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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
The Use of Micro Retractor in Endoscopic Endonasal Posterior Pseudocapsule Resection of Pituitary Macroadenoma.
Tao Xie1, Xiaobiao Zhang1,2,3, Chenghui Qu1
1Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Background:
The endoscopic endonasal approach and extra-pseudocapsule resection may be the main progress in modern pituitary surgery. However, for pituitary macroadenomas, discerning the pseudocapsule in the posterior plane of the tumor may be difficult. When the anterior-inferior debulking is performed, the early subsidence of the thinning normal pituitary gland and enlarged diaphragm may obstruct the surgical dissection view.
Method:
We describe the technique of using a micro retractor for the endoscopic endonasal posterior pseudocapsule resection of pituitary macroadenomas. This micro retractor that was 2 mm in width was placed at the 12 o'clock position on the nostrils, and the end was fixed in the flexible arms of the self-retaining retractor system. The head of the micro retractor elevated the herniated diaphragm sellae in order to continue the posterior pseudocapsule resection of the pituitary macroadenoma.
Result:
The technique was performed very easily and no complication was observed.
Conclusion:
The use of this micro retractor can increase the view of the posterior margin of the adenomas to facilitate the pseudocapsule dissection.
Insights
A novel micro retractor enhances endoscopic endonasal surgery for pituitary macroadenomas by improving visualization of the pseudocapsule, facilitating safer and more effective tumor resection.
Area of Science:
- Neurosurgery
- Endoscopic Surgery
- Pituitary Adenoma Research
Background:
- Modern pituitary surgery advances include endoscopic endonasal approaches and extra-pseudocapsule resection.
- Discerning the pseudocapsule in posterior pituitary macroadenomas can be challenging.
- Anterior-inferior debulking may obscure the surgical view due to gland subsidence and diaphragm changes.
Purpose of the Study:
- To describe a technique using a micro retractor for endoscopic endonasal posterior pseudocapsule resection of pituitary macroadenomas.
- To evaluate the efficacy and safety of this micro retractor in improving surgical access.
Main Methods:
- A 2 mm wide micro retractor was utilized.
- The retractor was positioned at the 12 o'clock position and secured with a self-retaining system.
- The micro retractor head elevated the herniated diaphragm sellae to aid posterior resection.
Main Results:
- The described technique was easily performed.
- No intraoperative or postoperative complications were observed.
- The micro retractor effectively improved the surgical view of the posterior margin.
Conclusions:
- The micro retractor facilitates clearer visualization of the adenoma's posterior margin.
- This improved view aids in precise pseudocapsule dissection during pituitary macroadenoma surgery.
- The technique offers a safe and effective method for enhancing endoscopic pituitary tumor resection.
