V.Yu. Cherebillo, V.R. Gofman, A.V. Polezhaev
(Faculty of Neurosurgery, Medicomilitary Academy, Saint Petersburg)
Use of endoscopic technique is conditioned by necessity to perform total selective removal of adenomas and to reduce a rate of intraoperative damage of cavernous sinuses, optic nerves and the saddle diaphragm. Specialists of the Clinic of Neurosurgery of the Medicomilitary Academy have gained a rather great experience in surgery of pituitary adenomas with a transnasosphenoidal endoscopic approach (1010 operations, performed during the last years).
Endoscopes with an angular view allow to widen indications for a transsphenoidal approach and to remove adenomas with different versions of growth, including giant tumors. The obtained experience has shown, that minimum-invasive interventions can be made in more than 95% of cases with pituitary adenomas. Thus, highly invasive giant tumors with numerous nodes are the only object of transcranial surgery.
The data of postoperative MRI examinations of the chiasm-sellar region and analysis of arrested visual and hormonal disorders make it possible to state, that transsphenoidal endoscopic surgery gives quite acceptable results (operation efficacy - 87.2% of cases, regression of visual and hormonal disorders – 89.35% and 82.9% of cases respectively, the mortality rate 0.37%).
Further improvement of surgical technique and high skills of a surgeon will permit to improve postoperative results, to ensure a “functional” character of an operation and to arrest both visual and hormonal disorders even in case of giant tumors.