Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Endoscopy Assisted Transsphenoidal Surgery for Pituitary Tumors

내시경적 경접형동 접근술에 의한 뇌하수체 종양의 수술

  • Ahn, Young Sang (Department of Neurological surgery Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Chun, Young Il (Department of Neurological surgery Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Ahn, Jae Sung (Department of Neurological surgery Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Jeon, Sang Ryong (Department of Neurological surgery Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Kim, Jeong Hoon (Department of Neurological surgery Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Ra, Young Shin (Department of Neurological surgery Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Roh, Sung Woo (Department of Neurological surgery Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Kim, Chang Jin (Department of Neurological surgery Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Kwon, Yang (Department of Neurological surgery Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Rhim, Seung Chul (Department of Neurological surgery Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Lee, Jung Kyo (Department of Neurological surgery Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Kwun, Byung Duk (Department of Neurological surgery Asan Medical Center, College of Medicine, University of Ulsan)
  • 안영상 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 전영일 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 안재성 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 전상룡 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 김정훈 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 나영신 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 노성우 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 김창진 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 권양 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 임승철 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 이정교 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 권병덕 (울산대학교 의과대학 서울중앙병원 신경외과학교실)
  • Received : 2000.12.28
  • Accepted : 2001.04.26
  • Published : 2001.05.28
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Abstract

Objective : Transseptal or sublabial transsphenoidal surgery has been standard teatment for pituitary tumors for decades. However, as an alternative to this surgery endonasal endoscopic technique has been reported with encouraging results. We have started endoscopy-assisted transsphednoidal surgery from May 1998. In this paper we analyzed the methods, outcome, advantage and disadvantage of this surgical approach for the purpose of planning optimal treatment of pituitary tumors. Methods : This study consisits of 13 cases of pituitary tumors who were treated by endoscopy-assisted transsphenoidal surgery using one nostril from May 1998 to July 1999. Mean follow up period was 12.9 months. Results : There was no septal or sublabial incision and little surgical damage to nasal structure. With this technique, rapid surgical approach and short hospital day were possible, being 3-6 days in patients without CSF leakage. Using various angled endoscope, good surgical view was obtained. Initially it was difficult to use various instruments in narrow nasal cavity, but became feasible after several procedures. Among 13 cases, total removal was possible in 11 cases. One of two cases in whom tumor was incompletely removed underwent gamma-knife radiosurgery and second underwent reoperation through subfrontal approach. There were 6 cases of hormone secreting tumors and hormonal remission was achived in all of these cases. Postoperative complications were CSF leakage(6 cases), diabetes insipidus(2 cases) and panhypopituitarysm(1 case). Lumbar drainage was done in all cases of CSF leakage. Conclusion : The advantage of endoscopy-assisted transsphenoidal surgery are rapid surgical approach, low postoperative morbidity, short hospital day and good surgical view. The disadvantage of this appoach are difficulty in manupulating various instruments in narrow nostril and difficulty in distance perception but these problems can be overcome by practice and using stereoscopic endoscope.

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