Endoscopic endonasal transsphenoidal approach of sellar tumors with suprasellar extension / Adel Mohamed ELmetwally Azzam ; Supervised Wael Mokhtar Elmahdy , Hazem Abdelbadee Ahmed , Hossam Mahmoud Elbosraty

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Neurosurgery

Background Transsphenoidal approach usually is the preferred method for treatment of sellar tumors with suprasellar extension because of a lower risk of complications. Microscope has been used alone in treatment of such tumor for long time. Recently, endoscope has been introduced as an alternative and effective tool in transsphenoidal surgery.During the endoscopic approach, the wide view of the nasal anatomy allows the surgeon to determine the appropriate level of entry into the sphenoid sinus more easily (either by visualizing the sphenoid ostia or the level of the superior turbinate). This wide angle of view and superior visualization of the sphenoid anatomy provide excellent information regarding superior and inferior limits of the sella. Pre-operative multisliced axial and coronal CT scans are very helpful as they allow a detailed display of major bony structures which act as anatomical landmarks of the endoscopic route. Complete hormonal profile should be done on the third post-operative week to assess the pituitary functions, to start the adequate replacement therapy if required, and to compare between the pre-operative and the post-operative hormonal profile. Any patients with post-operative visual deterioration or disturbed conscious level, follow up CT and MRI brain must be done as fast as possible to exclude postoperative intracranial abnormalities. In this way, it should be possible, by educative measures, to stimulate young neurosurgeons to learn this endoscopic technique, providing them with all the opportunities and encouragements in acquiring competence in this field. Aim of the work The objective of this study is to evaluate the feasibility, safety and efficacy of endoscopic endonasal transspenoidal approach of sellar tumors with suprasellar extension clinically and radiologically. Patients and Methods Retrospective review of the records of the patients with sellar tumors with suprasellar extention admitted to Kasr El Ainy hospitals within the last two years as well as their follow up records to detect their outcome. Results This work was carried out on 50 patients. 41 patients undergo total excision while nine patients undergo subtotal excision of these tumors. Most of them had a good outcome. All patients showed visual improvement post-operatively except three patients had stationary visual impairment. Post hormonal profile for all patients was normal except four cases which hormonal levels decreased but not normalize. The most common post-operative complications are CSF leak (four patients), DI (two patients) and death (one patient)

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