Endoscopic Endonasal Cavernous Sinus Surgery

0 downloads 0 Views 4MB Size Report
neoplasms because it allows a true definition of cavernous sinus invasion, ..... After dural opening the pituitary adenoma is removed with the combined use of ...
llùsLR Jr SheehrnlP (cds) Piluirar] Surgerv A NlrlcnL5ppruxto Frontllorn R.: Bisel. Kxfger,200tr.roll.1.pp6,1 8:

EndoscopicEndonasalCavernous Sinus Surgery,with Special Referenceto Pituitary Adenomas CiurgiaFnnk, ErnestoPatquí i Ccnrre ofsurgcrvfor Piruitary Tùhours, Dep.rn,cÌîofNeun)scjcDce. Be|a.ia llospilal,Bolosra. IÌaly

Ca\ernoùssinùssurecryhas al*,aysbeer ! sùgical cha|engcbecause of rhe hish iiLnction.limpofianceofd,js regìonlnd the assooi.rcdhigh moùidiry. rhc aùemenred periphcralvìsloùofthe endoscope hastcd to the dcvclolmenrof strgic.l rypeuchestbrt rlk\r .dequaîccxporúe of the caven,ous sinus.ù.ittra reductionr! surgicalmorbidir]. s,ncc 1998.ó5 parlerlswith pixriraryadcnomas andìntraopefurn.c cvldenceofcaremou\ sDusmvasonslrc trealed\!iù a pùrelycùdoscopic aFproach. Fìrltovup lrs ofat leasl6 (frean51 2) months.ThereNasno |eiopcrarile noraÌily rnd cxrrcmeÌykN Ìrorbidilr. Radicalnnbr rcmovalwa\ obhired ìn 21135.a\es rllh nontuÌclroningadcnomas. Hornonalrehission*6 obLaircdin 11,130 iinctioningadcDom.s. Ore patieù virhprutiaÌ ìrypopiruitiùsm and I parienrsirh pcrsisrerldjabcres insjpidusilere \eeÌ. Threeparìcnts {irh deLrycd CSFÌeaksrcqùiedendosopìcrepaìr.tn I prricnrwilh hemonùaeic ijjfa.clioù ùr a residulltuùor. ìeintcNtnlioÌ riih ùarn)tomvras neccssary \fe nd\ocrtetheceÌrml roÌeof lurgcq,ii ùe trcltmenrolcavcùoùs\inustùùor!. sifcc i aÌtovsdciìnilionoîh.uc cavernoùs smrs rnvolvcùrcrr. hlsropathoÌogicàt diaSlosi\dnd Rhen.urc is nor feasìbtc. tumorloluÌrc redùcrion,whichnighl be an nrpofidr frctq ìr rheresponsc to adjuvait

C,ìvernoussiùussurgcr) hasal\\,aysbeena surgicalchallengeduc ro the an romicalcomplexilyandthe higlÌ finctional vahreollhe srructurcs containcd rn thisleùelt' box .

\\'jnsloù [ | ] gavethe c,l\.ernous sirÌusis nanlein I 73.1.probabtyrelatingit ]ìe ca\emousbody oîthe penjs.For centuriesthis anatonricîl sr;Ìrúur! Í:as : :Ìnsscd or misundeNoodblr anaromìsrs, and fòr surgeonsìr \{:rsa .no manìs :ìJ Ahhougi lts originatdenomìnarìon rcrmjnsin currentuse.it is critjcizcd ihoscwho hale undertined thatit is nol a duralsinur.n", pf..", B| "*".* Sxrccthe 1960sù,henparkinson[3] detjbcrarelyenrcred lhe caven;u: . _rs ro treat a long-standingartcriovenous fistrìla. surgjcalintercst in rhis '::rin hasrncreased togetherù,ith anatomicatkno\ltcdge.parkìnson atso [2] rposcda more approprìarc namc f-orrlis rcgioni the.iateral se ar cànparr_ j . coÌìtajningthe'patasellarplcxus,. Trarscmnialsurgerywasjnjtially usedforthc trealrnent ofcavcrnoussìnus .ìors. mainl]'duero the safcrygivenby theprorimal and disralcontrolofthe :::rn|l caroridarlery (ICA). This tnc of surgeq/has increasingty clecreascd .rl\ duero theappearance ofaltenìati\,cnon surgjcalthcrapìes, suchasr,rttio_ . .rgcrytandparty duero jts high morbidity. Onc ofrhc mos;ùrìous skull base . .r. . gcùn\ InJeed$rnrc .rb^1,c,r\crna '

:,husrasm u,ilìundoubrc,rry bct..p...di"Ìi;:-T,ìì$::1,lil,#l.T*l

. .àrrorìsrhatwiìt bc encountercd in somepaiìents.[.1]. ( u er ||) c. \ernnL. .irLs qL gery r5 c c /(rr h) .orìì( dJho\ .5_. '. e'. the n r. o ctiùc., rmpro\Hnenr rìd r\oiorngdJ,rrgi rgrh; -cìi (ae -r efnoussjnus.The tberapyoîcavrrnoussìnustumon is maintymultiàiscr:plirr\. xnolving primarìly the endocrìnologist. oncoiogist.iìdiolherapistancl . .rlreoD.SurgerystiÌìrcmainsa cornerslone In the treatmcntofca'ernoìs sjnus ::ùplasms bccauscir allows a ruc cleîjnitionof cavernous sjnlìs i,n"sbÌì. ' ,'trrlìo'ugic. . dircnusi..lLmor,lel.rlkrnr arL .n .omec,r\(\.J (Lr( ot rt-c '.'