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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Sellar reconstruction algorithm in endoscopic transsphenoidal pituitary surgery: experience with 240 cases
Maryam Jalessi1, Guive Sharifi2, Mohammad Rasool Mirfallah Layalestani3
1Assistant Professor of ENT- Head and Neck Surgery, Endoscopic Pituitary and Skull Base Surgery Unit, ENT-Head and Neck Surgery Research Center and Department, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. jalessimd@gmail.com.
This study presents a novel sellar reconstruction strategy for pituitary adenoma surgery, utilizing an intra-operative cerebrospinal fluid (CSF) leak grading system to minimize postoperative complications. The approach proved safe and effective, significantly reducing CSF leak rates after endoscopic transsphenoidal surgery.
Area of Science:
- Neurosurgery
- Endoscopic Skull Base Surgery
- Pituitary Adenoma Treatment
Background:
- Endoscopic transsphenoidal surgery is a common approach for pituitary adenoma resection.
- Sellar reconstruction is crucial to prevent cerebrospinal fluid (CSF) leaks and other complications.
- A standardized strategy for sellar reconstruction is needed.
Purpose of the Study:
- To propose and evaluate a novel sellar reconstruction strategy for endoscopic transsphenoidal surgery in pituitary adenoma patients.
- To correlate intra-operative CSF leak grading with the chosen reconstruction method.
- To assess the safety and efficacy of the proposed strategy in preventing postoperative CSF leaks.
Main Methods:
- A cohort of 240 patients with pituitary adenoma underwent endoscopic endonasal transsphenoidal surgery.
- Intra-operative CSF leaks were graded (0, 1, 2) based on defect size and flow.
- A multi-stage sellar reconstruction protocol (Stages I, II, III) was applied based on the intra-operative CSF leak grade and surgical findings.
Main Results:
- 133 patients (55.4%) had grade 0, 78 (32.5%) grade 1, and 29 (12.1%) grade 2 intra-operative CSF leaks.
- Stage I reconstruction was used in 52.5% of patients, Stage II in 33.3%, and Stage III in 14.2%.
- Postoperative complications included 2 CSF leaks (0.8%), 1 pneumocephalus (0.4%), and 2 meningitis (0.8%) cases over an 18-month follow-up.
Conclusions:
- The proposed sellar reconstruction strategy, guided by an intra-operative CSF leak grading system, is safe and effective.
- This approach significantly reduces the incidence of devastating postoperative CSF leaks.
- The staging system provides a reliable method for tailored sellar reconstruction in endoscopic pituitary surgery.
