Endoscopic Endonasal Transsphenoidal Approach Through the Bilateral Nostrils for Pituitary Adenomas
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概要
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The endoscopic endonasal transsphenoidal approach through the bilateral nostrils was evaluated for the treatment of pituitary adenoma. The surgical approach is through the bilateral nostrils via minimal or wide dissection of the septal mucosa, depending on the degree of tumor extension. After anterior sphenoidotomy, the endoscope is fixed in one nostril and required instrumentation is inserted in either nostril. In addition, neuronavigation and real-time hormone monitoring are used. Tumor removal rate, endocrinological outcomes, and complications were retrospectively assessed in 194 patients with pituitary adenomas who underwent 213 procedures between December 2001 and March 2008. Greater than 95% resection was achieved in 74 of 131 nonfunctioning adenomas, and the removal rate was significantly higher during 2005-2008 compared to 2002-2004 (p<0.05). Endocrinological remission was achieved in 20 of 26 growth hormone-secreting tumors of Knosp grades 0-2, 16 of 17 microprolactinomas, and 6 of 9 cases of pure Cushing's disease. Postoperative complications were cerebrospinal fluid leakage in 9 cases, visual worsening in 5, anterior pituitary insufficiency in 5, and permanent diabetes insipidus in 2. The bilateral endonasal approach provides a wide working area without the need for special instrumentation. By modifying mucosal dissection, the endoscopic approach provides flexibility and less invasiveness. The use of neuronavigation or intraoperative hormone monitoring leads to improved surgical results. The present study confirms that this approach is suitable for more extensive sellar tumors.
- 社団法人日本脳神経外科学会の論文
- 2009-01-15
著者
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Nakamura Hideo
Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
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Kai Yutaka
Department Of Neurosurgery University Of The Ryukyu Faculty Of Medicine
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Kai Yutaka
Department Of Neurosurgery Kumamoto University Medical School
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KURATSU Jun-ichi
Department of Neurosurgery, Kumamoto University Medical School
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YANO Shigetoshi
Department of Neurosurgery, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University Grad
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KAWANO Takayuki
Department of Neurosurgery, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University Grad
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KUDO Mareina
Department of Neurosurgery, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University Grad
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MAKINO Keishi
Department of Neurosurgery, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University Grad
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MORIOKA Motohiro
Department of Neurosurgery, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University Grad
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Kuratsu Jun-ichi
Department Of Neurosurgery Faculty Of Medical And Pharmaceutical Sciences Kumamoto University Gradua
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Kudo Mareina
Department Of Neurosurgery Faculty Of Medical And Pharmaceutical Sciences Kumamoto University Gradua
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Makino Keishi
Department Of Neurosurgery Faculty Of Medical And Pharmaceutical Sciences Kumamoto University Gradua
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Kuratsu Jun-ichi
Department Of Neurosurgery Graduate School Of Medical Sciences Kumamoto University
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Kuratsu Jun-ichi
Department Of Neurosurgery Faculty Of Medical And Pharmaceutical Sciences Kumamoto University
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Kuratsu Jun-ichi
Department Of Neurosurgery Kumamoto University School Of Medicine
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Kawano Takayuki
Department Of Neurosurgery Faculty Of Medical And Pharmaceutical Sciences Kumamoto University Gradua
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Kawano Takayuki
Department Of 2nd Oral Surgery Osaka University Dental School
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Kuratsu Jun-ichi
Department Of Neurosurgery Shimonoseki Kosei Hospital
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Yano Shigetoshi
Department Of Neurosurgery Faculty Of Medical And Pharmaceutical Sciences Kumamoto University Gradua
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Yano Shigetoshi
Department Of Neurosurgery Kumamoto University School Of Medicine
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Morioka Motohiro
Department Of Neurosurgery Faculty Of Medical And Pharmaceutical Sciences Kumamoto University Gradua
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Nakamura Hideo
Department Of Cardiovascular Medicine Kyoto Prefectural University Of Medicine
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Yano Shigetoshi
Department Of Diagnostic Radiology Graduate School Of Medical Sciences Kumamoto University
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Shigematsu Yoshinori
Department Of Radiology Kumamoto University School Of Medicine
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Nakamura Hideo
Department Of Neurosurgery Graduate School Of Medical Sciences Kumamoto University
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Nakamura Hideo
Department Of Cardiology Kyoto Prefectural Yosanoumi Hospital
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Kai Yutaka
Department Of Neurosurgery Graduate School Of Medical Sciences Kumamoto University
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Kuratsu Jun-ichi
Department Of Neurosurgery Faculty Of Medical And Pharmaceutical Sciences Kumamoto University Gradua
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Kai Yutaka
Department Of Cerebrovascular Disease And Acute Coronary Syndrome Kumamoto University
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Post Kalmon
Mount Sinai School Of Medicine
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LUNSFORD L.
Neurological Surgery University of Pittsburgh Medical Center
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Kawano Takayuki
Departemtn of Neurorsurgery, Kumamoto University School of Medicine
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