뇌하수체선종에 대한 수술현미경적 비내 경접형동접근법 시 맞춤형 비공 선택의 경험

초록

PURPOSE : Transsphenoidal approach (TSA) has been traditionally done through right nostril or right submucosal space with the surgeon sitting on the right side of patient. The trajectory and angle of view obtained with the microscopic endonasal TSA are slightly off the midline and thus provide better visibility of the side contralateral to the approached nostril. We tailored selection of the nostril according to the laterality of pituitary adenoma (PA) to increase the visibility of lateral margin of tumor. MATERIALS AND METHODS : Nineteen macroadenomas operated by microscopic endonasal TSA with the intention of total resection were included in this study. Eleven cases were nonfunctioning PAs and 8 were functioning PAs. Seven cases were invasive PAs. In PAs with laterality, we used the nostril contralateral to the side of laterality. Right nostril was used for bilaterally symmetric PAs. If the tumor margin ipsilateral to the approached nostril could not be visualized adequately, the other nostril was used as well. RESULTS : Right, left and both nostrils were used in 6, 9 and 4 cases, respectively. Total resection could be done in 18 cases but 1 growth hormone secreting PA with invasion into the right cavernous sinus. The lateral margin of the tumor contralateral to the initially selected nostril could be visualized completely in 16 cases and almost completely in 3 cases. Poor visibility of the lateral margin of the tumor ipsilateral to the initially selected nostril necessitated additional use of the other nostril in 4 cases. CONCLUSION : Tailored selection of the nostril according to the laterality of tumor in microscopic endonasal TSA may increase the chance of total resection by improving visibility of lateral margins of tumor.