[Endoscopic endonasal surgery for extrasellar tumors: case presentation and its future perspective]

Area of Science:

• Neurosurgery and Otolaryngology
• Minimally Invasive Surgical Techniques
• Skull Base Surgery

Background:

• Endoscopic endonasal transsphenoidal surgery (EETSS) evolved from microscope-assisted to a fully endoscopic approach.
• The shift to EETSS aimed for less invasive management and more aggressive tumor resection, particularly for extrasellar lesions.
• This study reports on the institute's experience with endoscopic pituitary and skull base surgery since 2006.

Observation:

• The endonasal approach via the sphenoid ostium was performed without nasal specula, eliminating the need for postoperative nasal packing.
• For complex cases (meningiomas, craniopharyngiomas, giant pituitary adenomas), expanded endoscopic techniques including middle nasal conchotomy, posterior ethmoidectomy, optic canal decompression, and planum sphenoidale removal were utilized.
• Navigation and ultrasound-Doppler were crucial; angled endoscopes facilitated visualization and resection of tumors extending into the cavernous sinus and lower clivus.

Findings:

• A novel balloon catheter system was employed for cerebrospinal fluid (CSF) leakage management, fixing abdominal fat and fibrin glue.
• Suturing of dural openings and reduced reliance on lumbar drainage systems for CSF rhinorrhea prevention were observed.
• Newly designed instruments (angled suction tips, coagulation tools, forceps) enhanced procedural smoothness.

Implications:

• Endonasal endoscopic pituitary surgery represents a less invasive alternative to traditional transsphenoidal surgery.
• Endoscopic skull base surgery enables more aggressive tumor removal, though it requires specialized training, techniques, and patient selection.
• Collaboration with ENT specialists and performance in specialized centers are recommended for optimal outcomes in complex skull base procedures.