Interactive operation

ISCOMS 2018 offers you the opportunity to experience an endonasal trans-sphenoidal surgical exploration in order to remove a pituitary macroadenoma.

The endonasal approach to the skull base has shown a tremendous development during the last decades. This development started with the urge to find a relatively safe approach to the pituitary gland as transcranial surgery was a very high-risk procedure in the early twenty-first century. Transnasal surgery appeared to be much safer. In 1907, the first trans-sphenoidal exposure to a pituitary tumour using a wide facial exposure with a perinasal skin incision. This macrosurgical traumatizing approach was required in order to illuminate the nasal cavity as the operating microscope and endoscope had not yet been developed. This changed with the development of the operating microscope in the 1960s resulting in less invasive surgery.

Jules Hardy was the first neurosurgeon to use an operating microscope for trans-sphenoidal surgery. A limitation of the operating microscope was the fact that illumination was localized centrally; lateral and peri-tumoral areas within the endonasal field were less illuminated. In 1963, the Frenchman Gerard Guiot was the first to start using the endoscope for trans-sphenoidal pituitary surgery creating superior intranasal illumination. Innovating and improved surgical techniques have been described ever since. The combination of the development of MRI, endoscopic innovations, endoscopic surgical instruments and improved peri-operative care has made endonasal surgery a safe procedure for the patient. This tremendous development of endoscopic transnasal surgery has been achieved by the successful teamwork between both Ear, Nose and Throat surgeons (ENT) and neurosurgeons who are specialised in endonasal exploratory surgery.

Today, tumours arising from the pituitary gland are primarily explored through the endonasal trans-sphenoidal route. Innovations at the level of imaging software and display hardware (2D-HD or 3D) together with optimizing the surgical technique have contributed to a safer operative procedure, thereby creating a general acceptance of this surgical technique.
During the demonstration of this 3D operative technique video, an Ear Nose and Throat Surgeon (ENT) and Neurosurgeon will guide you through the operation. This operation will elaborate on the removal of a pituitary adenoma with sellar en suprasellar expansion. Recognition of important anatomical landmarks are crucial in this kind of skull base surgery to avoid complications. During this lecture we will guide you through these anatomical landmarks.

We want to invite you to our surgical technique 3D video lecture and hope you will find it meriting. See you at ISCOMS 2018.

With regards,

AGW Korsten-Meijer (ENT surgeon) MD PhD

JMA Kuijlen (Neurosurgeon) MD PhD