Ismail Mostafa, Abdelaziz Ahmed A, Darwish Mohab
Department of Otorhinolaryngology, Minia University Hospital, Minya, Egypt.
Department of Neurosurgery, Minia University Hospital, Minya, Egypt.
Eur Arch Otorhinolaryngol. 2019 Apr;276(4):1095-1100. doi: 10.1007/s00405-019-05305-y. Epub 2019 Jan 24.
Endoscopic endonasal transsphenoidal surgery (EETS) requires abundant collaborative work between neurosurgeon and ear, nose, and throat (ENT) surgeon. In low-volume centers, however, the surgery may be carried out completely and solely by a neurosurgeon. The current study evaluates the differences in both technique and complications in the approach to the sphenoid sinus for endoscopic endonasal approach (EEA) performed solely by a single neurosurgeon compared to collaborative effort between neurosurgery and otolaryngology.
The study comprises 50 consecutive patients with intra-sellar pituitary lesions undergoing EETS. Half of the patients were operated completely by single neurosurgeon (group A) and the other half by collaboration between single ENT surgeon, as a primary surgeon during nasal step, and the neurosurgeon (group B). Both groups were assessed intra-operatively as to operative technique, average time of EEA to sphenoid sinus, and presence of endonasal structural difficulties and complications.
A significant difference was recorded between both groups regarding average time of EEA to sphenoid sinus (P < 0.001) and incidence of intraoperative nasal complications (P = 0.006). There was a difference between ENT surgeon and neurosurgeon adopting the same approach to sphenoid sinus. Sphenoid sinus approaches from group B characterized by their short duration (mean 10 vs 22 min) and low incidence of intraoperative endonasal complications (4.8% vs 28%).
Study results emphasized the necessity of collaboration between neurosurgeon and ENT surgeon in endoscopic endonasal approaches, to efficiently deal with intraoperative endonasal difficulties and complications which pose difference for both surgeons performing the same surgical procedure.
鼻内镜下经蝶窦手术（EETS）需要神经外科医生与耳鼻喉科（ENT）医生密切协作。然而，在手术量较少的中心，该手术可能完全由神经外科医生单独完成。本研究评估了由单一神经外科医生单独进行的鼻内镜下经鼻入路（EEA）蝶窦手术与神经外科和耳鼻喉科协作进行的手术在技术和并发症方面的差异。
本研究纳入了50例连续接受EETS治疗的鞍内垂体病变患者。其中一半患者由单一神经外科医生完全独立完成手术（A组），另一半患者由单一耳鼻喉科医生作为鼻腔步骤的主刀医生与神经外科医生协作完成手术（B组）。术中对两组的手术技术、EEA至蝶窦的平均时间、鼻内结构困难情况及并发症进行评估。
两组在EEA至蝶窦的平均时间（P＜0.001）和术中鼻内并发症发生率（P = 0.006）方面存在显著差异。耳鼻喉科医生和神经外科医生采用相同方法处理蝶窦时存在差异。B组的蝶窦入路手术时间短（平均10分钟对22分钟），术中鼻内并发症发生率低（4.8%对28%）。
研究结果强调了神经外科医生与耳鼻喉科医生在鼻内镜下经鼻入路手术中协作的必要性，以便有效应对术中鼻内困难和并发症，而这些对于实施相同手术的两位医生而言存在差异。
