导航引导下内镜扩大经鼻蝶窦入路切除鞍上区和第三脑室内颅咽管瘤

目的 探讨导航引导下完全内镜扩大经鼻蝶窦入路切除位于鞍上区和第三脑室内颅咽管瘤的可行性和有效性.方法 采用内镜扩大经鼻蝶窦入路、术中导航引导下切除3例位于鞍上区和第三脑室内的颅咽管瘤.结果 3例颅咽管瘤全切,手术效果好.术后随访10-14个月,患者生活正常,需要激素替代治疗.结论 内镜扩大经鼻蝶窦入路可以安全有效地切除位于鞍上区、第三脑室内的颅咽管瘤,这种手术方式不需要牵拉脑组织,并能完全暴露视交叉后、下方区域,在直视下操作,有利于对下丘脑、垂体柄及其他重要结构的保护.对于选择性的颅咽管瘤病例,内镜扩大经鼻蝶窦入路是切除肿瘤的一种新型微创手术入路.神经导航可以验证解剖标记点,引导手术方向,增加手术安全性.

Abstract：

Objective To investigate the feasibility and efficacy of image -guided extended endoscopic endonasal transsphenoidal approach(EEETA) for the removal of craniopharyngiomas in the suprasellar region and third ventricle. Method A pure EEETA with image -guided system was used. Three patients with a craniopharyngioma involving the suprasellar region and third ventricle were treated. Results Total craniopharyngioma removal was achieved in three cases. All the patients recovered uneventfully. The follow - up study was carried out for 10 to 14 months with good outcomes. Compensatory endocrine substitution therapy was needed in all of them. Conclusions The EEETA for removal of craniopharyngiomas in the suprasellar region and third ventricle is feasible and effective. It has the advantages of no needing for brain retraction,offering panoramic view of retrochiasmatic and infrachiasmatic regions,manipulating under direct vision and protecting hypothalamus,pituitary stalk and other vital structures. The EEETA is a novel and minimally invasive approach for selected cases of craniopharyngioma. Neuronavigation plays an important role in identifying anatomic landmarks,guiding surgical direction and increasing safety of the operations.     

神经内镜下经鼻蝶窦垂体腺瘤切除术并发症的防治

目的 探讨神经内镜下经单鼻孔蝶窦切除垂体腺瘤的并发症的防治.方法 对在神经内镜下经单鼻孔蝶窦切除垂体腺瘤253例临床资料分析.结果 肿瘤全切除216例(85.38%),次全切除26例(10.28%),部分切除11例(4.34%),无手术死亡病例.术后并发暂时性尿崩45例,术后垂体功能低下9例,脑脊液鼻漏2例,鼻腔黏膜出血2例,嗅觉丧失2例,无发生颈内动脉、视神经损伤,无蛛网膜下腔出血、颅内和局部感染,无鼻中隔穿孔.结论 神经内镜下经单鼻孔蝶窦垂体腺瘤切除术手术创伤小,术前做好评估,术中精细操作,术后并发症可减至最小,是一种安全、有效的治疗方法.

Abstract：

Objective To discuss the complicatiaons's prophylaxis of removing pituitary adenomas of neuroendoscopy in tranasphenoidal surgery. Method To analayze 253 cases Clinically date of pituitary adenoma were treated by endoscopic endonasal transsphenoidal surgery. Results The tumor removal was total in 216 ( 85.38% ) cases, subtotal in 26 ( 10. 28% ), and partial in 11 ( 4. 34% ). Temporary diabetes insipidus in 45 cases, pituitary function subnomorlity in 9 cases, cerebrospinal fluid leaks in 2 cases, nostril stenoses in 2 cases, anodmia in 2 cases, there were no internal carotid artery and optic nerve lesion, no subarachnoid hemorrhage and intracranial infection, no nasoseptal tresis. Conclusions Featured by minimal invasion and less postoperative complications, neurendoscopic endonasal transsphenoidal surgery is a safe and effective method for the treatment of pituitary adenoma.     

经鼻内镜治疗颅底肿瘤的回顾性分析

<正>内镜经鼻入路(endoscopic endonasal approach,EEA)颅底肿瘤切除一直是近几年来神经外科和耳鼻喉-头颈外科共同研究的热点。其利用自然的鼻腔解剖腔隙通过黏膜及下方鼻窦或骨质到达颅底各区域,提供了一条隐蔽而直接的治疗通道,最终达到体表皮肤无切口的外科途径治疗疾病的理想效果。总结近20a国内外内镜经鼻入路治疗颅底肿瘤的相关文献结合笔者的体会,从手术入路解剖、内镜操作技术、     

扩大的内镜下经鼻至斜坡腹侧区入路手术的相关解剖研究

Objective To define the exposure extent of the ventral part of the clivus under the extended endoscopic endonasal approach,important anatomical landmarks and the distance between each other via this approach.Methods Twenty formalin-fixed intact adult human head-neck specimens,in which only the arteries was injected with red latex,were longitudinally and coronally dissected to evaluate the surgical key steps and the advantages and limitations via extended endoscopic endonasal approach and selected measurements were obtained.Five fresh and intact head-neck specimens were used to perform analogical operation via the extended endoscopic endonasai approach to the ventral part of the clivus.The surgical exposure of main landmarks in the clivus was extended under endoscope and microscope,and the interactions and distances between the landmarks were studied.ResultsAnatomic landmarks of the approach included the middle turbinate,the choana narium,the Eustachian tube ostium,and the nasopharynx mucosa,the aperture of sphenoidal sinus,the longus capitis,the longus colli,the basion,the internal carotid artery and the sphenopalatine artery.The distances between the anterior nasal spine and both the pharyngeal tubercle and the basion were (78.23±2.58) mm and (89.60±2.52) mm,respectively.The shortest distance exposuring ventral region of clivus completely should be (89.60+2.52) mm.The exposure in the inferior wall of sphenoid sinus and the lower clivus was limited by pterygoid canal and foramen lacerum,and the average distances from the median line to them were (9.22±0.52) mm and (9.70±0.70) mm,respectively; no significant difference between the left and right was found (P>0.05).Conclusion knowing the anatomical structure,understanding its connection with the brain tissue and its exposure extent of the ventral part of the clivus are the major problems that need to be solved in the extended endoscopic endonasal approach.     

扩大的内镜下经鼻至斜坡腹侧区入路手术的相关解剖研究

Objective To define the exposure extent of the ventral part of the clivus under the extended endoscopic endonasal approach,important anatomical landmarks and the distance between each other via this approach.Methods Twenty formalin-fixed intact adult human head-neck specimens,in which only the arteries was injected with red latex,were longitudinally and coronally dissected to evaluate the surgical key steps and the advantages and limitations via extended endoscopic endonasal approach and selected measurements were obtained.Five fresh and intact head-neck specimens were used to perform analogical operation via the extended endoscopic endonasai approach to the ventral part of the clivus.The surgical exposure of main landmarks in the clivus was extended under endoscope and microscope,and the interactions and distances between the landmarks were studied.ResultsAnatomic landmarks of the approach included the middle turbinate,the choana narium,the Eustachian tube ostium,and the nasopharynx mucosa,the aperture of sphenoidal sinus,the longus capitis,the longus colli,the basion,the internal carotid artery and the sphenopalatine artery.The distances between the anterior nasal spine and both the pharyngeal tubercle and the basion were (78.23±2.58) mm and (89.60±2.52) mm,respectively.The shortest distance exposuring ventral region of clivus completely should be (89.60+2.52) mm.The exposure in the inferior wall of sphenoid sinus and the lower clivus was limited by pterygoid canal and foramen lacerum,and the average distances from the median line to them were (9.22±0.52) mm and (9.70±0.70) mm,respectively; no significant difference between the left and right was found (P>0.05).Conclusion knowing the anatomical structure,understanding its connection with the brain tissue and its exposure extent of the ventral part of the clivus are the major problems that need to be solved in the extended endoscopic endonasal approach.     

内镜下经鼻腔-蝶窦入路手术并发症分析与防治

目的 分析内镜下经鼻腔-蝶窦入路手术常见并发症发生原因并探讨防治措施.方法 对我院2009年1月至2010年8月259例内镜下经鼻腔-蝶窦手术病历资料进行回顾性分析.结果 住院期间各类并发症总计31例,其中术中大出血2例,术后术区血肿2例,脑脊液鼻漏6例,垂体功能低下8例,尿崩4例,电解质紊乱4例,鼻衄3例,动眼神经麻痹1例,脑膜炎1例,因颅内血肿死亡1例,因颅内血肿行二次手术清除1例,脑脊液鼻漏行二次手术修补2例.出院后204例病例经3-18个月随访(平均7.3个月),肿瘤复发5例,鼻衄1例,失嗅2例,鼻腔粘连1例,垂体功能低下2例.结论 内镜下经鼻腔-蝶窦手术与传统手术方式相比,手术损伤明显减少,但仍可发生多种手术并发症,并发症的预防和处理要求医护人员必须具备丰富的临床经验及多学科专业知识的积累.

Abstract：

Objective To discuss the prevention and treatment of the complications in endoscopic transsphenoidal surgeries. Method From January 2009 to August 2010,259 patients received endoscopic transsphenoidal surgery were analyzed. Results The complications in hospital were intraoperative massive hemorrhage(0. 8% ) in 2 cases,postoperative intracranial hematoma(0. 8% ) in 2,CSF leak(2. 3% ) in 6,pituitary hypofunction(3. 1% ) in 8,diabetes insipidus( 1.5% ) in 4,electrolyte disturbance( 1.5% ) in 4,epistaxis ( 1.2% ) in 3 ,oculomotor nerve palsy(0. 4% ) in 1 and meningitis(0. 4% ) in 1. After a follow - up of 204 patients for 3 - 18 months ( average 7. 3 months ), 5 patient were recurrent ( 1. 9% ), 1 epistaxis (0.4%) ,2 anosmia(0. 8% ), 1 adhesion of nasal cavity (0. 4% ) and 2 pituitary hypofunction (0. 8% ).Conclusions Endonasal transsphenoidal approach tends to present mainly fewer damage than traditional style. But we must be aware of the complications, and the prevention and treatment need more clinical experience and multi -disciplinary knowledge.     

神经内镜高血压脑出血微创手术的三维重建手术定位

目的 探索神经内镜高血压脑出血(HICH)微创手术术前精确可靠的手术定位方法.方法南方医科大学珠江医院神经外科自2008年6月至2010年8月通过CT扫描及图像三维重建的方法定位脑内血肿、选择最佳内镜微创手术入路行神经内镜微创术治疗HICH患者18例,分析患者的临床资料和疗效.结果 根据CT三维重建结果,术者可以准确设计最佳内镜微创手术入路并实现颅骨钻孔部位的精确定位,减少手术前准备、麻醉及操作时间.本组患者平均手术时间仅1.5 h左右,手术失血量仅30～40mL,血肿清除率约为89.2%,且血肿清除后脑组织松弛,无需行去骨瓣减压.结论 HICH患者采用CT扫描、三维重建进行术前手术定位是一种快速、简便、可靠的神经内镜微创脑出血手术定位方法.

Abstract：

Objective To develop a simple, fast and accurate preoperative planning method for endoscopic surgery of patients with hypertensive intracerebral hemorrhage (HICH).Methods Eighteen patients with HICH, admitted to our hospital from June 2008 to August 2010, were performed endoscopic minimally invasive surgery; CT three-dimensional reconstruction was employed to locate the intracerebral hematoma and select the appropriate endoscopic approach before the endoscopic surgery.The clinical data and treatmem efficacy were analyzed.Results According to the results of CT three-dimensional reconstruction, our neurosurgeons could design the best endoscopic approach; the three-dimensional relationship between intracerebral hematoma and scalp markers was shown directly and accurate positioning of the location of drilling was achieved; therefore, the time for preoperative preparation, anesthesia and operation was shortened. The mean operating time of these 18 patients was about 1.5 h; the volume of blood loss was only 30-40 mL; and the evacuation ratio was about 89.2%.After the elimination of hematoma, the brain tissues were flabby, so decompressive craniectomy was not needed. Conclusion CT three-dimensional reconstruction is a simple, fast and accurate preoperative planning method for endoscopic surgery of patients with HICH.     

经蝶窦垂体腺瘤手术中发生脑脊液漏的原因和防治

目的 探讨经蝶窦入路垂体腺瘤手术中发生脑脊液漏的常见原因及其防治方法.方法 回顾性分析260例显微镜下、274例神经内镜下经蝶窦垂体腺瘤切除术中,46例术中发生脑脊液漏,其中显微镜手术24例,神经内镜手术22例.术中多用人工干燥硬脑膜或自体脂肪及纤维蛋白胶修补,蝶窦内填明胶海绵,对于肿瘤体积巨大,鞍底骨质广泛破坏甚至消失者,用骨片填放于蝶窦内固定填塞的软组织.根据术中修补情况36例术后即刻行腰大池置管持续引流.结果 术中修补46例脑脊液漏,术后13例发生脑脊液漏,经腰大池引流3-6 d愈合;6例发生细菌性脑膜炎,经腰大池引流治愈.结论 术前应充分估计容易发生脑脊液漏的患者,手术操作格外小心,并准备好修补措施;应用自体脂肪及纤维蛋白胶修补经蝶窦垂体腺瘤术中脑脊液漏是有效的方法;如果术后发生脑脊液漏或细菌性脑膜炎,则需要腰大池置管持续引流.

Abstract：

Objective To analyze the causes and prevention and treatment of cerebrospinal fluid leak during transsphenoidal pituitary adenoma surgery.Methods Retrospective study of 260 cases of microscopic transsphenoidal surgery and 274 cases of endoscopic surgery for resection of the pituitary adenomas was performed.CSF leak occurred in 24 cases with microscopic surgery and in 22 cases with endoscopic surgery during operation.The sellar floors were sealed by artificial dried dura or free autogenic fat and fibrin glue for the CSF leakage during surgery.For giant tumors which extensively destroyed sella floor,we put bony plates in sphenoid sinus to support the crammed tissue.Lumber drainage was performed immediately after operation in 36 cases.Methods In the 46 patients with CSF leakage during surgery,13 cases occurred CSF leakage postoperatively,cured in 3-6 days after lumber drainage.6 patients occurred bacterial meningitis,cured after long term lumber drainage.Conclusion Probability of CSF leak before transsphenoidal surgery should be estimated,and preparation for the fixing up the leak is necessary.Using free autogenic fat and ebonite to repaired the sellar floors in case of CSF leakage during surgery is a effective measurement.Patients with CSF leakage or bacterial meningitis after surgery require lumber drainage.     

神经内镜下经鼻蝶窦入路垂体腺瘤切除术

本文通过分析神经内镜下经鼻蝶入路切除垂体肿瘤的解剖基础、手术方法、技术要点、优势及并发症等，并对传统开颅手术、经蝶显微镜下垂体瘤切除术与神经内镜手术进行比较，认为神经内镜下的视野明显广于显微镜，且内镜手术失血少，损伤少，能够减少疼痛，减少手术及住院时间，更符合微侵袭手术的要求。内镜经鼻蝶垂体瘤手术是一种简捷、迅速、安全、有效的手术入路，具有广阔的应用前景。     

CT仿真内镜在内镜经鼻蝶窦垂体瘤手术中的应用

目的 探讨CT仿真内镜( CTVE)技术在神经内镜经鼻蝶窦垂体腺瘤手术中的应用价值.方法 自2010年9月至2011年6月,应用神经内镜行经鼻蝶窦垂体瘤切除术38例,患者术前均行蝶鞍区320排CT容积扫描,进行CT仿真内镜图像重建,将术前CTVE和术中神经内镜图像进行比较,分析两者在该手术入路过程中的相关性及吻合度.结果 CTVE可于术前模拟神经内镜经鼻蝶窦垂体瘤手术,显示手术入路过程中各个解剖结构.CTVE能于术前很好显示鼻腔、蝶窦、鞍底及周围解剖标志的三维图像,与术中内镜图像非常相似,解剖结构的吻合度良好,而蝶窦的大小、气化程度和分隔情况是影响CTVE图像的重要因素.结论 CTVE不仅可以成为内镜垂体瘤手术的训练工具,而且能够在术前直观地显示患者手术入路过程中个性化的解剖结构及变异,指导术前计划、提高手术操作的安全性.     

内镜下经单鼻孔蝶窦入路垂体瘤切除术的改良手术配合

目的 通过手术器械的改进与应用,提高神经内镜下经鼻蝶入路垂体瘤切除术的手术效率,总结手术配合的经验.方法 南方医科大学南方医院神经外科自2004年3月至2009年4月采用经单鼻孔鼻中隔蝶窦入路切除垂体瘤288例,术前改进各种手术器械(单极电凝器、吸引器的形状和功用)并应用,总结分析手术的疗效.结果 本组垂体瘤全切除204例,次全切54例,大部分切除30例.手术时间最短30 min,术中无脑脊液漏患者手术时间平均70 min;术后并发脑脊液漏3例,鼻黏膜迟发性出血3例,经治疗后控制.结论 手术器械的改进与正确应用,加上默契的手术配合,可以提高神经内镜下经单鼻孔鼻中隔蝶窦入路垂体瘤切除术的效率.     

内镜下经鼻蝶入路垂体腺瘤切除与鞍底重建

目的探讨内镜下经单鼻孔蝶窦入路切除垂体腺瘤及鞍底重建的方法。方法52例垂体腺瘤患者,在内镜控制下,经单鼻孔进入,直接自蝶窦开口打开蝶窦前壁,经鞍底切除垂体腺瘤,术中有脑脊液漏者,使用多层修补法修补鞍底。结果术中颈内动脉损伤1例。39例垂体瘤全部切除,13例垂体瘤次切除。术后随访3个月。术前39例有视力下降和视野缺损者,术后一个月内均改善。术后发生脑脊液漏1例,发生率为1.9%。12例术后发生暂时性尿崩症。6例术前激素水平增高的患者术后下降到正常水平。无颅内感染及死亡病例。结论内镜下经鼻蝶入路是一种能有效切除垂体瘤的微侵袭手术方法;鞍底多层修补能安全有效预防脑脊液漏的发生。     

无框架MRI导航下的内镜经蝶鞍区肿瘤切除术

目的探讨无框架MRI导航系统在内镜经蝶垂体腺瘤和颅咽管瘤切除术中的作用.方法对8例垂体腺瘤和2例颅咽管瘤病人在无框架MRI影像导航引导内镜下经蝶入路切除肿瘤.结果机器定位误差平均1.5mm,重要结构和病变定位满意,导航注册时间平均5 min,手术时间平均50min,术后病人症状均减轻.结论在内镜经蝶鞍区手术治疗中,无框架影像导航使重要结构及病变定位准确,可在手术中发挥重要作用.     

Preservation of hormonal function by identifying pituitary gland at endoscopic surgery

ObjectiveThe endonasal endoscopic approach has been established for perisellar tumor surgery with a higher resection rate and reduced complications. We analyzed the potential to identify the pituitary gland under endoscopic view, at surgery and see its relation to postoperative hormonal insufficiency in endonasal endoscopic procedures.MethodsBetween January 2011 and January 2014, 70 cases of pituitary adenomas with preoperative intact pituitary function underwent endoscopic endonasal transsphenoidal procedures for intrasellar pathologies. Endocrinologists and neurosurgeons followed these patients prospectively. Special attention was paid to intraoperative identification of gland tissue, surgical complications, degree of resection and postoperative hormonal insufficiency.ResultsThe pituitary gland was identified in 57 out of 70 procedures (81.4%). Eleven percent (8 of 70 patients) had persistent pituitary insufficiency. Two of these 8 patients belonged to the group with pituitary gland identification (2 out of 57); thus, when the pituitary gland was identified during the procedure postoperative hormonal insufficiency was seen in 3.5% of cases. Failure of pituitary gland identification presented with hormonal insufficiency of 46.2%. In analysis with Fisher’s exact test, there was a high significant correlation between the identification of the pituitary gland intraoperatively and normal pituitary function postoperatively (p < 0.005). On follow up radical tumor resection was seen in 88% (62 of 70 patients).ConclusionsThis study indicates that identification and preservation of pituitary gland tissue and function is possible in endoscopic transsphenoidal surgery. This preservation of gland tissue is a positive predictor of postoperative normal pituitary function.     

神经导航内镜下经单鼻孔蝶窦入路切除垂体腺瘤(附18例分析)

目的探讨神经导航结合内镜在经鼻蝶入路切除垂体腺瘤手术中的应用价值。方法回顾性分析18例大型垂体腺瘤病人的临床资料,均在神经导航下行内镜经鼻蝶入路肿瘤显微切除术。术前行薄层头颅CT扫描,采集导航数据;术中运用导航定位引导,单侧鼻孔进入,在内镜及导航引导下进行瘤体切除;术中改在显微镜下操作5例。结果肿瘤全切除13例,次全切除4例,大部切除1例。术中无定位偏差发生。无手术死亡病例,术后无永久性尿崩和脑脊液漏发生,术前视力和视野障碍病人术后均无恶化。结论神经导航内镜经鼻蝶入路切除垂体腺瘤定位准确,能明确肿瘤与周边重要解剖结构的关系,增加手术的安全性,提高手术疗效。     

美国《化学文摘》、《乌利希国际期刊指南》及波兰《哥白尼索引》正式收录本刊

美国《化学文摘》(Chemical Abstracts,CA)是世界最大的化学文摘库,也是目前世界上应用最广泛,最为重要的化学、化工及相关学科的检索工具。CA创刊于1907年,由美国化学协会化学文摘社(CAS)编辑出版,为国际六大著名检索期刊之一。     

Endoscopic endonasal pituitary surgery: surgical and outcome analysis of 50 cases.

OBJECTIVE: Microsurgical transsphenoidal surgery for pituitary tumors has been standard therapy for decades and was established by Harvey Cushing in the early twentieth century. Today, endoscopy is increasingly accepted in the therapy of pituitary lesions. In this retrospective study, we analysed the surgical technique and outcome of 50 patients with pituitary lesions treated with an endoscopic endonasal trans-sphenoidal approach. METHODS: Between January 2004 and July 2005, 50 patients (30 female and 20 male) with pituitary tumors were operated upon using an endoscopic endonasal trans-sphenoidal procedure without nasal speculum or postoperative nasal packing. The follow-up period ranged from 3 to 18 months. RESULTS: All patients had normal airways through both nostrils immediately after extubation. Postoperative discomfort was minimal and hospitalization was 4-5 days. Three patients developed postoperative transient diabetes insipidus, persisting in one for a further 2 months. Among the 50 patients, total tumor removal was achieved in 47 patients (94%), subtotal in two patients (4%). One patient died intraoperatively due to subarachnoid haemorrhage. CONCLUSION: The endoscopic endonasal transsphenoidal approach for removing pituitary lesions is a form of minimally invasive surgery offering excellent postoperative results.     

内镜经鼻垂体腺瘤切除术

目的 探讨内镜经鼻垂体腺瘤切除术的外科技术.方法 总结2003年9月至2006年3月100例内镜经鼻垂体腺瘤手术病人的临床资料.其中微腺瘤30例,大腺瘤35例,巨大腺瘤35例.功能性腺瘤68例,无功能性腺瘤32例.头痛82例,视力减退伴视野缺损76例,失明3例,闭经、泌乳36例,肢端肥大26例,垂体功能低下15例,其他症状者6例.结果 术中内镜下肿瘤全部切除93例,大部切除7例,7例均为质地硬韧的纤维型腺瘤.术后短暂性尿崩症32例;脑脊液鼻漏5例.术后随访平均28个月,肿瘤残余者10例;12例肿瘤复发,10例再次行经蝶手术,2例行开颅手术;术后内分泌症状改善不明显者,有11例行溴隐亭治疗,18例病人行伽玛刀治疗.结论 内镜经鼻垂体腺瘤切除术是一种安全、有效、微创的外科技术.     

垂体瘤的单鼻孔神经内镜下手术治疗

目的 探讨经单鼻孔蝶窦入路神经内镜下垂体腺瘤切除手术技术.方法 回顾总结47例近期临床资料,分析术式的优缺点和克服其弊端的方法.结果 47例神经内镜下经鼻碟窦手术组肿瘤全切除39例,次全切除8例,平均手术时间85 min.后27例平均手术时间及肿瘤全切率与前20例有显著差别.结论 经单鼻孔蝶窦垂体瘤神经内镜手术技术简便、安全和有效.神经内镜手术更加微创,在经鼻碟窦入路过程及鞍区肿瘤切除方面具有优势,可提高肿瘤全切率.对该术式的技术技巧的掌握将进一步发挥神经内镜的优势.     

Surgical complications after endoscopic transsphenoidal pituitary surgery

Between January 2004 and June 2007 we conducted a retrospective analysis to assess post-operative complications related to endoscopic pituitary surgery in a series of 150 patients. Patients were treated with an endoscopic endonasal transsphenoidal approach to the sellar region for removal of pathological sellar and suprasellar lesions. We analysed the complications in groups according to the anatomical structures of the approach and the functional systems of the pituitary gland (anterior and posterior endocrine systems), and compared them to a large historical series using the traditional microsurgical transsphenoidal approach. Overall, we observed a decreased incidence of complications with respect to the surgical trauma, the functionality of the pituitary gland and post-operative patient comfort. We believe that the reduction of the complication rate observed in this study was mainly due to the wide structural overview offered by the endoscope as well as the anatomically direct, and therefore minimally invasive, character of the procedure. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Furthermore, close cooperation between a multidisciplinary team consisting of endocrinologists, neurosurgeons, ear, nose and throat surgeons, radiologists, and radiation oncologists is of utmost importance.