Malleable endoscope increases surgical freedom compared with a rigid endoscope in endoscopic endonasal approaches to the parasellar region.

Document Type

Article

Abstract

BACKGROUND: One challenge when performing endoscopic endonasal approaches is the surgical conflict that occurs between the surgical instruments and endoscope in the crowded nasal corridor. This conflict decreases surgical freedom, increases surgeon frustration, and lengthens the learning curve for trainees.

OBJECTIVE: To evaluate the impact a malleable endoscope has on surgical freedom for endoscopic approaches to the parasellar region.

METHODS: Uninostril and binostril endoscopic transsphenoidal approaches to the pituitary gland and cavernous carotid arteries were performed on 8 silicon-injected, formalin-fixed cadaveric heads using both rigid and flexible 3-dimensional endoscopes. Surgical freedom to targets in the parasellar region was assessed using an established technique based on image guidance. Results are presented as 3 measurements: area of surgical freedom for a point target, area for the surgical field (cavernous carotids and sella), and angular surgical freedom (angle of attack).

RESULTS: Point target surgical freedom, exposed area surgical freedom, and angle of attack were all significantly greater in approaches using the malleable endoscope compared with the rigid endoscope (P values .06 to

CONCLUSION: This study demonstrates that application of a malleable endoscope to transsphenoidal approaches to the parasellar region decreases instrument-endoscope conflict and improves surgical freedom.

Medical Subject Headings

Cadaver; Humans; Neuroendoscopy; Nose; Pituitary Gland

Publication Date

9-1-2014

Publication Title

Neurosurgery

ISSN

1524-4040

Volume

10 Suppl 3

First Page

393

Last Page

399

PubMed ID

24818786

Digital Object Identifier (DOI)

10.1227/NEU.0000000000000411

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