Advertisement

A comparison between collaborative and single surgeon approach in endoscopic endonasal surgery to sphenoid sinus

  • Mostafa IsmailEmail author
  • Ahmed A. Abdelaziz
  • Mohab Darwish
Rhinology
  • 38 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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%).

Conclusion

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.

Keywords

Endoscopic surgery Transsphenoidal approach Anatomical variants 

Notes

Funding

All authors declare that they did not receive any source of funding for this study.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Jankowski R, Auque J, Simon C, Marchal JC, Hepner H, Wayoff M (1992) How i do it: head and neck and plastic surgery: endoscopic pituitary tumor surgery. Laryngoscope 102(2):198–202CrossRefGoogle Scholar
  2. 2.
    Jho H-D, Carrau RL (1997) Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87(1):44–51CrossRefGoogle Scholar
  3. 3.
    Stammberger H (1986) Endoscopic endonasal surgery—concepts in treatment of recurring rhinosinusitis. Part II. Surgical technique. Otolaryngol Head Neck Surg 94(2):147–156CrossRefGoogle Scholar
  4. 4.
    Har-El G (2007) Surgical approaches to the sphenoid sinus. In: Kountakis SE, Önerci M (eds) Rhinologic and sleep apnea surgical techniques. Springer, Berlin, Heidelberg, pp 73–81CrossRefGoogle Scholar
  5. 5.
    Singh A, Wessell AP, Anand VK, Schwartz TH (2011) Surgical anatomy and physiology for the skull base surgeon. Op Tech Otolaryngol Head Neck Surg 22(3):184–193CrossRefGoogle Scholar
  6. 6.
    van Lindert EJ, Ingels K, Mylanus E, Grotenhuis JA (2010) Variations of endonasal anatomy: relevance for the endoscopic endonasal transsphenoidal approach. Acta Neurochir 152(6):1015–1020CrossRefGoogle Scholar
  7. 7.
    D’Haens J, Van Rompaey K, Stadnik T, Haentjens P, Poppe K, Velkeniers B (2009) Fully endoscopic transsphenoidal surgery for functioning pituitary adenomas: a retrospective comparison with traditional transsphenoidal microsurgery in the same institution. Surg Neurol 72(4):336–340CrossRefGoogle Scholar
  8. 8.
    Prevedello DM, Kassam AB, Gardner PA, Carrau RL, Snyderman CH (2010) Expanded endoscopic endonasal approaches to the skull base. In: Cappabianca P, Iaconetta G, Califano L (eds) Cranial, craniofacial and skull base surgery. Springer, Milano, pp 239–251CrossRefGoogle Scholar
  9. 9.
    Doglietto F, Prevedello DM, Jane JA Jr, Han J, Laws ER Jr (2005) A brief history of endoscopic transsphenoidal surgery-from Philipp Bozzini to the First World Congress of Endoscopic Skull Base Surgery. Neurosurg Focus 19(6):1–6CrossRefGoogle Scholar
  10. 10.
    Gandhi CD, Christiano LD, Eloy JA, Prestigiacomo CJ, Post KD (2009) The historical evolution of transsphenoidal surgery: facilitation by technological advances. Neurosurg Focus 27(3):E8CrossRefGoogle Scholar
  11. 11.
    Sethi DS, Pillay PK (1995) Endoscopic management of lesions of the sella turcica. J Laryngol Otol 109(10):956–962Google Scholar
  12. 12.
    Jho H-D, Carrau R (1996) Endoscopy assisted transsphenoidal surgery for pituitary adenoma. Acta Neurochir 138(12):1416–1425CrossRefGoogle Scholar
  13. 13.
    Bolger WE, Parsons DS, Butzin CA (1991) Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 101(1):56–64CrossRefGoogle Scholar
  14. 14.
    Zinreich J (1993) Imaging of inflammatory sinus disease. Otolaryngol Clin N Am 26(4):535–547Google Scholar
  15. 15.
    Gupta T, Aggarwal A, Sahni D (2013) Anatomical landmarks for locating the sphenoid ostium during endoscopic endonasal approach: a cadaveric study. Surg Radiol Anat 35(2):137–142CrossRefGoogle Scholar
  16. 16.
    Dusick JR, Esposito F, Mattozo CA, Chaloner C, McArthur DL, Kelly DF (2006) Endonasal transsphenoidal surgery: the patient’s perspective—survey results from 259 patients. Surg Neurol 65(4):332–341CrossRefGoogle Scholar
  17. 17.
    Tataranu L, Gorgan M, Ciubotaru V, Dricu A, Dediu A, Ene B et al (2010) Endoscopic endonasal transsphenoidal approach in the management of sellar and parasellar lesions: alternative surgical techniques, results, complications (Part II). Rom Neurosurg 17:182–191Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of OtorhinolaryngologyMinia University HospitalMinyaEgypt
  2. 2.Department of NeurosurgeryMinia University HospitalMinyaEgypt

Personalised recommendations