Endoscopic Endonasal Transsphenoidal Removal of Pituitary Adenomas

D.V. Fomichev, P.L. Kalinin, B.A. Kadashev, Yu.K. Trunin, D.N. Kapitanov, S.N. Alekseev, M.A. Kutin, R.B. Faizullaev, A.N. Shkarubo, L.I. Astafyeva, O.F. Tropinskaya, I.A. Voronina, Yu.G. Sidneva

(Burdenko Research Institute of Neurosurgery, Moscow)

Since 2005 endoscopic endonasal transsphenoidal adenoectomy (EETA) has been used practically in all transnasal operations, performed in the Department of Surgery of Basal Tumors. The importance of an endoscope use in transsphenoidal surgery is conditioned by its field of view, which is not limited by a lens cell, as it happens in applying a microscope. It is the main advantage of EETA. Endoscopes with different view angles allow to visualize endo-, supra- and laterosellar structures under conditions of good illumination. It permits to reduce a risk of traumatizing important anatomic structures, to perform maximum radical removal, to diagnose intraoperative liquorrhea and to close a capsule defect. In contrast to conventional microscopic operations, when all manipulation in a narrow and deep wound are made by a surgeon, endoscopic removal gives a chance of “playing duets”. This method does not demand use of nasal dilators, conventional incisions of mucosa and postoperative tamponade of a nasal cavity. Thus, it is less traumatic in comparison with a standard transsphenoidal procedure and is endured by a patient more easily. This method allows to reduce duration of a restorative period and hospitalization duration (from 8 up to 4 days).

We have developed main algorithms of pre- and postoperative treatment, all stages of operation and the way of hermetic closure of the saddle cavity, including experimental technologies.

Introduction of endoscopic technique permits to widen indications for a transsphenoidal approach. Today it is possible to remove pituitary adenomas in the absence of marked saddle dilation, in considerable deviation of a suprasellar node from the saddle entrance, in case of tumor spread into the cavernous sinus and multiple nodes.