Publication year: 2012
Source:World Neurosurgery
Danilo Silva, Moshe Attia, Jothy Kandasamy, Marjan Alimi, Vijay K. Anand, Theodore H. Schwartz
Objectives To evaluate the feasibility of reaching the interpeduncular cistern through an endoscopic endonasal approach that leaves the pituitary gland in place. Methods We combined the transtuberculum ("above") and transclival ("below") approaches, without pituitary transposition in a series of 10 injected cadaver heads. Using 0°, 30° and 45° scopes we determined the extent of overlap and if a blind spot occurred. We also compared the visualization of the interpeduncular cistern with the "transposition" approach. Nonparametric statistics were used to evaluate our results. The approach was then implemented in 2 patients. Results For both the "above" and "below" views there was a statistically significant increase in field of view when comparing the 0° scope with either the 30° (p<0.05) or 45° (p<0.05). There was no difference between the 30° and the 45° (p>0.05) scope in the "below" approach but there was a difference (p<0.05) in the "above" approach. Hence, there was no blind spot with any combination of scopes. There was no practical statistically difference between the transposition and our approach. The approach was used successfully in two surgeries. Conclusion It is possible to work both above and below the pituitary gland to reach the interpeduncular cistern through an endoscopic endonasal approach. The advantages are the maintenance of normal pituitary and parasellar anatomy and the minimization of the size of the skull base defect. We show that there is no blind spot using this approach that would be revealed with a pituitary transposition and confirm the feasibility in two patients.
Source:World Neurosurgery
Danilo Silva, Moshe Attia, Jothy Kandasamy, Marjan Alimi, Vijay K. Anand, Theodore H. Schwartz
Objectives To evaluate the feasibility of reaching the interpeduncular cistern through an endoscopic endonasal approach that leaves the pituitary gland in place. Methods We combined the transtuberculum ("above") and transclival ("below") approaches, without pituitary transposition in a series of 10 injected cadaver heads. Using 0°, 30° and 45° scopes we determined the extent of overlap and if a blind spot occurred. We also compared the visualization of the interpeduncular cistern with the "transposition" approach. Nonparametric statistics were used to evaluate our results. The approach was then implemented in 2 patients. Results For both the "above" and "below" views there was a statistically significant increase in field of view when comparing the 0° scope with either the 30° (p<0.05) or 45° (p<0.05). There was no difference between the 30° and the 45° (p>0.05) scope in the "below" approach but there was a difference (p<0.05) in the "above" approach. Hence, there was no blind spot with any combination of scopes. There was no practical statistically difference between the transposition and our approach. The approach was used successfully in two surgeries. Conclusion It is possible to work both above and below the pituitary gland to reach the interpeduncular cistern through an endoscopic endonasal approach. The advantages are the maintenance of normal pituitary and parasellar anatomy and the minimization of the size of the skull base defect. We show that there is no blind spot using this approach that would be revealed with a pituitary transposition and confirm the feasibility in two patients.
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