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Endoscopic endonasal transsphenoidal "above and below" approach to the retroinfundibular area and interpeduncular cistern--cadaveric study and case illustrations.
World Neurosurg. 2014 Feb; 81(2):374-84.WN

Abstract

OBJECTIVE

To evaluate the feasibility of reaching the interpeduncular cistern (IC) through an endoscopic endonasal approach that leaves the pituitary gland in place.

METHODS

In a series of 10 injected cadaver heads, the transtuberculum ("above") and transclival ("below") approaches were combined, without pituitary transposition. Using 0-degree, 30-degree, and 45-degree endoscopes, the extent of overlap and if a blind spot occurred were determined. Also, the visualization of the IC was compared with the transposition of the pituitary gland approach. Nonparametric statistics were used to evaluate the results. The approach was implemented in 2 patients.

RESULTS

For both the "above" and "below" views, there was a statistically significant increase in field of view when comparing the 0-degree endoscope with either the 30-degree endoscope (P < 0.05) or the 45-degree endoscope (P < 0.05). There was no difference between the 30-degree endoscope and the 45-degree endoscope (P > 0.05) in the "below" approach, but there was a difference (P < 0.05) in the "above" approach. There was no blind spot with any combination of endoscopes. There was no practical statistically significant difference between the transposition approach and the "above and below" approach. The "above and below" approach was used successfully in 2 surgeries.

CONCLUSIONS

It is possible to work both "above" and "below" the pituitary gland to reach the IC through an endoscopic endonasal approach. The advantages are the maintenance of normal pituitary and parasellar anatomy and the minimization of the size of the skull base defect. There is no blind spot using this approach that would be revealed with a pituitary transposition. The feasibility of this approach has been confirmed in 2 patients.

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Authors+Show Affiliations

Silva D
Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
Attia M
Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
Kandasamy J
Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
Alimi M
Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
Anand VK
Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
Schwartz TH
Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA; Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA; Department of Neurology and Neuroscience, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA. Electronic address: schwarh@med.cornell.edu.

MeSH

AdenomaAdultCadaverCranial Fossa, PosteriorFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedNeuroendoscopyNosePituitary GlandPituitary Gland, PosteriorPituitary NeoplasmsSella TurcicaSkull Base NeoplasmsSphenoid BoneThird Ventricle

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

23022634

Citation

Silva, Danilo, et al. "Endoscopic Endonasal Transsphenoidal "above and Below" Approach to the Retroinfundibular Area and Interpeduncular Cistern--cadaveric Study and Case Illustrations." World Neurosurgery, vol. 81, no. 2, 2014, pp. 374-84.
Silva D, Attia M, Kandasamy J, et al. Endoscopic endonasal transsphenoidal "above and below" approach to the retroinfundibular area and interpeduncular cistern--cadaveric study and case illustrations. World Neurosurg. 2014;81(2):374-84.
Silva, D., Attia, M., Kandasamy, J., Alimi, M., Anand, V. K., & Schwartz, T. H. (2014). Endoscopic endonasal transsphenoidal "above and below" approach to the retroinfundibular area and interpeduncular cistern--cadaveric study and case illustrations. World Neurosurgery, 81(2), 374-84. https://doi.org/10.1016/j.wneu.2012.08.013
Silva D, et al. Endoscopic Endonasal Transsphenoidal "above and Below" Approach to the Retroinfundibular Area and Interpeduncular Cistern--cadaveric Study and Case Illustrations. World Neurosurg. 2014;81(2):374-84. PubMed PMID: 23022634.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic endonasal transsphenoidal "above and below" approach to the retroinfundibular area and interpeduncular cistern--cadaveric study and case illustrations. AU - Silva,Danilo, AU - Attia,Moshe, AU - Kandasamy,Jothy, AU - Alimi,Marjan, AU - Anand,Vijay K, AU - Schwartz,Theodore H, Y1 - 2012/09/25/ PY - 2012/03/09/received PY - 2012/06/23/revised PY - 2012/08/17/accepted PY - 2012/10/2/entrez PY - 2012/10/2/pubmed PY - 2014/5/20/medline KW - Clivus KW - Endoscopic endonasal KW - Interpeduncular cistern KW - Pituitary gland KW - Retroinfundibular area KW - Suprasellar cistern KW - Transsphenoidal approach SP - 374 EP - 84 JF - World neurosurgery JO - World Neurosurg VL - 81 IS - 2 N2 - OBJECTIVE: To evaluate the feasibility of reaching the interpeduncular cistern (IC) through an endoscopic endonasal approach that leaves the pituitary gland in place. METHODS: In a series of 10 injected cadaver heads, the transtuberculum ("above") and transclival ("below") approaches were combined, without pituitary transposition. Using 0-degree, 30-degree, and 45-degree endoscopes, the extent of overlap and if a blind spot occurred were determined. Also, the visualization of the IC was compared with the transposition of the pituitary gland approach. Nonparametric statistics were used to evaluate the results. The approach was implemented in 2 patients. RESULTS: For both the "above" and "below" views, there was a statistically significant increase in field of view when comparing the 0-degree endoscope with either the 30-degree endoscope (P < 0.05) or the 45-degree endoscope (P < 0.05). There was no difference between the 30-degree endoscope and the 45-degree endoscope (P > 0.05) in the "below" approach, but there was a difference (P < 0.05) in the "above" approach. There was no blind spot with any combination of endoscopes. There was no practical statistically significant difference between the transposition approach and the "above and below" approach. The "above and below" approach was used successfully in 2 surgeries. CONCLUSIONS: It is possible to work both "above" and "below" the pituitary gland to reach the IC through an endoscopic endonasal approach. The advantages are the maintenance of normal pituitary and parasellar anatomy and the minimization of the size of the skull base defect. There is no blind spot using this approach that would be revealed with a pituitary transposition. The feasibility of this approach has been confirmed in 2 patients. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/23022634/Endoscopic_endonasal_transsphenoidal_"above_and_below"_approach_to_the_retroinfundibular_area_and_interpeduncular_cistern__cadaveric_study_and_case_illustrations_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(12)00907-2 DB - PRIME DP - Unbound Medicine ER -