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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Extended endoscopic transsphenoidal approach for tuberculum sellae meningiomas
Enrico de Divitiis1, Luigi M Cavallo, Felice Esposito
1Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy. dediviti@unina.it
Neurosurgery
|January 8, 2008
Summary
The endoscopic endonasal approach offers a viable alternative for tuberculum sellae meningioma removal, achieving high gross total resection rates and good visual recovery. However, challenges remain in cranial base reconstruction and long-term follow-up.
Area of Science:
- Neurosurgery
- Endoscopic Skull Base Surgery
- Neuro-oncology
Background:
- Tuberculum sellae meningiomas traditionally treated via transcranial approaches.
- Extended endoscopic transsphenoidal techniques are increasingly considered for supra- and parasellar lesions.
- The endoscopic endonasal "low route" offers a minimally invasive alternative.
Purpose of the Study:
- To describe the surgical technique for the purely endoscopic endonasal variant of the extended transsphenoidal approach.
- To evaluate the efficacy and safety of this technique for tuberculum sellae meningiomas.
Main Methods:
- Six patients with tuberculum sellae meningiomas underwent the extended endoscopic transsphenoidal approach over 22 months.
- Tumor sizes ranged from <2 cm to 2-4 cm.
- Surgical technique details were documented.
Main Results:
- Gross total removal (83.3%) achieved without brain retraction or significant neurovascular manipulation.
- Complete visual recovery in 4/6 patients; temporary worsening in 2/6, with full recovery.
- Complications included CSF leak requiring repair, intraventricular hemorrhage (fatal in one patient), and new permanent diabetes insipidus.
Conclusions:
- The extended endoscopic transsphenoidal approach is a viable alternative for selected tuberculum sellae meningiomas in experienced hands.
- Current limitations include cranial base defect reconstruction techniques and insufficient long-term follow-up data.
- Careful patient selection is crucial for optimal outcomes.
