Surgical Pitfalls in Endoscopic Endonasal TSA for Sellar and Parasellar Lesions

초록

PURPOSE : It is comfortable to do surgery for sellar and parasellar lesions if endoscope is additionally used. However, there are many limitations for endoscopic surgery without microscopic assistance. We had tried to find the error and made the skill how to overcome the pitfall. MATERIALS AND METHODS : From 1996 we performed endoscopic surgery to remove lesions of sellar and parasellar lesions: 201 pituitary adenomas, 8 Rathke`s cleft cysts, 5 metastatic tumors, 3 craniopharyngiomas and 2 meningiomas. RESULTS : 1) Endoscopic holder is essentially required for the use of both hands. 2) Irrigation and cleansing system should be prepared to clean view and reduce the operation time. 3) Bleeding control technique is well trained in the process of removing turbinate and dural opening due to massive bleeding from circular sinus. 4) Anatomical knowledge around sellar and skull base is necessary not to injure cranial nerves and vessels 5) Special instrument forming bayonet is prepared to do in narrow space nor to interrupt each other. 6) 3-D idea to get over the distance to materials and anatomic structures. CONCLUSION : It is possible to do endoscopic surgery for the sellar and parasellar lesions if surgeon well recognize the anatomy and surgical pitfalls.