| Introduction to Expanded Endonasal Approach of the Pituitary Fossa: The Role of Rhinologic Surgeon |
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Dae Woo Kim, Sang Wook Kim, Kyung Bum Park, Jin Myung Jung, Sea Yuong Jeon |
1Department of Otorhinolaryngology, College of Medicine, Gyeongsang National University, Jinju, Korea. syjeon@nongae.gsnu.ac.kr
2Department of Neurosurgery, College of Medicine, Gyeongsang National University, Jinju, Korea.
3Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, Korea. |
| 내시경적 경비강 확장 접근법에 의한 뇌하수체와 병변의 수술 입문 : 이비인후과 의사의 역할 |
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김대우, 김상욱, 박경범, 정진명, 전시영 |
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경상대학교 의학전문대학원 이비인후과학교실,1 신경외과학교실,2 건강과학연구원3 |
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| Abstract |
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The expanded endonasal approach (EEA) to the ventral skull base provides endoscopic access from the frontal sinus to the second cervical vertebra. Potential advantages of the EEA include not only improved cosmesis but more importantly, the potential for reduced neurovascular manipulation. EEA is based on the principle of extracapsular dissection with full visualization of important neurovascular structures. There are significant risks of neural and vascular injury associated with EEA, and the reconstruction of dural defects is challenging. Experienced teams including rhinologists and neurosurgeons are needed for successful implementation of EEA. The surgical team must have adequate endoscopic skills to achieve hemostasis and address vascular emergencies. Advantages of having a skilled second surgeon to provide endoscopic visualization include dynamic adjustments of the endoscope to ensure the best view and avoid contact interference of instruments, second surgical opinions in complex anatomical areas, and maintenance of endoscopic views in cases of crisis such as vascular injury. Complications of the EEA such as neurovascular injury, cerebrospinal fluid leaks and infection are the same as those of open approaches. With the advent of the nasoseptal flap, problematic cases involving huge bony defects subsequent to the resection of skull base tumors have been greatly resolved. |
| Key Words:
Expanded endonasal approach;Pituitary neoplasms, endoscopy;Sella turcica;Reconstructive surgical procedures;Surgical flaps |
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