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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
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Transnasal Endoscopic Surgery for Suprasellar Meningiomas
Prasheelkumar P Gupta1, Salman T Shaikh1, Chandrashekhar E Deopujari1
1Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.
Neurology India
|June 25, 2021
Summary
Endoscopic trans-nasal surgery offers effective suprasellar meningioma resection with improved visual outcomes and reduced cerebrospinal fluid (CSF) leak rates. Vascularized flaps enhance defect closure, making it a viable alternative to transcranial approaches.
Area of Science:
- Neurosurgery
- Endoscopic Skull Base Surgery
Background:
- Endoscopic trans-nasal surgery has advanced significantly, improving outcomes for pituitary tumors.
- Suprasellar meningiomas present unique challenges for endoscopic trans-nasal excision regarding instrument manipulation, tumor removal, and defect closure to prevent cerebrospinal fluid (CSF) leaks.
Purpose of the Study:
- To evaluate the efficacy of trans-nasal endoscopic surgery for radical resection of suprasellar meningiomas.
- To compare outcomes with traditional transcranial approaches.
Main Methods:
- Retrospective review of 12 suprasellar meningioma cases treated over 14 years.
- Analysis of surgical approaches including primary extended endoscopic trans-sphenoidal surgery, management of residual/recurrent tumors after transcranial surgery, and combined approaches.
Main Results:
- All patients experienced visual improvement and headache resolution.
- No CSF leaks requiring further repair were observed.
- One transient case of Syndrome of Inappropriate Antidiuretic Hormone (SIADH) was managed successfully.
Conclusions:
- Trans-nasal endoscopic surgery is effective for suprasellar meningiomas, yielding comparable tumor excision results to transcranial surgery.
- Superior visual outcomes and significantly reduced CSF leak rates were achieved using vascularized flaps.
- Individual case assessment is crucial, considering tumor extension and carotid artery involvement.
