Neuronavigational Endoscopic Endonasal Sellar and Parasellar Surgery Using a 2-mm-diameter lens rlgid-rod endoscope: A Cadaver Study

摘要

OBJECTIVE: Mosl of the endoscopes used for endonasal transsphcnoidal surgery use 4-mm diameter lenses. The applicability of a newly developed neuroendoscope wilh a lens diameter of onlv 2 mm was tested in endonasal transsphenoidal pituitary surgery. METHODS: The newly developed rigid-rod neuroendoscope with a 2-mm lens and An endoscope with a 4-mm lens were coupled wilh a navigation system And used for this comparative study. Comparison he!ween the views obtained with these two devices was performed in a model and in formalin-fixed cadaver heads. A pure endonasal approach was used lo reach And explore the sellar And parasellar regions.The navigation system was used lo locate the same position in both lenses lor image comparison. RESULTS: The sellar And parasellar regions could be reached and explored using the new enclose ope wilh the 2-mm lens and an oval-shaped irrigation and suction channel. The visual field appeared-io be reduced compared wilh thai of the 4-mm lens. I lowever, this reduction was conipensated by greater mobility and easier introduction and maneuvering of the instruments at the sellar level. Reduced image si/.e and brightness were also found using the 2-mm lens compared with the 4-mm lens. These differences could be overcome by increasing the amount of light and enlarging ihe image but with subsequent reduction in image resolution. CONCLUSION: The small diameter of'this neuroendoscope resulted in good maneuverability and maintained a fine quality of vision. Children and patients wilh small nostrils are good candidates for ihe use of such a device.