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Journal of Korean Neurosurgical Society 1999;28(6): 769-774.
Endoscopic Endonasal Transsphenoidal Pituitary Tumor Surgery: An Early Experience.
Jong Hyun Kim, Hun Jong Dhong, Byung Moon Cho, Dong Ik Shin, Do Hyun Nam, Jung Il Lee, Jong Soo Kim, Seung Chyul Hong, Hyung Jin Shin, Kwan Park, Whan Eoh
1Department of Neurosurgery, Samsung Medical Center, College of Medicine, Sungkyunkwan University, Seoul, Korea.
2Department of Otolaryngology, Samsung Medical Center, College of Medicine, Sungkyunkwan University, Seoul, Korea.
Endoscopic surgery opened new fields in pituitary tumor surgery, not only by direct endonasal access, but also by affording a panoramic view inside the sphenoidal sinus and the sellar turcica. It provides an extremely sharp image with high resolution. We describe our initial experience in using the endonasal endoscopy for the pituitary tumor surgery. Seven operations were performed by the endonasal endoscopy. The endoclinologic diagnosis were prolactinoma in four cases and GH secreating adenoma in three. Four cases were macroadenoma and three were microadenoma. Among the three patients with GH secreting adenomas, two improved clinically with normal serum GH level, one improved clinically with elevated serum GH levels postoperatively. Of the four patients with prolactinomas, all four improved clinically elevated with serum prolactin levels. Two patients developed postoperative complications; one was transient cerebrospinal fluid(CSF) leakage and the other was transient diabetes insipedus(DI). The use of the endoscope allowed close inspection of sella and parasellar structures as well as differentiation between tumor tissue and normal pituitary gland. Gross total removal was possible with the help of angled view of the telescope even in the cases of moderate supra-and parasellar extensions. Although from short and early experience, endoscopic endonasal approach seems to be a valuable and safe procedure for removing pituitary adenomas. With improved techniques and an accumulation in operative experience, endoscopic pituitary surgery will gain in importance and present new horizons in pituitary surgery.
Key Words: Pituitary adenoma; Endoscopic transsphenoidal approach
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