Jho H D, Alfieri A
Center for Minimally Invasive Innovative Microneurosurgery, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Minim Invasive Neurosurg. 2001 Mar;44(1):1-12. doi: 10.1055/s-2001-13590.
The evolution of the senior author's (HD Jho) surgical experience on endoscopic endonasal transsphenoidal pituitary surgery is reviewed in order to introduce a standardized surgical technique for pituitary endoscopy.
The progressive evolution of the surgical technique and the development of surgical instrumentation in transsphenoidal endoscopy is reviewed based upon the experience of more than 150 operations performed by the senior author between the years 1993 and 1998.
An endoscope was used to assist visualization during conventional microscopic surgery in the first four cases (endoscope-assisted microsurgery). Subsequently, endonasal pituitary endoscopy was performed via a nostril. When the endonasal route was adopted, it eliminated the use of a transsphenoidal retractor. The use of vasoconstrictors and any form of nasal packing was discovered to be unnecessary. The inferior margin of the middle turbinate was such a consistent surgical landmark leading to the sella that the use of an intraoperative fluoroscopic C-arm was also eliminated. The adoption of a septal breaker, variously angled suction cannulas and suction-coagulators has made the operation cleaner, easier and faster. As experience increased, the operation time progressively shortened and mucosal trauma became minimal. The median patient hospital stay was one night and postoperative discomfort was noted to be minimal.
The evolution of the senior author's endoscopic pituitary surgery is reported with a description of our current standardized surgical technique.
回顾资深作者（HD Jho）在内镜下经鼻蝶窦垂体手术方面的手术经验演变，以引入一种标准化的垂体内镜手术技术。
基于资深作者在1993年至1998年间进行的150多例手术经验，回顾经蝶窦内镜手术技术的逐步演变和手术器械的发展。
在前四例手术中，使用内镜辅助传统显微镜手术以辅助可视化（内镜辅助显微手术）。随后，经鼻孔进行鼻内垂体内镜手术。当采用鼻内入路时，无需使用经蝶窦牵开器。发现无需使用血管收缩剂和任何形式的鼻腔填塞物。中鼻甲下缘是通向蝶鞍的一致手术标志，因此也无需使用术中荧光透视C形臂。采用鼻中隔分离器、不同角度的吸引套管和吸引-凝血器使手术更清洁、更容易且更快。随着经验的增加，手术时间逐渐缩短，黏膜创伤降至最低。患者的中位住院时间为一晚，术后不适也降至最低。
报告了资深作者内镜垂体手术的演变，并描述了我们目前的标准化手术技术。
