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Abstract
Objective: The purely transnasal endoscopic approach has taken in the last decade a paramount importance in the treatment of pituitary adenomas, but some authors have been linked it to an increase in vascular complications. The aim of this paper is to provide a stepwise description of the vascular risks and steps required to avoid them.
Method: We present the minimal invasive technique used by the senior author in over 900 transnasal purely endoscopic approaches focusing on the relevant vascular landmarks, preoperative and operative steps taken in order to avoid vascular injury and the management of vascular injury from a multitude of sources.
Conclusion: Endoscopy has brought a wider field of view, with numerous vascular structures well inside the operating field. This represents control but also higher risk. Solid knowledge of the skull base anatomy and proper preoperative imaging coupled with an experienced surgeon can greatly reduce the vascular risks associated with surgery.
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Details
1 University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures, Romania; Clinic of Neurosurgery, County Clinical Emergency Hospital Tirgu Mures, Romania
2 Service de neurochirurgie B, Unité de chirurgie de la base du crâne. Groupement hospitalier Est, Hospices civils de Lyon, Bron, France
3 Fédération d’endocrinologie du pôle Est, Aile A1, Groupement hospitalier Est, Hospices civils de Lyon, France; Université Claude-Bernard, Lyon-1, Lyon, France; Inserm U1028, CNRS UMR 5292, Centre de neurosciences de Lyon, France
4 Service de neurochirurgie B, Unité de chirurgie de la base du crâne. Groupement hospitalier Est, Hospices civils de Lyon, Bron, France; Université Claude-Bernard, Lyon-1, Lyon, France; Inserm U1028, CNRS UMR 5292, Centre de neurosciences de Lyon, France