The Comparison Of Endoscopic Anatomy And Microsurgical Anatomy Through Transsphenoidal Approach To Sellar Region And Its Clinical Application

PartⅠThe comparison of endoscopic anatomy and microsurgical anatomy through transsphenoidal approach to sellar regionObject: The objectives of the present study were to oberseve the anatomical structure to the sellar region through transsphenoidal approach under the endoscope and the microscope, to compare the difference in exposure, and to describe the relevant critical surgical landmarks for endoscopic approaches. The objectives of the study also were to master microanatomy and endoscopic anatomy knowledge about t the sellar region, to the help of the microneurosurgery assisted neuroendoscope in removing pituitary edema.Methods: 8 formalin-fixed adult cadaver heads were dip, washed, and affused, to oberseve the local structure and relation of the sellar region and to obtain anatomic measurements. Expose the anatomical structure to the sellar region through transsphenoidal approach by alternate using the endoscope and the microscope, to determine the extents of the sellar region through transsphenoidal approach under the endoscope and the microscope and compared with each other.Results: Under the endoscope and the microscope, we could see anatomical landmarks such as the sphenoidal ostium, the knob of ICA and that of the optic canal, the sellar floor, the pituitary, clivus, and et al. Other than the 0-degree lens, the 30-degree lens could attain better exposure of sellar structures such as the pituitary, the pituitary gland, the ICA, the optic chiasm ,the inferior hypophyseal artery, the tuberculum sellae, and et al. The extents of the sellar region through transsphenoidal approach under the microscope: rectus gyrus in anterior border, cavernous sinus of ICA in lateral, extreme of basilar artery in posterior boundary. The extents of the sellar region through transsphenoidal approach under the endoscope: optic ehiasm in anterior border, lateral wall of cavernous sinus in lateral, extreme of basilar artery in posterior boundary. Main landmarks for endoscopic transnasal procedure were sellar floor, carotid protuberance, optocarotid recess and clival indentation in sellar region.Conclusions: The extents of the sellar through transsphenoidal approach under the endoscope are more extensive and more structures than under the microscope. The surgeons must be familiar with the endoscopic characteristics of the sellar anatomy and landmarks, in order that lesions are resected completely and normal tissues remain uninjured.PartⅡThe comparison of endoscopic anatomy and microsurgical anatomy through transsphenoidal approach to sellar regionObject: To study the utility and advantages of the microneurosurgery assisted neuroendoscope in removing pituitary edema.Methods: According to the areas, positions, and characters of 32 pituitary edema, six cases with pterional approach, twenty six cases were resected by transsphenoidal approach. All cases were followed up by pituitary MRI, hormone, sight, and eyeshot for 3.1～23.2 months.Results: All cases were pituitary edema in 32 sellar area lesions through pathologal test. 30 cases had no relapse, and 2 cases had relapse, one is the relapse of big pituitary edema, another is big pituitary edema, the vision of 19 cases becomes better, the hormone of 20 cases descend to normal level, the pregnancy of 2 cases, and no died cases. one case appeared diabetes insipidus afer operation, but the patient were cured through careful treating at last. 2 cases needed hormone substitute treatment afer operation.Conlusions: The neurosurgery through microscope assisted neuroendoscope is practicable, which were combined with the advantages of them, full and reasonable exposure of the structures in the sellar region by use natural spaces, can profitably totally remove the tumor, and reduce the complications, improve the prognosis of the patients.