Surgery of Pituitary Neoplasms:

Endovideomonitoring in Transsphenoidal Surgery of Pituitary Neoplasms

V.Yu. Cherebillo, V.R. Gofman, A.V. Polezhaev, V.A. Manukovsky

Chair of Neurosurgery, Medicomilitary Academy, Saint Petersburg, Russia

Introduction

Striving for total selective removal of adenoma and a smaller rate of intraoperative damage of the cavernous sinuses, optic nerves and sella diaphragm has led to use of endoscopic devices, applied earlier only in transsphenoidal interventions for diseases of accessory sinuses [1,4,6,9].

Obtained results are indicative of such main advantages of the method, as a panoramic view of the sphenoid sinus cavity, precise differentiation of neoplastic and intact tissue of the pituitary body, early diagnosis and elimination of liquorrhea. Rigid and fiber endoscopes, having different diameters and angular views, are used at various stages of an operation both in combination with a surgery microscope and without it. In contrast to a limited tubular examination with a microscope, an optic system of an endoscope with a lateral and retrograde view of 0-120^o allows to examine supra- and retrosellar structures, to identify extrasellar areas of a tumor and to perform radical removal of adenoma with maximum preservation of intact adenohypophyseal tissue [3,5,8].

Today endoscopic systems are used widely. Endoscopic videomonitoring in a transseptal transsphenoidal approach to the pituitary gland is not only possible, but also expedient, as this method permits to visualize main anatomic landmarks of the sphenoid sinus in a panoramic examination of its cavity and to ensure optimum access to the saddle fundus and structures [2,7,8].

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