Valentin Favier1, Marine Le Corre2, François Segnarbieux2, Valérie Rigau3, Isabelle Raingeard4, César Cartier5, Louis Crampette5, Julien Boetto2. 1. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34090, Montpellier, France. valentin_favier@hotmail.com. 2. Department of Neurosurgery, University Hospital of Montpellier, Montpellier, France. 3. Department of Pathology, University Hospital of Montpellier, Montpellier, France. 4. Department of Endocrinology, University Hospital of Montpellier, Montpellier, France. 5. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34090, Montpellier, France.
Abstract
PURPOSE: To report the results of a series of patients undergoing the endoscopic subperichondrial transseptal (STRAS) approach for pituitary surgery and to evaluate the efficiency and the safety of this approach. METHODS: This is a single-centre retrospective study including all patients undergoing pituitary lesion resection through the STRAS approach from January 2002 to December 2017 by a multidisciplinary surgical team (ENT and neurosurgeon). Demographic data, tumour type, complication rate and pre- and post-operative visual, endocrine and tumour status were retrospectively analysed. RESULTS: 119 patients were included in the study, 80 (67%) presenting macroadenoma, 24 (20%) microadenoma (20%) and 6 (5%) giant adenoma. 61 (51%) patients had secreting adenoma and 51 (42%) patient had non-functioning adenoma. The STRAS approach allowed a good visualization of intrasphenoidal and intrasellar anatomical landmarks in all cases and no patient needed turbinate resection. No patient died or had neurological deficit. Endocrine remission or control was achieved in 90.5% of hormone-secreting microadenomas and in 84.2% of hormone-secreting macroadenomas. Gross-total resection was achieved for 39 patients (48.8%) of the 80 macroadenomas. Nasal complication rate was very low, with no septal perforation and two epistaxis (1.7%) medically treated. CONCLUSION: The STRAS approach is an elegant approach to the sphenoid sinus that enables a good exposure of the intrasphenoidal anatomical landmarks with a maximal preservation of the nasal mucosa. This approach allows an intrasellar work with great comfort and safety for the surgeon using a two-hand or a four-hand technique.
PURPOSE: To report the results of a series of patients undergoing the endoscopic subperichondrial transseptal (STRAS) approach for pituitary surgery and to evaluate the efficiency and the safety of this approach. METHODS: This is a single-centre retrospective study including all patients undergoing pituitary lesion resection through the STRAS approach from January 2002 to December 2017 by a multidisciplinary surgical team (ENT and neurosurgeon). Demographic data, tumour type, complication rate and pre- and post-operative visual, endocrine and tumour status were retrospectively analysed. RESULTS: 119 patients were included in the study, 80 (67%) presenting macroadenoma, 24 (20%) microadenoma (20%) and 6 (5%) giant adenoma. 61 (51%) patients had secreting adenoma and 51 (42%) patient had non-functioning adenoma. The STRAS approach allowed a good visualization of intrasphenoidal and intrasellar anatomical landmarks in all cases and no patient needed turbinate resection. No patient died or had neurological deficit. Endocrine remission or control was achieved in 90.5% of hormone-secreting microadenomas and in 84.2% of hormone-secreting macroadenomas. Gross-total resection was achieved for 39 patients (48.8%) of the 80 macroadenomas. Nasal complication rate was very low, with no septal perforation and two epistaxis (1.7%) medically treated. CONCLUSION: The STRAS approach is an elegant approach to the sphenoid sinus that enables a good exposure of the intrasphenoidal anatomical landmarks with a maximal preservation of the nasal mucosa. This approach allows an intrasellar work with great comfort and safety for the surgeon using a two-hand or a four-hand technique.
Authors: Jackson A Gondim; Joao Paulo C Almeida; Lucas Alverne F Albuquerque; Michele Schops; Erika Gomes; Tania Ferraz; Wladia Sobreira; Meissa T Kretzmann Journal: Pituitary Date: 2011-06 Impact factor: 4.107
Authors: Reem D Almutairi; Ivo S Muskens; David J Cote; Mark D Dijkman; Vasileios K Kavouridis; Erin Crocker; Kholoud Ghazawi; Marike L D Broekman; Timothy R Smith; Rania A Mekary; Hasan A Zaidi Journal: Acta Neurochir (Wien) Date: 2018-01-06 Impact factor: 2.216
Authors: Ching-Jen Chen; Natasha Ironside; I Jonathan Pomeraniec; Srinivas Chivukula; Thomas J Buell; Dale Ding; Davis G Taylor; Robert F Dallapiazza; Cheng-Chia Lee; Marvin Bergsneider Journal: Acta Neurochir (Wien) Date: 2017-09-14 Impact factor: 2.216
Authors: Jackson A Gondim; Michele Schops; João Paulo C de Almeida; Lucas Alverne F de Albuquerque; Erika Gomes; Tânia Ferraz; Francisca Andréa C Barroso Journal: Pituitary Date: 2009-08-21 Impact factor: 4.107