The prime aim of rhinosinusal surgical endoscopy is to safeguard the nasal mucosa and thereby maintain intact rhinosinusal physiology and complex functions. The endoscopic approach to the sellar region offers the best view of intrasellar structures and allows appropriate functioning of the ventilation system of the paranasal sinuses. The limitations of endoscopy depend on the type of lesion and local anatomy and are basically the same as those of the microscopic approach. Relative limitations are those of surgical endoscopy in general and include the need for a blood-free field, the lack of a three-dimensional view and the need for specific training. Trans-sphenoidal surgical endoscopy is only mildly invasive and well-tolerated by patients. It has a low complication rate comprising major and minor complications. Major complications are generally intra-operative or arise in the immediate postoperative period and are caused by lesions to adjacent organs. Minor complications, generally underestimated in neurosurgical literature on the classic microscopic approach, are markedly reduced when the two techniques are assessed by comparable criteria. In our experience of around a hundred patients treated at the Neurosurgical and Otorhinolaryngology Clinic, San Matteo Hospital, University of Pavia, there were no major complications, whereas the incidence of minor complications was around 5.4%. Minor complications comprised lesions of the lamina papyracea (0.9%), synechiae (3.6%) and infections (0.9%) all of which resolved with medical treatment. Refinements to new technologies with monitored systems for both lavage and tissue removal and the possible evolution of a 3D view combined with specific training with an improvement in surgical dexterity have enhanced the mildly invasive features of this technique, making it the best approach to the sellar cavity safeguarding the vital functions of the paranasal sinuses such as mucociliary transport and rhinosinusal ventilation.
Limiti e complicanze dell’endoscopia transfenoidale
LOCATELLI, DAVIDE;CASTELNUOVO, PAOLO GIOCONDO MARIA;
2000-01-01
Abstract
The prime aim of rhinosinusal surgical endoscopy is to safeguard the nasal mucosa and thereby maintain intact rhinosinusal physiology and complex functions. The endoscopic approach to the sellar region offers the best view of intrasellar structures and allows appropriate functioning of the ventilation system of the paranasal sinuses. The limitations of endoscopy depend on the type of lesion and local anatomy and are basically the same as those of the microscopic approach. Relative limitations are those of surgical endoscopy in general and include the need for a blood-free field, the lack of a three-dimensional view and the need for specific training. Trans-sphenoidal surgical endoscopy is only mildly invasive and well-tolerated by patients. It has a low complication rate comprising major and minor complications. Major complications are generally intra-operative or arise in the immediate postoperative period and are caused by lesions to adjacent organs. Minor complications, generally underestimated in neurosurgical literature on the classic microscopic approach, are markedly reduced when the two techniques are assessed by comparable criteria. In our experience of around a hundred patients treated at the Neurosurgical and Otorhinolaryngology Clinic, San Matteo Hospital, University of Pavia, there were no major complications, whereas the incidence of minor complications was around 5.4%. Minor complications comprised lesions of the lamina papyracea (0.9%), synechiae (3.6%) and infections (0.9%) all of which resolved with medical treatment. Refinements to new technologies with monitored systems for both lavage and tissue removal and the possible evolution of a 3D view combined with specific training with an improvement in surgical dexterity have enhanced the mildly invasive features of this technique, making it the best approach to the sellar cavity safeguarding the vital functions of the paranasal sinuses such as mucociliary transport and rhinosinusal ventilation.
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