Sella access technique?

[AngkorWuT]

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Neurosurgical attending stated there were no advantages in reality (but not in theory) of an endoscopic versus microscopic approach to the sella.

It seems like the oto literature supports endoscopic approaches citing better visualization during the transnasal approach (same for transethmoidal and translabial) versus microscopic. Also they cite better visualization of the supra-, para- and intrasellar spaces during tumor removal. According to Strychowsky et al, 2011 (J. of Oto HNS), complications also were lower with the endoscopic approach (as well as gross tumor removal). However, there's gotta be some bias since most of the things I've read are dong by ENT's not neurosurgeons.

Essentially, neurosurgery said it was just professional courtesy to allow ENT to do the initial approach. I had never seen a microscopic approach until residency, as my previous institution always used ENT for the approach whereas now it varies. IMHO, ENT's approaches always seem more elegant whereas NSURG kind of treats the nasal cavity as a wall meant to be busted through.

Would like to hear your opinions on this.

 

[neutropeniaboy]

Sure.

I consider it a professional courtesy to involve neurosurgery in 90% of my acoustics.

 

[neusu]

Sure.

I consider it a professional courtesy to involve neurosurgery in 90% of my acoustics.

We appreciate that.

To answer the original question, there is no evidence based benefit to endoscopic approaches. Neurosurgeons like the microscope better because it allows for 3-dementional visualization as well as the ability to work with two hands. Agreed, there are 3D scopes and 3-hand techniques. Nonetheless, most surgeons trained initially on microscopes and therefore prefer them.

 

[neutropeniaboy]

We appreciate that.

To answer the original question, there is no evidence based benefit to endoscopic approaches. Neurosurgeons like the microscope better because it allows for 3-dementional visualization as well as the ability to work with two hands. Agreed, there are 3D scopes and 3-hand techniques. Nonetheless, most surgeons trained initially on microscopes and therefore prefer them.

3D scopes are a fad that I am sure will die as soon as the da vinci or similar system improves its sinonasal access. I don't know any serious sinus surgeon or head and neck surgeon who believes 3D systems as they exist now are the way to go.

As far as pituitary surgery goes...

The benefit is the sinonasal quality of life outcomes, which neurosurgeons often overlook. As far as tumor resection, I am aware of no significant outcomes benefit.