The transition from microscopic to endoscopic transsphenoidal surgery in high-caseload neurosurgical centers: the experience of Foch Hospital.

Abstract

To report the experience of 1 hospital in the transition from the microscopic approach to the endoscopic endonasal approach for pituitary disease and skull base tumor surgery. From 2006 to August 2011, 1000 procedures to treat pituitary disease and skull base tumors were performed in our department by a single neurosurgeon using the endoscopic endonasal approach. The endonasal endoscopic approach for pituitary adenoma surgery decreased nasal complications, increased patient comfort by avoiding postoperative nasal packing, provided a better view of the intrasellar and suprasellar areas, obtained the same endocrinologic results as the microscopic approach, provided better control of the invasion of the cavernous sinus, and allowed removal of tumors of the cavernous sinus in some cases. It is important to separate the 2 approaches, the endoscopic endonasal transsellar approach and the endoscopic endonasal extended approach, and to avoid unnecessary extended approaches. The use of an endoscopic endonasal approach has added value for lesions localized between the tuberculum sellae and the odontoid. The added value of endoscopic endonasal approaches for lesions in front of the tuberculum sellae is less clear and must be evaluated in the future.