Endoscopic rhino-neurosurgical approach for non-adenomatous sellar and skull base lesions

Abstract

Objective: Since endoscopic endonasal transsphenoidal surgery requires skills of both neurosurgeons and otorhinolaryngologists, and the nose is the primary corridor of approach, we favour the term "endoscopic rhino-neurosurgery" and report on our interdisciplinary experience treating non-adenomatous lesions with skull base extension.Methods: Between 2004 and 2009, 58 patients with 21 different disease patterns underwent endoscopic rhino-neurosurgical procedures.Mean age was 39.9 years, 50% were female.Seven had undergone prior surgery.Clinically, 34.5% presented with visual field deficits and with nerve palsies.Preoperatively, 62.1% showed a normal pituitary function.Results: Mean follow-up was 13.1 months.The surgical goal depended on type of lesion; the intended extent of resection was achieved in 81%.Recovery from visual field deficits occurred in 80%.Neither deteriorated nor new cranial nerve palsies were observed.A normal endocrinological function could be maintained in 94.4%.Permanent diabetes insipidus occurred in 7 patients.Surgical complications included cerebrospinal fluid (CSF) leaks in 6 patients and meningitis in 4.All complications were managed successfully.There was no surgery-related mortality.Conclusion: The endoscopic rhino-neurosurgical approach is applicable for a wide variety of lesions comprising sella and skull base.As our data prove, this technique can be performed with satisfying results in non-adenomatous lesions as well.