The Expanding Spectrum of Disease Treated by the Transnasal, Transsphenoidal Microscopic and Endoscopic Anterior Skull Base Approach: A Single-Center Experience 2008-2015.

The transsphenoidal approach was initially developed in neurosurgical practice as an operative approach to the pituitary gland. The introduction of the operating endoscope has improved the versatility of the transsphenoidal approach, broadening the spectrum of lesions that can be treated effectively with this operative strategy. We performed a retrospective review of all patients who underwent transnasal, transsphenoidal operations at Brigham and Women's Hospital from April 2008 to February 2015 and categorized each case by pathologic diagnosis. A total of 792 transnasal, transsphenoidal operations (512 endoscopic) were performed by 9 neurosurgeons for 33 pathologies over a 7-year period. Pituitary adenomas (535, 67.55%) were the most common impetus for a transsphenoidal operation. Others included Rathke cleft cysts (86, 10.86%), craniopharyngiomas (25, 3.16%), lympocytic hypophysitis/pituitary inflammation (21, 2.65%), arachnoid cysts (8, 1.01%), spindle cell oncocytoma (4, 0.51%), colloid cysts (4, 0.51%), and pituicytoma (2, 0.25%). Pituitary hyperplasia was treated in 9 cases (1.14%) and pituitary apoplexy in 7 (0.88%). Nineteen operations were undertaken for postoperative repairs (2.40%) and 3 for abscesses (0.38%). Other diseases treated transsphenoidally included chordomas (12, 1.52%), metastases (9, 1.14%), meningiomas (5, 0.63%), clival lesions (4, 0.51%), germinomas (3, 0.38%), granulomas (2, 0.25%), dermoid tumors (2, 0.25%), and 1 (0.13%) each of esthesioneuroblastoma, granular cell tumor, Wegener granulomatosis, olfactory neuroblastoma, glioneuronal tumor, chondromyxoid fibroma, epidermoid, meningoencephalocele, aneurysm, neuroendocrine carcinoma, chondrosarcoma, and lymphoma. Although initially devised in neurosurgical practice for tumors of the pituitary gland, developments in technology now make the transsphenoidal approach an effective operative strategy for a wide range of anterior skull base lesions.

Cote DJ ，Wiemann R ，Smith TR ，Dunn IF ，Al-Mefty O ，Laws ER ... -  《-》

Endoscopic endonasal transsphenoidal removal of recurrent and regrowing pituitary adenomas: experience on a 59-patient series.

The nature of the pituitary adenomas itself exposes the possibility of a recurrence of the tumor. The aim of this study was to evaluate the effectiveness of the endoscopic endonasal transsphenoidal approach for the removal of recurrent and residual pituitary adenomas, already treated by a microscopic or endoscopic transsphenoidal approach or by a transcranial route. A total of 59 adult patients with a recurrent or regrowing pituitary adenoma underwent surgery using a pure endoscopic endonasal transsphenoidal approach. Of these patients, 31 were previously operated on by a microsurgical transsphenoidal approach, 22 by means of an endoscopic transsphenoidal route, and 6 via a transcranial route. The patient series has been divided into 3 tiers according to the primary surgery, and the results were evaluated accordingly. Gross total removal was achieved in 37 of our cases (62.7%). According to prior surgery at primary disease, we found that in the subgroup of patients who underwent a microsurgical transsphenoidal approach we achieved gross total removal in 23 cases (74.2%; 23 of 31), whereas in the group of patients who underwent the endoscopic endonasal approach, gross total removal was attained respectively in 13 cases (59.1%; 13 of 22) and in only 1 case of those who underwent the transcranial approach (16.7%; 1 of 6). Postoperative complications included 1 case (1.7%) of cerebrospinal fluid leak and meningitis, and 1 with an hematoma in the tumor field (1.7%); both needed surgical reoperation. The endoscopic endonasal approach is a safe and effective procedure for the management of recurrent and/or regrowing pituitary tumors previously treated by either a microsurgical or an endoscopic approach.

Cavallo LM ，Solari D ，Tasiou A ，Esposito F ，de Angelis M ，D'Enza AI ，Cappabianca P ... -  《-》

The transition from microscopic to endoscopic transsphenoidal surgery in high-caseload neurosurgical centers: the experience of Foch Hospital.

To report the experience of 1 hospital in the transition from the microscopic approach to the endoscopic endonasal approach for pituitary disease and skull base tumor surgery. From 2006 to August 2011, 1000 procedures to treat pituitary disease and skull base tumors were performed in our department by a single neurosurgeon using the endoscopic endonasal approach. The endonasal endoscopic approach for pituitary adenoma surgery decreased nasal complications, increased patient comfort by avoiding postoperative nasal packing, provided a better view of the intrasellar and suprasellar areas, obtained the same endocrinologic results as the microscopic approach, provided better control of the invasion of the cavernous sinus, and allowed removal of tumors of the cavernous sinus in some cases. It is important to separate the 2 approaches, the endoscopic endonasal transsellar approach and the endoscopic endonasal extended approach, and to avoid unnecessary extended approaches. The use of an endoscopic endonasal approach has added value for lesions localized between the tuberculum sellae and the odontoid. The added value of endoscopic endonasal approaches for lesions in front of the tuberculum sellae is less clear and must be evaluated in the future.

Gaillard S 《-》

Extended transsphenoidal approach for pituitary adenomas invading the anterior cranial base, cavernous sinus, and clivus: a single-center experience with 126 consecutive cases.

Zhao B ，Wei YK ，Li GL ，Li YN ，Yao Y ，Kang J ，Ma WB ，Yang Y ，Wang RZ ... -  《-》

Endoscopic endonasal surgery for nonadenomatous sellar/parasellar lesions.

This article demonstrates the experience with endoscopic transphenoidal anterior skull base surgery for lesions other than pituitary adenomas. The spectrum of lesions, results, and complications are presented. This series includes patients with 102 lesions other than pituitary adenomas operated upon using the endoscopic approach. The results and complications were reviewed retrospectively. The most common lesions treated were Rathke Cleft Cysts (n = 39) and craniopharyngiomas (n = 18) in a total of 82 tumors. There were 8 patients with inflammatory lesions, and the remainder had a variety of unusual pathologies. Complications other than diabetes insipidus (n = 12) were uncommon, with 6 postoperative cerebrospinal fluid leaks. The endoscopic anterior skull base approach is highly effective in treating a large variety of lesions other than pituitary adenomas. The adoption of the nasoseptal flap for closure has markedly reduced the incidence of spinal fluid leaks, and is used routinely for lesions that violate the intracranial compartment.

Barkhoudarian G ，Zada G ，Laws ER 《-》