Combined Hybrid Microscopic and Endoscopic Transsphenoidal Surgery: Anatomy, Instrumentation, and Technique
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Surgical management of pituitary tumors has evolved considerably since the first report by Victor Horsley in the early 1900s. Made largely possible by advancing technology, various approaches have been used including a lateral rhinotomy, sublabial, transcranial, and transnasal to name a few. Presently the transnasal approach is the most popular and has evolved to rely heavily upon the endoscope for visualization though historically it was the operating microscope that made the operation possible. The merits of endoscopic-transnasal versus microscopic-transnasal have been debated much like the clip-versus-coil debate for treatment of intracranial aneurysms. Similar to the vascular debate, no one instrument or technique is superior in all regards. This chapter describes the utility of a hybrid approach combining both endoscopic and microsurgical techniques which are used as individual circumstances dictate. As no single surgical approach is perfect, surgeons should not limit themselves to only one technique or approach, but rather use all options available.
KeywordsTransnasal Endoscopic Microsurgical Hybrid approach
This work was supported by the Donna and Kenneth R. Peak Foundation, The Kenneth R. Peak Brain and Pituitary Treatment Center at Houston Methodist Hospital, The Taub Foundation, The Blanche Green Estate Fund of the Pauline Sterne Wolff Memorial Foundation, The Verelan Foundation, The John S. Dunn Foundation, The Houston Methodist Hospital Foundation, The Kelly Kicking Cancer Foundation, The American Brain Tumor Association, the senior author’s referring physicians who have allowed us to gain knowledge of the many nuances of this surgery, and the many patients and families who have been impacted by the devastating effects of brain and pituitary tumors. We also thank Nyla Ismail, Ph.D. and Megan Fulin for editorial support and assistance.
Endoscopic approach (MP4 191,611 kB)
Entry into the sella (MP4 166,365 kB)
Tumor resection (MP4 78,854 kB)
Use of lumbar drain (MP4 191,859 kB)
Skull base reconstruction (MP4 62,875 kB)
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