|Paper title||Pituitary endoscopic surgery: the mononostril, two-hands three-instruments technique with high field 3-Tesla MRI.|
|Form of presentation||Poster|
Aims: To present the surgical results of the three instruments, two-hands, one nostril technique (3-2-1) with the combined use of intraoperative high field 3-Tesla MRI (3T-ioMR) in endoscopic pituitary surgery (TSS).
Methods: We reviewed clinical and radiological data from our prospective patients database of those patients who underwent TSS with the 3-2-1. With the 3-2-1, the operating surgeon holds in the left hand the endoscope and the suction leaving the right hand free for bimanual dissection within a clean surgical field. No mechanical arm is used, guaranteeing in this way a continuously adaptable surgical view.
Results: 118 patients were operated on with the 3-2-1 technique. 3-mos follow up was available for 112. Gross total resection (GTR) was the surgical goal in 90 patients and was achieved in 82 (91%) allowing for an average extent of resection of 99.6%. There was no surgical mortality. Three patients needed surgical revision because of CSF leak. Two patients experienced postoperative epistaxis. At last follow-up one patient had a permant neurologic deficit (visual acuity defect). Of the 95 patients with pre- and postoperative rhinologic evaluation, no patient experienced a severe impairment of nasal qualitiy of life (corresponding to a SNOT test > 40 points). 2 patients only experienced new postoperative hyposmia (defined as sniffin test less than 9/12).
Conclusions: the 3-2-1 technique with 3T-ioMR allowed in our hands excellent resection results at no adjunctive morbidity. It offers the possibility to minimize surgical invasiveness whithout renouncing to dinamic bimanual dissection technique