Regmi Deepak, Thapa Amit, Kc Bidur, Shakya Bikram
Department of ENT- Head and Neck Surgery, Kathmandu Medical College, Sinamangal Kathmandu, Nepal.
Department of Neurological Surgery, Kathmandu Medical College, Sinamangal Kathmandu, Nepal.
J Nepal Health Res Counc. 2017 Sep 8;15(2):174-177. doi: 10.3126/jnhrc.v15i2.18209.
The excellent visualization and minimally invasive approach employed in endoscopic endonasal procedures has now revolutionized the pituitary surgery, replacing the transnasal microscopic technique worldwide. However, it involves major shift in hand-eye co-ordination from static 3 dimensional images of microscope to 2 dimensional endoscopic images hence demands training and inter-disciplinary approach. Here we present our experiences in learning and developing a safe endonasal transsphenoidal endoscopic approach to resect pituitary adenomas.
This prospective study was jointly conducted in the departments of ENT and Neurologicals surgery Kathmandu Medical College, Nepal, from September 2014 to August 2016. The endoscopic approach to the sphenoid sinus was performed by an Otolaryngologist and ablative surgery by Neurosurgeon. The ease of procedure, intra operative challenges, surgical cure, post-operative cerebro spinal fluid (CSF) leaks and postoperative complaints were analyzed.
Sixteen consecutive patients with pituitary adenoma (macro adenoma=13, micro adenoma =3) were analyzed. There were three intraoperative CSF leak, managed successfully. Two patients developed transient diabetes insipidus and surgical cure rate was 90%. No case had to be switched over to traditional microscopic route due to technical failure. There was no mortality.
The endoscopic endonasal transsphenoidal approach to pituitary tumors is a safe and minimally invasive procedure, which can be employed safely in any of our centers in Nepal, equipped with endoscopic sinus surgery and endoscopically trained ENT and Neurosurgeons. A multi disciplinary approach provides good access, greater tumor excision and excellent postoperative follow up.
鼻内镜手术所采用的出色可视化效果和微创方法现已彻底改变了垂体手术，在全球范围内取代了经鼻显微技术。然而，这涉及到手眼协调从显微镜的静态三维图像到二维内镜图像的重大转变，因此需要培训和跨学科方法。在此，我们介绍我们在学习和开发一种安全的经鼻蝶窦内镜入路切除垂体腺瘤方面的经验。
这项前瞻性研究于2014年9月至2016年8月在尼泊尔加德满都医学院的耳鼻喉科和神经外科联合进行。蝶窦的内镜入路由耳鼻喉科医生进行，切除手术由神经外科医生进行。分析了手术的难易程度、术中挑战、手术治愈率、术后脑脊液漏和术后并发症。
对连续16例垂体腺瘤患者（大腺瘤=13例，微腺瘤=3例）进行了分析。术中发生3例脑脊液漏，均成功处理。2例患者出现短暂性尿崩症，手术治愈率为90%。没有病例因技术失败而不得不改用传统的显微手术路径。无死亡病例。
经鼻内镜蝶窦入路治疗垂体肿瘤是一种安全、微创的手术方法，在尼泊尔任何配备鼻窦内镜手术设备以及经过内镜培训的耳鼻喉科医生和神经外科医生的中心均可安全开展。多学科方法提供了良好的入路、更大范围的肿瘤切除和出色的术后随访。
