Neurosurgical Review

, Volume 31, Issue 1, pp 55–64 | Cite as

The role of the endoscope in the transsphenoidal management of cystic lesions of the sellar region

  • Luigi M. Cavallo
  • Daniel Prevedello
  • Felice Esposito
  • Edward R. LawsJr.
  • Joshua R. Dusick
  • Andrea Messina
  • John A. JaneJr.
  • Daniel F. Kelly
  • Paolo Cappabianca
Original Article

Abstract

Cystic mass lesions within the sella turcica are common, and they include cystic pituitary adenomas, craniopharyngiomas, Rathke’s cleft cysts, arachnoid cysts, and other entities. Until recently, such lesions were typically removed by a microsurgical transsphenoidal route. Given the increased use of the endoscope in transsphenoidal surgery, we evaluated the potential benefits of this tool in the treatment of such lesions. Between January 1997 and March 2005, 76 consecutive patients with sellar–suprasellar cystic lesions treated in three Neurosurgical Divisions underwent transsphenoidal removal in which the endoscope was used at least during the sellar step of the procedure (endoscope-assisted or fully endoscopic). The series consisted of 26 pituitary macroadenomas, 20 Rathke’s cleft cysts, 18 craniopharyngiomas, 10 arachnoid cysts, one craniopharyngioma associated with an adrenocorticotropic hormone-secreting adenoma, and one chordoid glioma. Rigid 4-mm endoscopes (0°, 30°, and/or 45°) were used, and the advantages and limits of the endoscope during the sellar step of the procedure were recorded. Endoscopic exploration after lesion evacuation was generally easier and of greatest efficacy when the residual cystic cavity was larger as opposed to smaller. The use of angled endoscopes was optimal in larger residual cavities. Early descent of the suprasellar cistern, bleeding inside the residual cyst cavity, and a small sella were the most common causes preventing thorough exploration of the residual cavity after its evacuation. In no cases did the endoscope cause injury during the sellar cavity exploration. Endoscopic exploration of the sellar cavity during transsphenoidal surgery offers both general and specific advantages in the treatment of a variety of different cystic sellar lesions. Its routine use during transsphenoidal surgery for such lesions is recommended to achieve maximal and safe tumor removal.

Keywords

Endoscope Arachnoid cyst Craniopharyngioma Pituitary adenoma Rathke’s cleft cyst Sellar cyst Transsphenoidal Endonasal surgery 

Notes

References

  1. 1.
    Alfieri A, Schettino R, Tarfani A, Bonzi O, Rossi GA, Monolo L (2002) Endoscopic endonasal removal of an intra-suprasellar Rathke’s cleft cyst: case report and surgical considerations. Minim Invasive Neurosurg 45:47–51PubMedCrossRefGoogle Scholar
  2. 2.
    Baskin DS, Wilson CB (1984) Transsphenoidal treatment of non-neoplastic intrasellar cysts. A report of 38 cases. J Neurosurg 60:8–13PubMedGoogle Scholar
  3. 3.
    Cappabianca P, Cavallo LM, de Divitiis E (2004) Endoscopic endonasal transsphenoidal surgery. Neurosurgery 55:933–940 (discussion 940–931)PubMedCrossRefGoogle Scholar
  4. 4.
    Carrau RL, Jho HD, Ko Y (1996) Transnasal-transsphenoidal endoscopic surgery of the pituitary gland. Laryngoscope 106:914–918PubMedCrossRefGoogle Scholar
  5. 5.
    Cohan P, Foulad A, Esposito F, Martin NA, Kelly DF (2004) Symptomatic Rathke’s cleft cysts: a report of 24 cases. J Endocrinol Invest 27:943–948PubMedGoogle Scholar
  6. 6.
    de Divitiis E, Cappabianca P, Cavallo LM (2003) Endoscopic endonasal transsphenoidal approach to the sellar region. In: de Divitiis E, Cappabianca P (eds) Endoscopic endonasal transsphenoidal surgery. Springer, New York, pp 91–130Google Scholar
  7. 7.
    de Divitiis E, Spaziante R, Stella L (1981) Empty sella and benign intrasellar cysts. In: Krayenbühl H (ed) Advances and technical standards in neurosurgery. Springer, New York, pp 3–74Google Scholar
  8. 8.
    el-Mahdy W, Powell M (1998) Transsphenoidal management of 28 symptomatic Rathke’s cleft cysts, with special reference to visual and hormonal recovery. Neurosurgery 42:7–16 (discussion 16–17)PubMedCrossRefGoogle Scholar
  9. 9.
    Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M (1999) Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 90:237–250PubMedGoogle Scholar
  10. 10.
    Frank G, Sciarretta V, Mazzatenta D, Farneti G, Modugno GC, Pasquini E (2005) Transsphenoidal endoscopic approach in the treatment of Rathke’s cleft cyst. Neurosurgery 56:124–128 (discussion 129)PubMedGoogle Scholar
  11. 11.
    Iqbal J, Kanaan I, Al Homsi M (1999) Non-neoplastic cystic lesions of the sellar region presentation, diagnosis and management of eight cases and review of the literature. Acta Neurochir (Wien) 141:389–397 (discussion 397–388)CrossRefGoogle Scholar
  12. 12.
    Jho HD, Carrau RL, Ko Y (1996) Endoscopic pituitary surgery. In: Wilkins H, Rengachary S (eds) Neurosurgical operative atlas. American Association of Neurological Surgeons, Park Ridge, pp 1–12Google Scholar
  13. 13.
    Kaptain GJ, Vincent DA, Sheehan JP, Laws ER Jr (2001) Transsphenoidal approaches for the extracapsular resection of midline suprasellar and anterior cranial base lesions. Neurosurgery 49:94–101PubMedCrossRefGoogle Scholar
  14. 14.
    Kern EB, Laws ER (1982) The rationale and technique of selective transsphenoidal microsurgery for the removal of pituitary tumors. In: Laws ER, Randall RV, Kern EB, Abboud CF (eds) Management of pituitary adenomas and related lesions with emphasis on transsphenoidal microsurgery. Aplleton-Century-Crofts, New YorkGoogle Scholar
  15. 15.
    Laws ER Jr (1980) Transsphenoidal microsurgery in the management of craniopharyngioma. J Neurosurg 52:661–666PubMedGoogle Scholar
  16. 16.
    Laws ER Jr (1994) Transsphenoidal removal of craniopharyngioma. Pediatr Neurosurg 21(Suppl 1):57–63PubMedCrossRefGoogle Scholar
  17. 17.
    Laws ER, Weiss MH, White WL (2003) Craniopharyngioma. Skull Base 13:55–58PubMedCrossRefGoogle Scholar
  18. 18.
    Locatelli D, Levi D, Rampa F, Pezzotta S, Castelnuovo P (2004) Endoscopic approach for the treatment of relapses in cystic craniopharyngiomas. Childs Nerv Syst 20:863–867PubMedCrossRefGoogle Scholar
  19. 19.
    Marks MP, Chee H, Liddell RP, Steinberg GK, Panahian N, Lane B (1994) A mechanically detachable coil for the treatment of aneurysms and occlusion of blood vessels. AJNR Am J Neuroradiol 15:821–827PubMedGoogle Scholar
  20. 20.
    Midha R, Jay V, Smyth HS (1991) Transsphenoidal management of Rathke’s cleft cysts. A clinicopathological review of 10 cases. Surg Neurol 35:446–454PubMedCrossRefGoogle Scholar
  21. 21.
    Oskouian RJ, Samii A, Laws ER Jr (2006) The craniopharyngioma. Front Horm Res 34:105–126PubMedGoogle Scholar
  22. 22.
    Saeki N, Tokunaga H, Hoshi S, Sunada S, Sunami K, Uchino F, Yamaura A (1999) Delayed postoperative CSF rhinorrhea of intrasellar arachnoid cyst. Acta Neurochir (Wien) 141:165–169CrossRefGoogle Scholar
  23. 23.
    Shin JL, Asa SL, Woodhouse LJ, Smyth HS, Ezzat S (1999) Cystic lesions of the pituitary: clinicopathological features distinguishing craniopharyngioma, Rathke’s cleft cyst, and arachnoid cyst. J Clin Endocrinol Metab 84:3972–3982PubMedCrossRefGoogle Scholar
  24. 24.
    Smith AR, Elsheikh TM, Silverman JF (1999) Intraoperative cytologic diagnosis of suprasellar and sellar cystic lesions. Diagn Cytopathol 20:137–147PubMedCrossRefGoogle Scholar
  25. 25.
    Spaziante R, de Divitiis E (1997) Drainage techniques for cystic craniopharyngiomas. Neurosurg Quart 7:183–208CrossRefGoogle Scholar
  26. 26.
    Spaziante R, de Divitiis E, Stella L, Cappabianca P, Donzelli R (1981) Benign intrasellar cysts. Surg Neurol 15:274–282PubMedCrossRefGoogle Scholar
  27. 27.
    Teo C (2005) Application of endoscopy to the surgical management of craniopharyngiomas. Childs Nerv Syst 21:696–700PubMedCrossRefGoogle Scholar
  28. 28.
    Van Effenterre R, Boch AL (2002) Craniopharyngioma in adults and children: a study of 122 surgical cases. J Neurosurg 97:3–11PubMedGoogle Scholar
  29. 29.
    Weber EL, Vogel FS, Odom GL (1970) Cysts of the sella turcica. J Neurosurg 33:48–53PubMedGoogle Scholar
  30. 30.
    Yoshida J, Kobayashi T, Kageyama N, Kanzaki M (1977) Symptomatic Rathke’s cleft cyst. Morphological study with light and electron microscopy and tissue culture. J Neurosurg 47:451–458PubMedCrossRefGoogle Scholar
  31. 31.
    Zada G, Kelly DF, Cohan P, Wang C, Swerdloff R (2003) Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions. J Neurosurg 98:350–358PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Luigi M. Cavallo
    • 1
  • Daniel Prevedello
    • 2
  • Felice Esposito
    • 1
  • Edward R. LawsJr.
    • 2
  • Joshua R. Dusick
    • 3
  • Andrea Messina
    • 1
  • John A. JaneJr.
    • 2
  • Daniel F. Kelly
    • 3
  • Paolo Cappabianca
    • 1
  1. 1.Department of Neurological Sciences, Division of NeurosurgeryUniversità degli Studi di Napoli Federico IINaplesItaly
  2. 2.Department of NeurosurgeryUniversity of VirginiaCharlottesvilleUSA
  3. 3.Department of NeurosurgeryUniversity of California at Los AngelesLos AngelesUSA

Personalised recommendations