Endoscopic Endonasal Transsphenoidal Surgery de Enrico de Divitiis

Endoscopic Endonasal Transsphenoidal Surgery

Enrico de Divitiis

Paolo Cappabianca

Currently, surgical management provides the definitive treatment of choice for most pituitary adenomas, craniopharyngiomas and meningiomas of the sellar region. The elegant minimally invasive transnasal endoscopic approach to the sella turcica and the anterior skull base has added a new dimension of versatility to pituitary surgery and can be adapted to many lesions in the region. In this multi-author book with numerous color illustrations the main aspects of the endonasal endoscopic approach to the skull base are presented, starting with a clear description of the endoscopic anatomy, the panoramic view afforded by the endoscope and the development of effective instruments and adjuncts. After the diagnostic studies, the strictly surgical features are considered in detail. The standard technique is described and particular aspects are treated, including the new extended approaches to the cavernous sinus, spheno-ethmoid planum and clival regions.

Citește tot Restrânge

Cuprins

1. Evolution of transsphenoidal surgerya.- 2. The endoscope, endoscopic equipment and instrumentation.- 2.1 The endoscope.- 2.2 Endoscopic equipment.- 2.3 Surgical instruments for endoscopic endonasal pituitary surgery.- 3. Endoscopic anatomy along the transnasal approach to the pituitary gland and the surrounding structures.- 3.1 Nasal cavity.- 3.2 Sphenoid sinus.- 3.3 Ethmoid labyrinth (complex).- 3.4 Sellar region.- 3.5 Suprasellar region.- 3.6 Parasellar region.- 3.7 Retrosellar - retroclival region.- 4. The role of the endocrinologist.- 4.1 PRL-secreting pituitary adenomas: is there still a role for neurosurgery?.- 4.2 GH-secreting pituitary adenomas: the dilemma on the primary therapy.- 4.3 TSH-secreting pituitary adenomas: the usefulness of somatostatin analog therapy.- 4.4 ACTH-secreting pituitary adenomas: a challenge for neurosurgeons, endocrinologists and radiotherapists.- 4.5 Clinically nonfunctioning pituitary adenomas: is there any new on pharmacotherapy?.- 5. The role of the neuroradiologist.- 5.1 Identification of the lesion.- 5.2 Follow-up after medical therapy.- 5.3 Pre-surgical planning.- 5.4 Post-surgical follow-up.- 6. The role of the ophthalmologist.- 6.1 Visual field defects.- 6.2 Reduced visual acuity.- 6.3 VEP abnormalities.- 6.4 Dischromatopsy.- 6.5 Eye motility impairment.- 7. Endoscopic endonasal transsphenoidal approach to the sellar region.- 7.1 Indications.- 7.2 Surgical planning.- 7.3 Operating theatre.- 7.4 Surgical procedure.- 7.5 Results & complications.- 7.6 Advantages & problems of the endoscopic technique.- 8. The role of the anesthesiologist.- 8.1 Anesthetic management, patient positioning and operating room set-up.- 9. Extended endoscopic approaches to the skull base Anterior Cranial Base CSF leaks.- 9.1 Anterior Cranial Base CSFleaks.- 9.2 Approach to the cavernous sinus.- 9.3 Extended endoscopic endonasal transsphenoidal approaches to the suprasellar region, planum sphenoidale & clivus.- 10. The role of the neuropathologist.- 11. Conclusions.