Endoscopic Endonasal Transsphenoidal Approach of Sellar Tumors with Suprasellar Extension

Abstract

Background: Transsphenoidal approach usually is the preferred method for treatment of sellar tumors with suprasellar extension because of a lower risk of complications. Microscope has been used alone in treatment of such tumor for long time. Recently, endoscope has been introduced as an alternative and effective tool in transsphenoidal surgery. Aim of the work: The objective of this study is to evaluate the feasibility, safety and efficacy of endoscopic endonasal transspenoidal approach of sellar tumors with suprasellar extension clinically and radiologically.

Patients and Methods: Retrospective review of the records of the patients with sellar tumors with suprasellar extention admitted to Kasr El Ainy hospitals within the last two years as well as their follow up records to detect their outcome.

Results: This work was carried out on 50 patients. 41 patients undergo total excision while nine patients undergo subtotal excision of these tumors. Most of them had a good outcome. All patients showed visual improvement post-operatively except three patients had stationary visual impairment. Post hormonal profile for all patients was normal except four cases which hormonal levels decreased but not normalize. The most common post-operative complications are CSF leak (four patients), DI (two patients) and death (one patient).

Conclusions: Endoscopic transsphenoidal surgery is the preferred method for removal of the sellar tumors with suprasellar extentions because it provides better visualization and makes the orientation in the operative field of surgery easier and safer than the microscopic transsphenoidal approach. The growing experience and the current development of optical devices and instrumentations in the field of transsphenoidal surgery, allow the development of new strategies for less traumatic and safer approaches to the sella and cranial base.