ENDOSCOPIC TRANSSPHENOIDAL PITUITARY SURGERY//CASE PRESENTATION скачать в хорошем качестве

ENDOSCOPIC TRANSSPHENOIDAL PITUITARY SURGERY//CASE PRESENTATION

Steps of Endoscopic Transsphenoidal Pituitary Surgery 1. Preoperative Preparation • Imaging: MRI (sellar, parasellar, suprasellar), CT scan (bony anatomy). • Hormonal profile: Prolactin, cortisol, GH, TSH, ACTH, etc. • ENT and neurosurgical evaluation. • Lumbar drain: Occasionally used if high risk of CSF leak. • Antibiotic prophylaxis. 2. Patient Positioning • Supine, head slightly extended. • Head fixed in a Mayfield clamp or horseshoe headrest. • Neuronavigation system may be used. 3. Nasal Phase (Approach to Sphenoid Sinus) • Endoscopic entry via one nostril (uninasal) or both (binostril technique). • Lateralize the middle turbinate gently. • Identify landmarks: • Sphenoid ostium • Superior turbinate • Nasal septum • Posterior septectomy may be performed for better access. • Preserve nasoseptal flap (Hadad flap) if a CSF leak is anticipated. 4. Sphenoid Phase (Opening the Sphenoid Sinus) • Enlarge sphenoid ostium bilaterally. • Remove intersphenoid septum(s) carefully (may attach to carotid protuberance). • Identify landmarks inside sphenoid sinus: • Sella turcica floor • Optic nerve prominence • Carotid artery protuberance • Planum sphenoidale 5. Sellar Phase (Exposure of Pituitary Fossa) • Remove the sellar floor bone using a Kerrison punch or diamond burr. • Open sellar dura cruciately or linearly under neuronavigation guidance. • Take care to avoid cavernous sinus injury. 6. Tumor Removal • Use suction + ring curettes to debulk tumor. • Remove soft adenomas piecemeal. • For fibrous tumors, microdissectors are used. • Inspect cavity endoscopically for residual tumor. 7. Hemostasis and Reconstruction • Control bleeding using bipolar cautery or hemostatic agents. • If CSF leak present: • Use nasoseptal flap (Hadad flap) • Gelfoam, fat graft, or fascia lata patch • Close sphenoid sinus partially with packing. 8. Postoperative Care • Keep head elevated. • Monitor for: • CSF leak • Diabetes insipidus (polyuria, hypernatremia) • Hypopituitarism • Visual changes • Nasal packing removed after 24–48 hrs. • MRI follow-up at 3 months. #anatomy #biology #ear #ent #nose #nosebleed #otolaryngology #science #throathealth #tonsils