[Transnasal-transsphenoidal endoscopic surgery of the sellar region]. / Cirugía transnasal transesfenoidal endoscópica en afecciones de región selar.

UNLABELLED: Transnasal transsphenoidal endoscopic approach to the sella turcica has recently become an option to the pituitary surgery which could predominate in a near future. OBJECTIVES: To evaluate through the analysis of our results whether it is possible to perform in our Hospital the endoscopic transnasal transsphenoidal approach to the sella with results at least as good as those we obtain with the microscopic sublabial transseptal transsphenoidal approach. MATERIAL AND METHODS: As the first stage of a three stage randomized trial, this is a prospective study of 10 patients operated on, using transnasal transsphenoidal endoscopic approach between august 2002 and August 2003 at the department of neurosurgery of "Hermanos Ameijeiras Hospital". RESULTS: Six patients had pituitary macroadenomas and four had cerebrospinal fluid leak through the sellar floor. In five of six macroadenomas total tumor resection was obtained and in the other one a subtotal resection was performed. Two of four patients with cerebrospinal fluid leak could be cured while the other two patients do not. Complications were present in 30% of cases, but in only 1 (10%) it reached the postoperatory period. CONCLUSIONS: Transnasal transsphenoidal endoscopic approach to the sella can be done save enough in our Hospital to justify the start of the second stage of one randomized trial to determine if the endoscopic technique is better than the usual transsphenoidal approach.

Cirugìa transnasal transesfenoidal endoscòpica en afeciones de regiòn selar / s. t

Transnasal transsphenoidal endoscopic approach to the sella turcica has recently become an option to the pituitary surgery which could predominate in a near future. To evaluate through the analysis of our results whether it is possible to perform in our Hospital the endoscopic transnasal transsphenoidal approach to the sella with results at least as good as those we obtain with the microscopic sublabial transseptal transsphenoidal approach...(AU)

Cirugía transnasal transesfenoidal endoscópica en afecciones de región selar / Transnasal-transsphenoidal endoscopic surgery of the sellar region

Introducción. Para un gran número de tumores pituitarios la cirugía es el tratamiento de primera línea y el abordaje transesfenoidal microquirúrgico el más utilizado. En estos momentos, el mismo se ejecuta tanto por la vía sublabial como por la transnasal. Recientemente, el abordaje transnasal endoscópico ha irrumpido como una opción en desarrollo, que pudiera llegar a predominar en un futuro próximo. Objetivos. Evaluar mediante el análisis de los resultados si es posible realizar en nuestro medio el abordaje transnasal transesfenoidal endoscópico para las lesiones de la región selar con resultados quirúrgicos, al menos, similares a los obtenidos con el método transesfenoidal tradicional. Material y método. Como fase I de un ensayo en 3 etapas se realiza una investigación limitada tipo cohorte, estrictamente controlada y prospectiva de 10 pacientes seleccionados según criterios de inclusión y a los cuales se les practicó el abordaje transnasal endoscópico como método de tratamiento quirúrgico entre Agosto del 2002 y Agosto del 2003 en el servicio de Neurocirugía del Hospital "Hermanos Ameijeiras". Resultados. Se operaron seis casos que tenían macroadenomas hipofisarios, tres productores de GH, uno secretor de PRL y otros dos no productores. A los otros cuatro se les había diagnosticado fístula de LCR a través del piso selar. De los seis macroadenomas, en cinco se logró exéresis total del tumor, mientras que en el otro se obtuvo exéresis subtotal. La rinorrea desapareció en 2 pacientes con fístula de LCR y se mantuvo en los otros 2. De las complicaciones observadas en el 30% de los casos, solo en 1 (10%) transcendieron más allá del transoperatorio. Conclusiones. Los resultados obtenidos en la fase 1 con la utilización del método transnasal endoscópico, hacen que el procedimiento en nuestro medió sea lo suficientemente seguro como para justificar el pase a la fase II del ensayo (aleatorizada y controlada), en busca de información más consistente, en relación al valor real de la técnica a estas alturas del desarrollo de la cirugía hipofisaria

Transnasal transsphenoidal endoscopic approach to the sella turcica has recently become an option to the pituitary surgery which could predominate in a near future. Objectives. To evaluate through the analysis of our results whether it is possible to perform in our Hospital the endoscopic transnasal transsphenoidal approach to the sella with results at least as good as those we obtain with the microscopic sublabial transseptal transsphenoidal approach. Material and methods. As the first stage of a three stage randomized trial, this is a prospective study of 10 patients operated on, using transnasal transsphenoidal endoscopic aproach between august 2002 and August 2003 at the department of neurosurgery of "Hermanos Ameijeiras Hospital". Results. Six patients had pituitary macroadenomas and four had cerebrospinal fluid leak through the sellar floor. In five of six macroadenomas total tumor resection was obtained and in the other one a subtotal resection was performed. Two of four patients with cerebrospinal fluid leak could be cured while the other two patients do not. Complications were present in 30% of cases, but in only 1 (10%) it reached the postoperatory period. Conclusions. Transnasal transsphenoidal endoscopic approach to the sella can be done save enough in our Hospital to justify the start of the second stage of one randomized trial to determine if the endoscopic technique is better than the usual transsphenoidal approach