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Journal of Neurosurgery
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July 1997 / Vol. 87 / No. 1 / Pages 44-51
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CLINICAL ARTICLES
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Endoscopic endonasal transsphenoidal surgery: experience with 50 patients
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Hae-Dong Jho, M.D., Ph.D., and Ricardo L. Carrau, M.D.
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3 An endoscope was used in transsphenoidal surgery and By Keywords: chordoma, eventually replaced the operating microscope as the tool for craniopharyngioma, Cushing's visualization. This study focuses on 50 patients (28 females disease, endoscopy, pituitary and 22 males) with a median age of 38 years (range 14–88 tumor, prolactinoma, years). Initially, four patients underwent operation via a transsphenoidal approach sublabial—transseptal approach using a rigid endoscope in conjunction with an operating microscope. The 48 subsequent operations were performed through a nostril using only rigid endoscopes. Forty-four patients had pituitary adenomas and six had various other lesions. Thirteen patients had microadenomas, 16 had intrasellar macroadenomas, nine had macroadenomas with suprasellar extension, and six had invasive macroadenomas involving the cavernous sinus. Seven patients had recurrent pituitary adenomas and 25 had hormonesecreting adenomas (eight patients with Cushing's disease and 17 patients with prolactinomas). Among the eight patients with Cushing's disease, seven had resolution of hypercortisolism clinically and chemically. Of the 17 patients with prolactinomas, 10 improved clinically with normal serum prolactin levels, four improved clinically with elevated serum prolactin levels, and three had residual tumors in the cavernous sinus. Among the 19 patients with nonsecreting adenomas, 16 underwent total resection and three subtotal resection leaving residual tumor in the cavernous sinus. Postoperatively, all patients who had undergone endonasal endoscopic surgery had unobstructed nasal airways with minimal discomfort. More than half of the patients required only an overnight hospitalization.
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Address reprint requests to: Hae-Dong Jho, M.D., Ph.D., Department of Neurological Surgery, Presbyterian University Hospital, Suite B-400, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213.
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Enrico de Divitiis, Paolo Cappabianca, Luigi M. Cavallo, Felice Esposito, Oreste de Divitiis, Andrea Messina. (2007) EXTENDED ENDOSCOPIC TRANSSPHENOIDAL APPROACH FOR EXTRASELLAR CRANIOPHARYNGIOMAS. Operative Neurosurgery 61, 219-228. . Online publication date: 1-Nov-2007. [Crossref] 247. Enrico de Divitiis, Luigi M. Cavallo, Felice Esposito, Lucio Stella, Andrea Messina. (2007) EXTENDED ENDOSCOPIC TRANSSPHENOIDAL APPROACH FOR TUBERCULUM SELLAE MENINGIOMAS. Operative Neurosurgery 61, 229-238. . Online publication date: 1Nov-2007. [Crossref] 248. Wei Hong Jiang, Jian Yun Xiao, Su Ping Zhao, Zhi Hai Xie, Hua Zhang. (2007) Resection of extensive sellar tumors with extended endoscopic transseptal transsphenoidal approach. European Archives of Oto-Rhino-Laryngology 264:11, 1301-1308. . Online publication date: 27-Sep-2007. [Crossref] 249. Dimitris G. Placantonakis, Abtin Tabaee, Vijay K. Anand, David Hiltzik, Theodore H. Schwartz. (2007) SAFETY OF LOW-DOSE INTRATHECAL FLUORESCEIN IN ENDOSCOPIC CRANIAL BASE SURGERY. Operative Neurosurgery 61, 161-166. . Online publication date: 1-Sep-2007. [Crossref] 250. Luigi M. Cavallo, Oreste de Divitiis, Salih Aydin, Andrea Messina, Felice Esposito, Giorgio Iaconetta, Kiris Talat, Paolo Cappabianca, Manfred Tschabitscher. (2007) EXTENDED ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL APPROACH TO THE SUPRASELLAR AREA. Operative Neurosurgery 61, 24-34. . Online publication date: 1-Sep-2007. [Crossref] 251. L. R. Barzaghi, M. Losa, M. Giovanelli, P. Mortini. (2007) Complications of transsphenoidal surgery in patients with pituitary adenoma: experience at a single centre. Acta Neurochirurgica 149:9, 877-886. . Online publication date: 1-Sep-2007. [Crossref] 252. J GONG, G MOHR, J VEZINA. (2007) Experimental image-guided endoscopic pituitary surgery: A useful learning model. Journal of Clinical Neuroscience 14:8, 758-763. . Online publication date: 1-Aug-2007. [Crossref] 253. Masahiko Kitano, M.D., Mamoru Taneda, M.D., and Yuzo Nakao, M.D. 1Departments of Neurosurgery and 2Ophthalmology, Kinki University School of Medicine, Osaka, Japan . (2007) Postoperative improvement in visual function in patients with tuberculum sellae meningiomas: results of the extended transsphenoidal and transcranial approaches. Journal of Neurosurgery 107:2, 337-346. . Online publication date: 1-Aug-2007. Abstract | Full Text | PDF (2933 KB) 254. Rodrigo de Paula Santos, Samuel Tau Zymberg, Júlio Zaki Abucham Filho, Luis Carlos Gregório, Luc Louis Maurice Weckx, , , , . (2007) Acesso endoscópico transnasal aos tumores selares. Revista Brasileira de Otorrinolaringologia 73:4, 463-475. . Online publication date: 1-Aug-2007. [Crossref] 255. Rodrigo de Paula Santos, Samuel Tau Zymberg, Júlio Zaki Abucham Filho, Luis Carlos Gregório, Luc Louis Maurice Weckx. (2007) Endoscopic transnasal approach to sellar tumors. Brazilian Journal of Otorhinolaryngology 73:4, 463-475. . 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(2007) Expanded endonasal approach: a fully endoscopic completely transnasal resection of a skull base arteriovenous malformation. Child's Nervous System 23:5, 491-498. . Online publication date: 5-Apr-2007. [Crossref] 260. D SETHI, K KUMAR. (2007) Endoscopic pituitary surgery. Operative Techniques in Otolaryngology-Head and Neck Surgery 18:1, 57-64. . Online publication date: 1-Mar-2007. [Crossref] 261. Ilya Laufer, M.D., Vijay K. Anand, M.D., and Theodore H. Schwartz, M.D. 1Departments of Neurological Surgery and 2Otolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York . (2007) Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. Journal of Neurosurgery 106:3, 400-406. . Online publication date: 1-Mar-2007. Abstract | Full Text | PDF (809 KB) 262. Amin Kassam, M.D., Ajith J. Thomas, M.D., Carl Snyderman, M.D., Ricardo Carrau, M.D., Paul Gardner, M.D., Arlan Mintz, M.D., Hilal Kanaan, M.D., Michael Horowitz, M.D., and Ian F. Pollack, M.D.. (2007) Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients. Journal of Neurosurgery: Pediatrics 106:2, 75-86. . Online publication date: 1-Feb-2007. Abstract | Full Text | PDF (3732 KB) 263. J. Honegger, U. Ernemann, T. Psaras, B. Will. (2007) Objective criteria for successful transsphenoidal removal of suprasellar nonfunctioning pituitary adenomas. A prospective study. Acta Neurochirurgica 149:1, 21-29. . Online publication date: 14-Jan-2007. [Crossref] 264. Domenico Solari, M.D., Francesco Magro, M.D., Paolo Cappabianca, M.D., Luigi M. Cavallo, M.D., Ph.D., Amir Samii, M.D., Ph.D., Felice Esposito, M.D., Vincenzo Paternò, M.D., Enrico de Divitiis, M.D., and Madjid Samii, M.D., Ph.D. 1 Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di
Napoli Federico II, Naples, Italy and 2 International Neuroscience Institute, Division of Neurosurgery, Hannover, Germany
. (2007) Anatomical study of the pterygopalatine fossa using an endoscopic endonasal approach: spatial relations and distances between surgical landmarks. Journal of Neurosurgery 106:1, 157-163. . Online publication date: 1-Jan-2007. Abstract | Full Text | PDF (1412 KB) 265. Enrico de Divitiis, Luigi Maria Cavallo, Paolo Cappabianca, Felice Esposito. (2007) Extended Endoscopic Endonasal Transsphenoidal Approach Forthe Removalof Suprasellartumors: PART 2. Neurosurgery 60:1, 46-59. . Online publication date: 1-Jan2007. [Crossref] 266. Yoshiyasu Iwai, Kouji Yamada, Kazuhiro Yamanaka, Kazuhito Nakamura, Tomoya Ishiguro, Masaki Komiyama, Toshihiro Yasui. (2007) The Experience of Bilateral Endonasal Tarnssphenoidal Approach with the Collaboration of Otolaryngologists for Pituitary Tumors(SURGICAL TECHNIQUES and PERIOPERATIVE MANAGEMENT). Japanese Journal of Neurosurgery 16:9, 712-716. . Online publication date: 1-Jan-2007. [Crossref] 267. Koc Kenan, Anik İhsan, Ozdamar Dilek, Cabuk Burak, Keskin Gurkan, Ceylan Savas. (2006) The learning curve in endoscopic pituitary surgery and our experience. Neurosurgical Review 29:4, 298-305. . Online publication date: 1-Oct-2006. [Crossref] 268. Ritvik P. Mehta, Roberto A. Cueva, J. Dale Brown, Dan M. Fliss, Ziv Gil, Amin B. Kassam, Christopher H. Rassekh, Rodney J. Schlosser, Carl H. Snyderman, Gady Har-El. (2006) What's New in Skull Base Medicine and Surgery? Skull Base Committee Report. Otolaryngology-Head and Neck Surgery 135:4, 620-630. . Online publication date: 1-Oct2006. [Crossref] 269. Giorgio Frank, Ernesto Pasquini, Francesco Doglietto, Diego Mazzatenta, Vittorio Sciarretta, Giovanni Farneti, Fabio Calbucci. (2006) The Endoscopic Extended Transsphenoidal Approach for Craniopharyngiomas. Operative Neurosurgery 59, ONS-75-ONS-83. . Online publication date: 1-Jul-2006. [Crossref] 270. Alberto Pierallini, Francesca Caramia, Carlo Falcone, Emanuele Tinelli, Amalia Paonessa, Alessia Bernardo Ciddio, Marco Fiorelli, Federico Bianco, Stefania Natalizi, Luigi Ferrante, Luigi Bozzao. (2006) Pituitary Macroadenomas: Preoperative Evaluation of Consistency with Diffusion-weighted MR Imaging—Initial Experience. Radiology 239:1, 223-231. . Online publication date: 1-Apr-2006. [Crossref] 271. Jay Jagannathan, M.D., Daniel M. Prevedello, M.D., Vivek S. Ayer, Aaron S. Dumont, M.D., John A. Jane Jr., M.D., and Edward R. Laws, M.D.. (2006) Computer-assisted frameless stereotaxy in transsphenoidal surgery at a single institution: review of 176 cases. Neurosurgical Focus 20:2, 1-6. . Online publication date: 1-Feb-2006. Abstract | PDF (509 KB) | PDF Plus (525 KB) 272. Theodore H. Schwartz, Phillip E. Stieg, Vijay K. Anand. (2006) Endoscopic Transsphenoidal Pituitary Surgery with Intraoperative Magnetic Resonance Imaging. Operative Neurosurgery 58, ONS-44-ONS-51. . 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(2006) Valor predictivo de la clasificación de Knosp en el grado de resección quirúrgica de los macroadenomas invasivos. Estudio prospectivo de una serie de 23 casos. Neurocirugía 17:6, 519-526. . Online publication date: 1-Jan-2006. [Crossref] 277. Francesco Doglietto, M.D., Daniel M. Prevedello, M.D., John A. Jane Jr., M.D., Joseph Han, M.D., and Edward R. Laws Jr., M.D.. (2005) A brief history of endoscopic transsphenoidal surgery—from Philipp Bozzini to the First World Congress of Endoscopic Skull Base Surgery. Neurosurgical Focus 19:6, 1-6. . Online publication date: 1-Dec-2005. Abstract | PDF (1235 KB) | PDF Plus (1281 KB) 278. John A. Jane Jr., M.D., Joseph Han, M.D., Daniel M. Prevedello, M.D., Jay Jagannathan, M.D., Aaron S. Dumont, M.D., and Edward R. Laws Jr., M.D.. (2005) Perspectives on endoscopic transsphenoidal surgery. Neurosurgical Focus 19:6, 1-10. . Online publication date: 1-Dec-2005. Abstract | PDF (3841 KB) | PDF Plus (3857 KB) 279. Edwin Cunningham, Marc Mayberg. 2005. Transphenoidal Hypohysectomy. ComputerAssisted Neurosurgery, 209-220. [Crossref] 280. C Arturo Solares, Samer Fakhri, Pete S. Batra, Joung Lee, Donald C. Lanza. (2005) Transnasal Endoscopic Resection of Lesions of the Clivus: A Preliminary Report. The Laryngoscope 115:11, 1917-1922. . Online publication date: 1-Nov-2005. [Crossref] 281. Mohamed S Kabil, Joseph B Eby, Hrayr K Shahinian. (2005) Fully Endoscopic Transnasal Versus Transseptal Transphenoidal Pituitary Surgery. Neurosurgery Quarterly 15:3, 190196. . Online publication date: 1-Sep-2005. [Crossref] 282. Amin Kassam, M.D., Carl H. Snyderman, M.D., Arlan Mintz, M.Sc., M.D., Paul Gardner, M.D., and Ricardo L. Carrau, M.D.. (2005) Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurgical Focus 19:1, 1-12. . Online publication date: 1-Jul-2005. Abstract | PDF (4887 KB) | PDF Plus (4898 KB) 283. Luigi M. Cavallo, M.D., Ph.D., Andrea Messina, M.D., Paul Gardner, M.D., Felice Esposito, M.D., Amin B. Kassam, M.D., Paolo Cappabianca, M.D., Enrico de Divitiis, M.D., and Manfred Tschabitscher, M.D.. (2005) Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations. Neurosurgical Focus 19:1, 1-7. . Online publication date: 1-Jul-2005. Abstract | PDF (5443 KB) | PDF Plus (5454 KB) 284. Joseph C. Maroon, M.D.. (2005) Skull base surgery: past, present, and future trends. Neurosurgical Focus 19:1, 1-4. . Online publication date: 1-Jul-2005. Abstract | PDF (81 KB) | PDF Plus (108 KB) 285. Takakazu Kawamata, Osami Kubo, Tomokatsu Hori. (2005) Surgical removal of growth hormone-secreting pituitary adenomas with intensive microsurgical pseudocapsule resection results in complete remission of acromegaly. Neurosurgical Review 28:3, 201208. . Online publication date: 1-Jul-2005. [Crossref] 286. Erik J. van Lindert, J André Grotenhuis. (2005) New Endoscope Shaft for Endoscopic Transsphenoidal Pituitary Surgery. Operative Neurosurgery 57, 203-206. . Online publication date: 1-Jul-2005. [Crossref] 287. Jay Jagannathan, M.D., Aaron S. Dumont, M.D., John A. Jane Jr., M.D., and Edward R. Laws Jr., M.D.. (2005) Pediatric sellar tumors: diagnostic procedures and management. Neurosurgical Focus 18:6, 1-5. . Online publication date: 1-Jun-2005. Abstract | PDF (113 KB) | PDF Plus (155 KB) 288. Giuseppe Cinalli, Paolo Cappabianca, Raffaele de Falco, Pietro Spennato, Emilio Cianciulli, Luigi Maria Cavallo, Felice Esposito, Claudio Ruggiero, Giuseppe Maggi, Enrico de Divitiis. (2005) Current state and future development of intracranial neuroendoscopic surgery. Expert Review of Medical Devices 2:3, 351-373. . Online publication date: 1-May-2005. [Crossref] 289. Adam S. Kanter, M.D., Aaron S. Dumont, M.D., Ashok R. Asthagiri, M.D., Rod J. Oskouian, M.D., John A. Jane Jr., M.D., and Edward R. Laws Jr., M.D.. 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Paolo Cappabianca, Luigi Maria Cavallo, Felice Esposito, Enrico Divitiis. (2004) Endoscopic endonasal transsphenoidal surgery: procedure, endoscopic equipment and instrumentation. Child's Nervous System 20:11-12, 796-801. . Online publication date: 1-Nov-2004. [Crossref] 298. Charles Y. Liu, Michael Y. Wang, Michael L. J. Apuzzo. (2004) The physics of image formation in the neuroendoscope. Child's Nervous System 20:11-12, 777-782. . Online publication date: 1-Nov-2004. [Crossref] 299. Akio Morita, Yoshikazu Okada, Masahiko Kitano, Tomokatsu Hori, Mamoru Taneda, Takaaki Kirino. (2004) Development of Hybrid Integrated Endoscope-holder System for Endoscopic Microneurosurgery. Neurosurgery, 926-932. . Online publication date: 1-Oct-2004. [Crossref] 300. John A Jane, Aaron S Dumont, Jason P Sheehan, Edward R Laws. (2004) Surgical techniques in transsphenoidal surgery: what is the standard of care in pituitary adenoma surgery?. Current Opinion in Endocrinology & Diabetes 11:5, 264-270. . 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[Crossref] 305. Ryuta Suzuki, M.D., Jun-ichiro Asai, M.D., Goro Nagashima, M.D., Hiroshi Itokawa, M.D., Chih-Wei Chang, M.D., Masayuki Noda, M.D., Michio Fujimoto, M.D., and Tsukasa Fujimoto, M.D.. (2004) Transcranial echo-guided transsphenoidal surgical approach for the removal of large macroadenomas. Journal of Neurosurgery 100:1, 68-72. . Online publication date: 1Jan-2004. Abstract | Full Text | PDF (297 KB) 306. James K. Liu, M.D., Richard R. Orlandi, M.D., Ronald I. Apfelbaum, M.D., and William T. Couldwell, M.D., Ph.D.. (2004) Novel closure technique for the endonasal transsphenoidal approach. Journal of Neurosurgery 100:1, 161-164. . Online publication date: 1-Jan-2004. Abstract | Full Text | PDF (153 KB) 307. E. J. van Lindert, J. A. Grotenhuis, T. Beems. (2004) The use of a head-mounted display for visualization in neuroendoscopy. Computer Aided Surgery 9:6, 251-256. . Online publication date: 1-Jan-2004. [Crossref] 308. R ABBOTT. (2004) History of neuroendoscopy. 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Abstract | Full Text | PDF (127 KB) 312. A. Díaz, M. Armengot, J.R. Alba, J.A. Barcia, J. Basterra. (2003) Abordajes transnasales para los tumores de región hipofisaria. nuestra experiencia. Acta Otorrinolaringológica Española 54:6, 419-424. . Online publication date: 1-Jan-2003. [Crossref] 313. James K Liu, Martin H Weiss, William T Couldwell. (2003) Surgical approaches to pituitary tumors. Neurosurgery Clinics of North America 14:1, 93-107. . Online publication date: 1Jan-2003. [Crossref] 314. P SINGER, L SEVILLA. (2003) Postoperative endocrine management of pituitary tumors. Neurosurgery Clinics of North America 14:1, 123-138. . Online publication date: 1-Jan-2003. [Crossref] 315. Masahiro Shin, Hiroki Kurita, Takaaki Kirino. (2003) Gamma Knife Radiosurgery for Pituitary Adenomas. Japanese Journal of Neurosurgery 12:5, 337-342. . Online publication date: 1Jan-2003. [Crossref] 316. Hae-Dong Jho. (2002) Endoscopic transsphenoidal tumor surgery. Operative Techniques in Neurosurgery 5:4, 218-225. . Online publication date: 1-Dec-2002. [Crossref] 317. Alessandra Alfieri, M.D., Raffaele Schettino, M.D., Angelo Taborelli, M.D., Maurizio Pontiggia, M.D., Paolo Reganati, M.D., Valerio Ballarini, M.D., and Luigi Monolo, M.D.. (2002) Endoscopic endonasal treatment of a spontaneous temporosphenoidal encephalocele with a detachable silicone balloon. Journal of Neurosurgery 97:5, 12121216. . Online publication date: 1-Nov-2002. Abstract | Full Text | PDF (193 KB) 318. A TERAMOTO. (2002) Section 4. PituitaryContemporary transsphenoidal surgery for pituitary adenomas with emphasis on complications. Biomedecine & Pharmacotherapy 56, 154-157. . Online publication date: 1-Nov-2002. [Crossref] 319. A KUROKI. (2002) Section 4. PituitaryEndoscopic approach to the pituitary lesions: Contemporary method and review of the literature. Biomedecine & Pharmacotherapy 56, 158-164. . Online publication date: 1-Nov-2002. [Crossref] 320. Roy F. 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