 219-225
    CrossrefPubMedGoogle Scholar
  • 12 Moore C E, Ross D A, Marentette L J. Critical pathways in anterior cranial base surgery.  Otolaryngol Head Neck Surg . 1999;  121 113-118
    PubMedGoogle Scholar
  • 13 Rabadan A, Contesa H. Transmaxillary transnasal approach to the anterior clivus: a microsurgical anatomic model.  Neurosurgery . 1992;  30 473-482
    PubMedGoogle Scholar
  • 14 Fraioli B, Esposito V, Santoro A, Ianetti G, Giuffre R, Cantore G. Transmaxillosphenoidal approach to tumors invading the medial compartment of the cavernous sinus.  J Neurosurg . 1995;  82 63-69
    PubMedGoogle Scholar
  • 15 Sabit I, Schaefer S D, Couldwell W T. Extradural extranasal combined transmaxillary trans-sphenoidal approach to the cavernous sinus: a minimally invasive microsurgical model.  Laryngoscope . 2000;  110 286-291
    CrossrefPubMedGoogle Scholar
  • 16 Apuzzo M LJ, Heifetz M D, Weiss M H, Kurze T. Neurosurgical endoscopy using the side-viewing telescope: technical note.  J Neurosurg . 1977;  46 398-400
    CrossrefPubMedGoogle Scholar
  • 17 Sugita K, Hirota T, Tsugane R. Application of nasopharyngeal mirror for aneurysm operation: technical note.  J Neurosurg . 1975;  43 244-246
    PubMedGoogle Scholar
  • 18 Bushe K A, Halves E. Modified technique in trans-sphenoidal operations of pituitary adenomas: technical note [in German, abstract].  Acta Neurochir . 1978;  41 163-175
    CrossrefPubMedGoogle Scholar
  • 19 Spencer W R, Das K, Nwagu C. Approaches to the sellar and parasellar region: anatomic comparison of the microscope versus endoscope.  Laryngoscope . 1999;  109 791-799
    PubMedGoogle Scholar
  • 20 Jho H D, Carrau R L. Endoscopic endonasal trans-sphenoidal surgery: experience with 50 patients.  J Neurosurg . 1997;  87 44-51
    CrossrefPubMedGoogle Scholar
  • 21 Cappabianca P, Alfieri A, de Divitis E. Endoscopic endonasal trans-sphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS).  Minimal Invasive Neurosurgery . 1998;  41 66-73
    Google Scholar
      >