Anatomia cirúrgica do acesso nasal transesfenoidal para tumores da hipófise

Meneses, Murilo S.; Rocha, Juliana G.; Gonçalves, Carolina G.; Petry, Anna Carolina M.; Ramina, Ricardo; Maniglia, João J.; Pedrozo, Ari A.

doi:10.1590/S0004-282X1997000300015

Resumos

Foram analisadas diferentes medidas relacionadas ao acesso nasal transesfenoidal em 18 hemicabeças de cadáveres com o objetivo de estudar os limites e vantagens dessa via. Foram obtidos os seguintes valores médios (mm) para as principais medidas: diâmetro maior da narina 15,18; altura da cavidade nasal 44,11; distância narina - sela turca 71,71. Esses valores demonstram ser o acesso nasal uma via ampla e direta à sela turca. O presente estudo demonstrou também ser possível nesse acesso preservar o septo cartilágino e outras estruturas que são usualmente lesadas no acesso sublabial.

anatomia cirúrgica; acesso nasal transesfenoidal; hipófise

Different distances related to the nasal transphenoidal approach were measured on the hemiheads of eighteen cadavers in order to study its limits and advantages. The main mean measures obtained (mm) were: major diameter of the nostril 15.18; height of the nasal cavity 44.11; nostril-sella turcica distance 71.71. These results show that the nasal approach is wide and direct to the sella turcica. The present study demonstrate the possibility of preservation of the cartilaginous septum and other structures which are usually damaged when the sublabial approach is employed.

surgical anatomy; nasal transphenoidal approach; pituitary gland

Anatomia cirúrgica do acesso nasal transesfenoidal para tumores da hipófise

Surgical anatomy of the nasal transphenoidal approach for pituitary tumors

Murilo S. Meneses^I^,^II; Juliana G. Rocha^II; Carolina G. Gonçalves^II; Anna Carolina M. Petry^II; Ricardo Ramina^I; João J. Maniglia^I; Ari A. Pedrozo^I

^IServiço de Neurocirurgia da Unidade de Ciências Neurológicas do Hospital das Nações, Curitiba

^IIDepartamento de Anatomia da Universidade Federal do Paraná

RESUMO

Foram analisadas diferentes medidas relacionadas ao acesso nasal transesfenoidal em 18 hemicabeças de cadáveres com o objetivo de estudar os limites e vantagens dessa via. Foram obtidos os seguintes valores médios (mm) para as principais medidas: diâmetro maior da narina 15,18; altura da cavidade nasal 44,11; distância narina - sela turca 71,71. Esses valores demonstram ser o acesso nasal uma via ampla e direta à sela turca. O presente estudo demonstrou também ser possível nesse acesso preservar o septo cartilágino e outras estruturas que são usualmente lesadas no acesso sublabial.

Palavras-chave: anatomia cirúrgica, acesso nasal transesfenoidal, hipófise.

ABSTRACT

Different distances related to the nasal transphenoidal approach were measured on the hemiheads of eighteen cadavers in order to study its limits and advantages. The main mean measures obtained (mm) were: major diameter of the nostril 15.18; height of the nasal cavity 44.11; nostril-sella turcica distance 71.71. These results show that the nasal approach is wide and direct to the sella turcica. The present study demonstrate the possibility of preservation of the cartilaginous septum and other structures which are usually damaged when the sublabial approach is employed.

Key words: surgical anatomy, nasal transphenoidal approach, pituitary gland.

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Aceite: 8-abril-1997.

Dr. Murilo S. Meneses - Av. Getúlio Vargas 2159 - 80250-180 Curitiba PR - Brasil.

1. Beahm EK, Becker EK, Cerullo JL. The transnasal approach to advanced lesions of the sphenoid sinus and pituitary. Otolaryngol Clin North Am 1991;24:1535-1557.
2. Bynke O. Hole of transsphenoidal operation in the management of pituitary adenomas with suprasellar extension. Acta Neurochir (Wien) 1989;100:50-55.
3. Ciric IS, Cozzens JW. Craniopharyngiomas: transsphenoidal metod of approach: for valuous only? Clin Neurosurg 1980;27:169-187.
4. Cook RS. Experience with the direct transnasal transsphenoidal approach to the pituitary fossa Br J Neurosurg 1994;8:193-199.
5. Cushing H. Weir Mitchell lecture: surgical experiences with pituitary disorders. JAMA 1914;63:1515-1525.
6. Dagi TF. Ocular and endocrine function in patients with pituitary tumors: operative results following transnasal, transsphenoidal approach with marsupialization of the sella tursica. Am Surg 1986;52:165-174.
7. Davis C. Transsphenoidal pituitary surgery [Letter]. Br J Neurosurg 1992;6:506.
8. Dott NM, Bailey P. A consideration of the hypophyseal adenomata. Br J Surg 1925;13:314-366.
9. Fahlbusch R, Buchefelder M. Transsphenoidal surgery of parasellar pituitary adenomas. Acta Neurochir (Wien) 1988;92:93-99.
10. Fraioli B, Esposito V, Santoro A. Iannetti G, Giuffrè R, Cantore G. Transmaxillosphenoidal approach to tumors invading the medial compartment of the cavernous sinus. J Neurosurg 1995;82:63-72.
11. Guiot G, Derome P: Surgical problems of pituitary adenomas. In Krayenbühl H et al, (eds) Advances and technical standards in neurosurgery Vol 3. New York: Springer-Verlag, 1976;7-33.
12. Hardy J. Transsphenoidal microsurgery of the normal and pathological pituitary. Gin Neurosurg 1969;16:185-216.
13. Hashimoto N, Handa H, Yamagami T. Transphenoidal extracapsular approach to pituitary tumors. J Neurosurg 1986;64:16-20.
14. Helal MZ. Combined micro-endoscopic trans-sphenoidal excisions of pituitary macroadenomas. Eur Arch Otorhinolaryngol 1995;252:186-189.
15. Honegger J, Buchfelder M, Fahlbusch R, Daubler B, Dörr HG. Transsphenoidal microsurgery for craniopharyngiomas. Surg Neurol 1992;37:189-196.
16. Kern EB, Laws ER Jr. The transeptal approach to the pituitary gland. Rhinology 1978;16:59-78.
17. Kern EB, Pearson BW, MacDonald TJ, Laws ER Jr. The transeptal approach to lesions of the pituitary and parasellar regions. Laryngoscope 1979;89:1-34.
18. Kònig A, Lübecke DK, Herrmann HD: Transnasal surgery in the treatment of craniopharyngiomas. Acta Neurochir (Wien) 1986;83:1-7.
19. Laws ER Jr, Onofre BM, Peason BW, MacDonald TJ, Dirremberger RA. Successful management of bilateral carotid-cavernous fistula with a transsphenoidal approach. Neurosurgery 1979;4:162-167.
20. Laws ER Jr. Transsphenoidal microsurgery in the management of craniopharyngioma. J Neurosurg 1980;52:661-666.
21. Laws ER Jr. Transsphenoidal approach to lesions in and about sella tursica. In Schmidek HH, Sweet WH (eds). Operative neurosurgical techniques. New York: Grune & Stratton, 1982, 327-341.
22. Lin SZ, Wang GF. Some anatomical data related to the transnaso-sphenoidal resection of pituitary fossa tumors. Chin Med J [Engl] 1986;99:602-605.
23. MacDonald TJ, Kern EB, Laos ER Jr, Pearson BW. Surgical approaches to the pituitary gland with emphasis on the transseptal route. Head Neck Surg 1979;1:498-504.
24. Maira G, Anile C, Rossi FG, Colosimo C. Surgical treatment of craniopharyngiomas: an evaluation of the transsphenoidal and pterional approaches. Neurosurgery 1995;36:715-724.
25. Nakane T, Kurwayama A, Watambe M, Kageyama N. Transsphenoidal approach to pituitary adenomas with suprasellar extension. Surg Neurol 1981;16:225-229.
26. Papay FA, Benninger MS, Levini HL, Lavertu P. Transnasal transeptal endoscopy repair of sphenoidal cerebral spinal fluid fistula. Otolaryngol Head Neck Surg 1989;101:595-597.
27. Papel ID, Kennedy DW, Chon E. Sublabial transeptal transsphenoidal approach to the skull base. Ear Nose Throat J 1986;65:107-116.
28. Patil AA, Chand A. Modifications of transnasal and transoral stereotactic procedures- technical notes. Acta Neurochir (Wien) 1995;134:46-50.
29. Rand RW. Fifteen years experience with trans-nasal trans-sphenoidal operation for pituitary tumors. In Brock H (ed). Modem neurosurgery 1. Berlin: Springer-Verlag, 1982:173-180.
30. Saito K, Kuwayama A, Yamamoto N, Sugita K. The transsphenoidal removal of nonfunctioning pituitary adenomas with suprasellar extensions: the open sella methods and intentionally staged operation. Neurosurgery 1995;36:668-675, discussion 675-676.
31. Spaziante R, Divitüs E, Coppabianca P. Reconstruction of the pituitary fossa in transsphenoidal surgery: and experience of 140 cases. Neurosurgery 1985;17: 453-458.
32. Tindall GT, Collins WF Jr, Kirchner JÁ. Unilateral septal techniques for transsphenoidal microsurgical approach to the sella tursica: technical note. J Neurosurg 1978;49:138-149.
33. Wilson CB, Dempsey LC. Transsphenoidal microsurgery of 250 pituitary adenomas. J Neurosurg 1978;48:13-22.
34. Wilson WR, Laws ER Jr. Transnasal septal displacement approach for secondary transsphenoidal pituitary surgery. Laryngoscope 1992;102:951-953.
35. Yang SY, Zhu T, Zhang JN, Sun YS. Transsphenoidal microsurgical managements of pituitary adenomas. Microsurgery 1994;15:754-759.
36. Yasargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P. Total removal of craniopharyngiomas: approaches and long-term results in 144 patients. J Neurosurg 1990;73:3-11.

Datas de Publicação

Publicação nesta coleção
18 Out 2010
Data do Fascículo
Set 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Beahm EK, Becker EK, Cerullo JL. The transnasal approach to advanced lesions of the sphenoid sinus and pituitary. Otolaryngol Clin North Am 1991;24:1535-1557.

[2] 2. Bynke O. Hole of transsphenoidal operation in the management of pituitary adenomas with suprasellar extension. Acta Neurochir (Wien) 1989;100:50-55.

[3] 3. Ciric IS, Cozzens JW. Craniopharyngiomas: transsphenoidal metod of approach: for valuous only? Clin Neurosurg 1980;27:169-187.

[4] 4. Cook RS. Experience with the direct transnasal transsphenoidal approach to the pituitary fossa Br J Neurosurg 1994;8:193-199.

[5] 5. Cushing H. Weir Mitchell lecture: surgical experiences with pituitary disorders. JAMA 1914;63:1515-1525.

[6] 6. Dagi TF. Ocular and endocrine function in patients with pituitary tumors: operative results following transnasal, transsphenoidal approach with marsupialization of the sella tursica. Am Surg 1986;52:165-174.

[7] 7. Davis C. Transsphenoidal pituitary surgery [Letter]. Br J Neurosurg 1992;6:506.

[8] 8. Dott NM, Bailey P. A consideration of the hypophyseal adenomata. Br J Surg 1925;13:314-366.

[9] 9. Fahlbusch R, Buchefelder M. Transsphenoidal surgery of parasellar pituitary adenomas. Acta Neurochir (Wien) 1988;92:93-99.

[10] 10. Fraioli B, Esposito V, Santoro A. Iannetti G, Giuffrè R, Cantore G. Transmaxillosphenoidal approach to tumors invading the medial compartment of the cavernous sinus. J Neurosurg 1995;82:63-72.

[11] 11. Guiot G, Derome P: Surgical problems of pituitary adenomas. In Krayenbühl H et al, (eds) Advances and technical standards in neurosurgery Vol 3. New York: Springer-Verlag, 1976;7-33.

[12] 12. Hardy J. Transsphenoidal microsurgery of the normal and pathological pituitary. Gin Neurosurg 1969;16:185-216.

[13] 13. Hashimoto N, Handa H, Yamagami T. Transphenoidal extracapsular approach to pituitary tumors. J Neurosurg 1986;64:16-20.

[14] 14. Helal MZ. Combined micro-endoscopic trans-sphenoidal excisions of pituitary macroadenomas. Eur Arch Otorhinolaryngol 1995;252:186-189.

[15] 15. Honegger J, Buchfelder M, Fahlbusch R, Daubler B, Dörr HG. Transsphenoidal microsurgery for craniopharyngiomas. Surg Neurol 1992;37:189-196.

[16] 16. Kern EB, Laws ER Jr. The transeptal approach to the pituitary gland. Rhinology 1978;16:59-78.

[17] 17. Kern EB, Pearson BW, MacDonald TJ, Laws ER Jr. The transeptal approach to lesions of the pituitary and parasellar regions. Laryngoscope 1979;89:1-34.

[18] 18. Kònig A, Lübecke DK, Herrmann HD: Transnasal surgery in the treatment of craniopharyngiomas. Acta Neurochir (Wien) 1986;83:1-7.

[19] 19. Laws ER Jr, Onofre BM, Peason BW, MacDonald TJ, Dirremberger RA. Successful management of bilateral carotid-cavernous fistula with a transsphenoidal approach. Neurosurgery 1979;4:162-167.

[20] 20. Laws ER Jr. Transsphenoidal microsurgery in the management of craniopharyngioma. J Neurosurg 1980;52:661-666.

[21] 21. Laws ER Jr. Transsphenoidal approach to lesions in and about sella tursica. In Schmidek HH, Sweet WH (eds). Operative neurosurgical techniques. New York: Grune & Stratton, 1982, 327-341.

[22] 22. Lin SZ, Wang GF. Some anatomical data related to the transnaso-sphenoidal resection of pituitary fossa tumors. Chin Med J [Engl] 1986;99:602-605.

[23] 23. MacDonald TJ, Kern EB, Laos ER Jr, Pearson BW. Surgical approaches to the pituitary gland with emphasis on the transseptal route. Head Neck Surg 1979;1:498-504.

[24] 24. Maira G, Anile C, Rossi FG, Colosimo C. Surgical treatment of craniopharyngiomas: an evaluation of the transsphenoidal and pterional approaches. Neurosurgery 1995;36:715-724.

[25] 25. Nakane T, Kurwayama A, Watambe M, Kageyama N. Transsphenoidal approach to pituitary adenomas with suprasellar extension. Surg Neurol 1981;16:225-229.

[26] 26. Papay FA, Benninger MS, Levini HL, Lavertu P. Transnasal transeptal endoscopy repair of sphenoidal cerebral spinal fluid fistula. Otolaryngol Head Neck Surg 1989;101:595-597.

[27] 27. Papel ID, Kennedy DW, Chon E. Sublabial transeptal transsphenoidal approach to the skull base. Ear Nose Throat J 1986;65:107-116.

[28] 28. Patil AA, Chand A. Modifications of transnasal and transoral stereotactic procedures- technical notes. Acta Neurochir (Wien) 1995;134:46-50.

[29] 29. Rand RW. Fifteen years experience with trans-nasal trans-sphenoidal operation for pituitary tumors. In Brock H (ed). Modem neurosurgery 1. Berlin: Springer-Verlag, 1982:173-180.

[30] 30. Saito K, Kuwayama A, Yamamoto N, Sugita K. The transsphenoidal removal of nonfunctioning pituitary adenomas with suprasellar extensions: the open sella methods and intentionally staged operation. Neurosurgery 1995;36:668-675, discussion 675-676.

[31] 31. Spaziante R, Divitüs E, Coppabianca P. Reconstruction of the pituitary fossa in transsphenoidal surgery: and experience of 140 cases. Neurosurgery 1985;17: 453-458.

[32] 32. Tindall GT, Collins WF Jr, Kirchner JÁ. Unilateral septal techniques for transsphenoidal microsurgical approach to the sella tursica: technical note. J Neurosurg 1978;49:138-149.

[33] 33. Wilson CB, Dempsey LC. Transsphenoidal microsurgery of 250 pituitary adenomas. J Neurosurg 1978;48:13-22.

[34] 34. Wilson WR, Laws ER Jr. Transnasal septal displacement approach for secondary transsphenoidal pituitary surgery. Laryngoscope 1992;102:951-953.

[35] 35. Yang SY, Zhu T, Zhang JN, Sun YS. Transsphenoidal microsurgical managements of pituitary adenomas. Microsurgery 1994;15:754-759.

[36] 36. Yasargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P. Total removal of craniopharyngiomas: approaches and long-term results in 144 patients. J Neurosurg 1990;73:3-11.