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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
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Endoscopic endonasal transcavernous posterior clinoidectomy with interdural pituitary transposition
Juan C Fernandez-Miranda1, Paul A Gardner, Milton M Rastelli
1Departments of Neurological Surgery and.
Journal of Neurosurgery
|May 13, 2014
Summary
This study details an endoscopic endonasal transcavernous posterior clinoidectomy approach, preserving pituitary function. The technique offers improved access for removing tumors near the posterior clinoid, enhancing surgical outcomes.
Area of Science:
- Neurosurgery
- Endoscopic Skull Base Surgery
Background:
- Posterior clinoidectomy is crucial for accessing certain skull base tumors.
- Traditional approaches may pose risks to the pituitary gland and surrounding neurovascular structures.
Purpose of the Study:
- To describe the surgical anatomy and technical nuances of an endonasal transcavernous posterior clinoidectomy with interdural pituitary transposition.
- To report the clinical outcomes of this modified surgical technique.
Main Methods:
- Anatomical study using 10 silicon-injected specimens.
- Retrospective review of 12 patients undergoing the described surgical technique.
Main Results:
- The approach utilizes the cavernous sinus corridor, mobilizing the pituitary gland interdurally.
- Preservation of the medial cavernous sinus wall and pituitary venous drainage was achieved.
- Successful tumor removal in all 12 patients (chordomas, meningiomas, epidermoid tumor) without neurovascular injury.
- No permanent hypopituitarism or diabetes insipidus observed.
Conclusions:
- The endoscopic endonasal transcavernous approach is a safe and effective variant for posterior clinoidectomy.
- This technique enhances working space and preserves pituitary function compared to purely extradural methods.
