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FULLY ENDOSCOPIC SELLAR AND PARASELLAR SURGERY

FULLY ENDOSCOPIC SELLAR AND PARASELLAR SURGERY. NOVEMBER 01, 2006 Mohamed Kabil, MD Hrayr Shahinian, MD, FACS presentation for. The 8th Asian Oceanian International Congress of Skull Base Surgery Dubai, United Arab Emirates. TABLE OF CONTENTS. 02 Objectives

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FULLY ENDOSCOPIC SELLAR AND PARASELLAR SURGERY

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  1. FULLY ENDOSCOPIC SELLAR AND PARASELLAR SURGERY NOVEMBER 01, 2006 Mohamed Kabil, MD Hrayr Shahinian, MD, FACS presentation for The 8th Asian Oceanian International Congress of Skull Base Surgery Dubai, United Arab Emirates

  2. TABLE OF CONTENTS 02Objectives 04 Tumors/Anatomy of the Sellar region 06 Brief History 08 Advantages 10 Operation Room Setup 12 Patient Positioning 14 Operative Technique 16 Fully Endoscopic Transcranial Approaches 18 Demographic Information 20 Complication Rates 22 Summary and Conclusion

  3. INTRODUCTION • OBJECTIVES • To compare and contrast the three different surgical approaches to the sellar region including the transcranial, transseptal transsphenoidal and the fully endoscopic endonasal approach • To describe the operative technique and our experience with the fully endoscopic endonasal approach • To display the results from our series of 1,000 patients who underwent fully endoscopic pituitary adenoma resections • To compare the outcomes and complication rates of endoscopic vs. microscopic pituitary surgery FULLY ENDOSCOPIC SELLAR AND PARASELLAR SURGERY 002

  4. INTRODUCTION • TUMORS OF THE SELLAR REGION • Pituitary adenomas are the most common sellar tumors • after the age of 30 and they represent 10% of all • intracranial tumors • OTHER TUMORS • May mimic pituitary tumors radiologically and clinically • Craniopharyngiomas • Meningiomas • Rathke's cleft cysts • Epidermoid tumors • Arachnoid cyst • Carotid aneurysms • Others • ANATOMY OF THE SELLAR REGION FULLY ENDOSCOPIC SELLAR AND PARASELLAR SURGERY 004

  5. INTRODUCTION • BRIEF HISTORY • Transcranial, 1889, Victor Horsley • Transseptal Transsphenoidal, 1909, Harvey Cushing (Schloffler, Kanavel, Halstead, Hirsch, and others) • Microsurgical transsphenoidal, 1970s, Jules Hardy • Early trials with the endoscope, 1970’s – 1990’s (Guiot, Apuzzo, others) • MODERN ENDOSCOPIC PITUITARY SURGERY • Early 1990s, Endoscope-Assisted, (Including a series of patients at the SBI demonstrated 33-49% residual tumor only recognized with the endoscope) • Fully Endoscopic • OPEN TRANSCRANIAL FULLY ENDOSCOPIC FULLY ENDOSCOPIC SELLAR AND PARASELLAR SURGERY 006

  6. THE FULLY ENDOSCOPIC ENDONASAL APPROACH • ADVANTAGES • A completely endonasal approach • A targeted approach • A more clear visualization - Contact anatomy • A panoramic view - Angled endoscopes • A more complete operation leading to a lower rate of recurrence • FULLY ENDOSCOPIC ENDONASAL APPROACH FULLY ENDOSCOPIC SELLAR AND PARASELLAR SURGERY 008

  7. THE FULLY ENDOSCOPIC ENDONASAL APPROACH OPERATION ROOM SETUP FULLY ENDOSCOPIC SELLAR AND PARASELLAR SURGERY 010

  8. THE FULLY ENDOSCOPIC ENDONASAL APPROACH OPERATIVE TECHNIQUE FULLY ENDOSCOPIC SELLAR AND PARASELLAR SURGERY 014

  9. FULLY ENDOSCOPIC TRANSCRAIAL APPROACHES TRANSGLABELLAR SUPRAORBITAL SUBTEMPORAL FULLY ENDOSCOPIC SELLAR AND PARASELLAR SURGERY 016

  10. ENDOSCOPIC VS. MICROSCOPIC APPROACH DEMOGRAPHIC INFORMATION (November 1998 - October 2006) FULLY ENDOSCOPIC SELLAR AND PARASELLAR SURGERY 018

  11. ENDOSCOPIC VS. MICROSCOPIC APPROACH TUMOR CHARACTERISTICS FULLY ENDOSCOPIC SELLAR AND PARASELLAR SURGERY

  12. ENDOSCOPIC VS. MICROSCOPIC APPROACH COMPLICATION RATES a. Results of a national survey (Ciric et al., 1997) Reference: Kabil MS, Eby JB, Shahinian HK: Fully Endoscopic Endonasal vs. Transseptal Transsphenoidal Pituitary Surgery.  Minim Invasive Neurosurg. 2005 Dec; 48(6):348-54. (An earlier series, 300 patients) Reference: Kabil MS, Eby JB, Shahinian HK: Fully Endoscopic Transnasal vs. Transseptal Transsphenoidal Pituitary Surgery. Neurosurg. Q 15(3):2005. (An earlier series, 300 patients) FULLY ENDOSCOPIC SELLAR AND PARASELLAR SURGERY 020

  13. SUMMARY AND CONCLUSION • SUMMARY • Endoscopy provides distinct advantages over microscopy • Allows for focus on preserving neurological function and reducing morbidity • Modern pituitary surgery has few complications and requires only a short hospitalization • CONCLUSION • Skull base surgery has benefited significantly from advances in biotechnology • Impact upon the efficacy of tumor resection and subsequent rates of recurrence is significant • New stereoscopic endoscopes FULLY ENDOSCOPIC SELLAR AND PARASELLAR SURGERY 022

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