Endoscopic pituitary surgery
The microsurgical transsphenoidal approach to the sella turcica is a safe and reliable technique for experienced neurosurgeons and is often used today to treat pituitary lesions. Transsphenoidal endoscopic intervention is a further development of this method and provides:
- better conditions for observing the patient's anatomy
- reduction of surgical trauma
- better tolerance of the consequences of operations
- reducing the number of possible surgical complications
The intervention is performed through the endonasal route using a rigid diagnostic endoscope, which serves as the only observation tool. The endoscope is inserted into one of the nostrils without using a transsphenoidal retractor. All other instruments pass through the guiding endoscope and can move simultaneously in any direction.
As is customary in otolaryngology, during operations, the endoscope is in one, not the leading hand, but the required surgical instrument in the other, or the endoscope is fixed with a holder, thereby freeing the surgeon's hands. The latter method is widespread in neurosurgery and, in our opinion, deserves a recommendation.
Expansion of the sphenoid sinus up to 15-20 mm in diameter is of decisive importance for sufficient freedom of movement of instruments in the operating field, due to which a wide operating angle is created: it extends from the top of the sphenoethmoidal region down to the lower part of the clivus and is laterally bounded by an optical protrusion on the one hand and the protrusion of the carotid artery on the other. An opto-carotid depression with an anterior wedge-shaped process on the opposite side is located between them.
To carry out this neurosurgical intervention, it is necessary to use special instruments, since the optics and instruments have a very wide working angle; on the other hand, the operation is performed in a very limited space due to the absence of the expansive effect of the transsphenoidal retractor. This means that not all areas visible with an endoscope are accessible without the use of specially provided instruments for such cases, which ensure ease, reliability, and speed of surgical intervention.