834:, and post-operative obesity. The study showed that there was a greater chance of CSF leaks with endoscopic endonasal surgery. The visual function improved more with endoscopic surgery for TSM, CRA, and CHO patients. Diabetes insipidus occurred more in open procedure patients. The endoscopic patients showed a higher recurrence rate. In another case study on CRAs, they showed similar results with the CSF leaks being more of a problem in endoscopic patients. Open procedure patients showed a higher rate of post operative seizures as well. Both of these studies still suggest that despite the CSF leaks, that the endoscopic technique is still an appropriate and suitable surgical option. Otologic surgery, which is traditionally performed via an open approach using a microscope, may also be performed endoscopically, and is called
785:) and retrochiasmatic (behind the optic chiasm) regions. He also says that when these conditions are met, endoscopic endonasal surgery is a valid surgical option. For a case study on large adenomas, the doctors showed that out of 50 patients, 19 had complete tumor removal, 9 had near complete removal, and 22 had partial removal. The partial removal came from the tumors extending into more dangerous areas. They concluded that endoscopic endonasal surgery was a valid option for surgery if the patients used pharmacological therapy after surgery. Another study showed that with endoscopic endonasal surgery 90% of
101:, developed a tool to see the inner workings of the body. Bozzini called his invention a Light Conductor, or Lichtleiter in German, and later wrote about his experiments on live patients with this device that consisted of an eyepiece and a container for a candle. Following Bozzini's success, The University of Vienna starting using the device to test its practicality in other forms of medicine. After Bozzini's device received negative results from live human trials, it had to be discontinued. However,
769:
to the original tissue. These flaps are then stretched or maneuvered onto the desired location. When technology advanced and larger defects could be fixed endoscopically, more and more failures and leaks started to occur with the free graft technique. The larger defects are associated with a wider dural removal and an exposure to high flow CSF, which could be the reason for failure among the free graft.
596:. Surgery includes a uninectomy (removal of the osteomeatal complex), a medial maxillectomy (removal of maxilla), an ethmoidectomy (removal of ethmoid cells and/or ethmoid bone), a sphenoidectomy (removal of part of sphenoid), and removal of the maxillary sinus and the palatine bone. The posterior septum is also removed at the beginning to allow use of both nostrils.
492:. The sella is a cradle where the pituitary gland sits. Under normal circumstances, a surgeon would use this approach on a patient with a pituitary adenoma. The surgeon starts with the transnasal approach prior to using the transsphenoidal approach. This allows access to the sphenoid ostium and sphenoid sinus. The sphenoid
806:
write, he and the other authors compared the effects of the 2-D technique vs the 3-D technique on patient outcome. It showed that the 3-D endoscopy gave the surgeon more depth of field and stereoscopic vision and that the new technique did not show any significant changes in patient outcomes during or after surgery.
473:
768:
flaps or titanium mesh to repair the skull base defects, which is very successful (95% without CSF leaks) with small CSF fistulas or small defects. The local or regional vascularized flaps are pieces of tissue relatively close to the surgery site that have been mostly freed up but are still attached
504:
to allow the use of both nostrils for tools during surgery. There are several triangles of blood vessels traversing this region, which are just very delicate areas of blood vessels that can be deadly if injured. A surgeon uses stereotactic imaging and a micro
Doppler to visualize the surgical field.
117:
and intracranial approaches to pituitary tumors began in the 1800s but with little success. Gerard Guiot popularized the transphenoidal approach which later became part of the neurosurgical curriculum, however he himself discontinued the use of this technique because of inadequate sight. In the late
544:
is involved in the surgical approach, different neurovascular structures are placed at risk. The upper third lies inferior to the dorsum sellae and posterior clinoid processes and superior to the petrous apex, the middle third lies at the level of the petrous segments of the internal carotid artery
805:
The newer 3-D technique is gaining ground as the ideal way to do surgery because it gives the surgeon a better understanding of the spatial configuration of what they are seeing on a computer screen. Dr. Nelson
Oyesiku at Emory University helped develop the 3-D technique. In an article he helped
781:(CRAs) are starting to be removed via this method. Dr. Paolo Cappabianca described the perfect CRA for this surgery to be a median lesion with a solid parasellar component (beside the sellar) or encasement of the main neuromuscular structures that are localized in the subchiasmatic (below the
141:
The endoscope consists of a glass fiber bundle for cold light illumination, a mechanical housing, and an optics component with four different views: 0 degree for straight forward, 30 degrees for forward plane, 90 degrees for lateral view, and 120 degrees for retrospective view. For endoscopic
400:, causing impaired vision. In these cases, an ophthalmologist maintains optic health by administering pre-surgical treatment, advising proper surgical techniques so that the optic nerve is not in danger, and managing post-surgery eye care. Common problems include:
105:
and Joseph Leiter used the invention of the light bulb by Thomas Edison to make a more refined device similar to modern day endoscopes. This iteration was used for urological procedures, and eventually otolaryngologists began to use Nitze and Leiter's device for
797:, which means fragile blood vessel triangles would have to be dealt with so only 1/3 of those patients recovered. Endoscopic endonasal approach has been shown even among young patients to be superior to traditional microscopic transsphenoidal surgery.
235:. There are currently less than 400,000 cases worldwide and approximately 30,000 new cases every year. Despite the rarity of this condition, these tumors constitute 16% of the pituitary tumors that are removed. The tumor normally results in
690:
does not expand into the surgical view. This will happen if the top part of the tumor is taken out too early. After tumor removal, CSF leaks are tested for with fluorescent dye, and if there are no leaks, the patient is closed.
96:
Antonin Jean
Desomeaux, a urologist from Paris, was the first person to use the term, endoscope. However, the precursor to the modern endoscope was invented in the 1800s when a physician in Frankfurt, Germany by the name of
1503:
Kari E, Oyesiku NM, Dadashev V, Wise SK (February 2012). "Comparison of traditional 2-dimensional endoscopic pituitary surgery with new 3-dimensional endoscopic technology: intraoperative and early postoperative factors".
740:: This time the pituitary stalk is in the front because the tumor is pushing it towards the area the dura was opened. Removal then starts on both sides of the stalk to preserve the connection between the pituitary and the
685:
procedure, which consists of cutting the tumor into many sections for removal. If the tumor is larger, the center of the tumor is removed first, then the back, then the sides, then top of the tumor to make sure that the
463:
or posterior septum is removed so that the surgeon can use both sides of the nose. One side can be used for a microscope and the other side for a surgical instrument, or both sides can be used for surgical instruments.
146:. The endoscope has an eyepiece for the surgeon, but it is rarely used because it requires the surgeon to be in a fixed position. Instead, a video camera broadcasts the image to a monitor that shows the surgical field.
545:(ICA), and the inferior third extends from the jugular tubercle to the foramen magnum. It is important that the Perneczky triangle is treated carefully. This triangle has optic nerves, cerebral arteries, the
316:, controlling the effects of the medical therapy, defining the spatial situation of the lesions, and verifying the removal of the lesions. The lesions associated with endoscopic endonasal surgery include:
154:
Several specialties need to be involved to determine the complete surgical plan. These include: an
Endocrinologist, a Neuroradiologist, an Ophthalmologist, a Neurosurgeon, and an Otolaryngologist.
1600:
Komotar R, Starke RM, Raper DMS, Anand VK, Schwartz TH (February 2012). "Endoscopic
Endonasal Compared with Microscopic Transsphenoidal and Open Transcranial Resection of Craniopharyngiomas".
753:
When there is a tumor, injury, or some type of defect at the skull base whether the surgeon used an endoscopic or open surgical method, the problem still arises of providing separation of the
1124:
Cavallo LM, Cappabianca P, Galzio R, Iaconetta G, de
Divitiis E, Tschabitscher M (2005). "Endoscopic transnasal approach to the cavernous sinus versus transcranial route: anatomic study".
814:
In a case study from 2013, they compared the open vs endoscopic techniques for 162 other studies that contained 5,701 patients. They only looked at four tumor types: the olfactory groove
734:: This tumor is closest to the dura. The tumor is decompressed by the surgeon. After decompression, the tumor is removed taking care to not disrupt any optic nerve or major arteries.
122:, is considered to be a pioneer of the use of an endoscope in neurosurgery. Perneczky said that endoscopy, "improved appreciation of micro-anatomy not apparent with the microscope."
1400:
Gondim J, Almerida JP, Albuquerque LAF, Gomes EF, Schops M (August 2013). "Giant
Pituitary Adenomeas: Surgical outcomes of 50 cases operated by the endonasal endoscopic approach".
661:
is found. Then the mucosa around the ostium is cauterized for microadenomas and removed completely for macroadenomas. Then the endoscope enters the ostium and meets the sphenoid
225:. Endoscopic endonasal surgery is normally performed as a last resort when the tumor is resistant to the drugs, shows no tumor shrinkage, or the PRL levels cannot be normalized.
277:, resulting in headaches and visual disturbances. Although surgery is the first step of treatment, it does not usually cure the patient. After surgery, patients are treated by
83:. The use of endoscope was first introduced in Transsphenoidal Pituitary Surgery by R Jankowsky, J Auque, C Simon et al. in 1992 G (Laryngoscope. 1992 Feb;102(2):198-202).
118:
1970s, the endoscopic endonasal approach was used by neurosurgeons to augment microsurgery which allowed them to view objects out of their line of sight. Another surgeon,
1322:
Harvey R, Parmar, P., Sacks, R., Zanation, A. M. (2012). "Endoscopic skull base reconstruction of large dural defects: a systematic review of published evidence".
162:
An endocrinologist is only involved in preparation for an endoscopic endonasal surgery, if the tumor is located on the pituitary gland. The tumor is first treated
110:
manipulation and removal of foreign bodies. The endoscope made its way to the US when Walter
Messerklinger began teaching David Kennedy at Johns Hopkins Hospital.
126:
1049:
649:
For removal of a small tumor, it is accessed through one nostril. However, for larger tumors, access through both nostrils is required and the posterior nasal
476:
This picture shows important anatomy involved in endoscopic endonasal surgery. The pituitary gland sits at the top of the picture behind the sphenoid sinus.
764:
For this procedure, there are two ways to start: with a free graft repair or with a vascularized flap repair. The free grafts use secondary material like
616:
bone, which allows a surgeon to expose the roof of the ethmoid, and the medial orbital wall. This procedure is often successful in the removal of small
497:
1094:
142:
endonasal surgery, rigid rod-lens endoscopes are used for better quality of vision, since these endoscopes are smaller than the normal endoscope used
1464:"Endonasal endoscopic versus microscopic transsphenoidal surgery in pituitary tumors among the young: A comparative study & meta-analysis"
777:
This surgery is turned from a very serious surgery into a minimally invasive one through the nose with the use of the endoscope. For instance
308:
A neuroradiologist takes images of the defect so that the surgeon is prepared on what to expect before surgery. This includes identifying the
513:
962:
673:
to open the surgical pathway. At this point, imaging and
Doppler devices are used to define the important structures. Then the floor of the
1656:
864:"Brief history of endoscopic transsphenoidal surgery--from Philipp Bozzini to the First World Congress of Endoscopic Skull Base Surgery"
500:
is then removed to allow the surgeon a panoramic view of the surgical area. This procedure also requires the removal of the posterior
480:
This approach is the most common and useful technique of endoscopic endonasal surgery and was first described in 1910 concurrently by
263:
has had little effect on these tumors, a trans-sphenoidal surgery to remove part of the pituitary gland is the first treatment option.
174:
secretes and reducing the size of the tumor. If this approach does not work, the patient is referred to surgery. The main types of
1365:
Cappabianca P, Cavallo L (February 2012). "The
Evolving Role of Transsphenoidal Route in the Management of Craniopharyngiomas".
299:. Pharmacology has little effect and therefore surgery is the best option. Removal of the tumor results in an 80%-90% cure rate.
512:
to the suprasellar (above the sellar) region. This is done with the addition of four approaches. First the transtuberculum and
703:
is drilled into instead of the sella. Then an opening is made that extends halfway down the sella to expose the dura, and the
681:. Once the dura is visible, it is cut with microscissors for precision. If the tumor is small, the tumor can be removed by an
1032:
945:
209:(BRC), which normalizes PRL levels and has been shown to lead to tumor shrinkage. Other drugs to treat prolactinomas include
79:; a neurosurgeon performs the rest of the surgery involving drilling into any cavities containing a neural organ such as the
496:
is located on the anterosuperior surface of the sphenoid sinus. The anterior wall of the sphenoid sinus and the sphenoid
269:: Another rare condition only resulting in 1% of pituitary surgeries is a result of the increase in the secretion of the
593:
525:
1553:"A panoramic view of the skull base: systematic review of open and endoscopic endonasal approaches to four tumors"
1170:
Little RE, Taylor RJ, Miller JD, Ambrose EC, Germanwala AV, Sasaki-Adams DM, Ewend MG, Zanation AM (August 2014).
727:
is performed, the dura is then cut, and the tumor is removed. These types of tumors are separated into two types:
52:
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and above pituitary gland to protect the stalk. The tumor is carefully removed and the patient is closed up.
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292:
282:
270:
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and posterior wall of the maxillary sinus. This involves penetrating three separate sinus cavities: the
1641:
1227:
Perneczky A, E. Knosp, Ch. Matula (1988). "Cavernous Sinus Surgery Approach Through the Lateral Wall".
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532:. Endoscopic endonasal transclival approaches are often described according to which segment of the
410:
1172:"Endoscopic endonasal transclival approaches: case series and outcomes for different clival regions"
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The transnasal approach is used when the surgeon needs to access the roof of the nasal cavity, the
370:
260:
114:
636:. However, with larger tumors or lesions, one of the other approaches listed above is required.
835:
704:
332:
1651:
296:
1435:
Hofstetter C, Anand VK, Schwartz TH (2011). "Endoscopic transsphenoidal pituitary surgery".
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that is entered through the nose, fixes or removes brain defects or tumors in the anterior
1272:"Endoscopic Reconstruction of Cranial Base Defects following Endonasal Skull Base Surgery"
8:
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1054:"Harvey Cushing and Oskar Hirsch: early forefathers of modern transsphenoidal surgery"
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71:. Normally an otolaryngologist performs the initial stage of surgery through the
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1053:
830:(CSF) leaks, neurological death, post-operative visual function, post operative
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1413:
1378:
1095:"Transsphenoidal Approach to Lesions of the Sella Turcica: Historical Overview"
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609:
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581:
481:
452:
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285:, because TSH related tumors increase the expression of somatostatin receptors.
236:
232:
119:
60:
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Snyderman CH, Kassam, Amin B., Carrau, Ricardo, Mintz, Arlan (January 2007).
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are visible, the pituitary gland and optic chasm are pushed apart to see the
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625:
617:
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509:
489:
244:
231:: A very rare condition that is a result of the increase in the secretion of
206:
76:
68:
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553:. Damage to any of these could provide a devastating post-surgical outcome.
1621:
1586:
1551:, Golfinos JG, Lebowitz T, Kleinberg D, Placantonakis DG (September 2013).
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1421:
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1343:
1305:
1213:
1187:
1145:
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963:"Santé: Tizi-Ouzou: Lancement de la chirurgie par voie endoscopique au CHU"
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typically divided into three regions. Depending on which segment of the
1335:
1240:
815:
678:
633:
561:
The transpterygoidal approach enters through the posterior edge of the
456:
380:
341:
189:: These are the most common pituitary tumors. They are associated with
1517:
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must be removed. Then the surgeon slides the endoscope into the nasal
472:
365:
202:
64:
1546:
823:
621:
488:. This procedure allows the surgeon to access the sellar space, or
448:
422:
313:
252:
218:
677:
is opened with a high speed drill being careful to not pierce the
1599:
1123:
765:
699:
This technique is the same as to the sellar region. However the
613:
576:, and the maxillary sinus. Surgeons use this method to reach the
517:
429:
167:
1502:
666:
658:
650:
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The invention of the angled endoscope is used to go beyond the
501:
493:
460:
360:
309:
528:. Lastly, the inferior approach is used to reach the superior
291:: This tumor is a result of the increase in the secretion of
1434:
194:
1437:
Operative Techniques in Otolaryngology-Head and Neck Surgery
862:
Doglietto F, Prevedello DM, Jane JA, Han J, Laws ER (2005).
1226:
809:
639:
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861:
149:
91:
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is retracted from this structure and is removed from the
520:. The lateral approach is then used to reach the medial
1093:
Lanzino G, Laws ER Jr, Feiz-Erfan I, White WL (2002).
1047:
761:
leakage through the opening referred to as a defect.
1364:
1593:
1176:
Journal of Neurological Surgery. Part B, Skull Base
757:and cavity between the sinuses and nose to prevent
1540:
63:. A neurosurgeon or an otolaryngologist, using an
694:
604:This approach makes a surgical corridor from the
1633:
826:(CHO). They looked at gross total resection and
800:
1393:
1317:
1315:
612:. This is done by the complete removal of the
430:Surgical approaches to the anterior skull base
1547:Graffeo C, Dietrich AR, Grobelny B, Zhang M,
1117:
1048:Liu J, Cohen-Gadol A, Laws E, Cole C, Kan P,
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1016:
1014:
1012:
1010:
1008:
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929:
927:
793:could be removed if they did not go into the
516:approaches are used to reach the suprasellar
205:or PRL. One drug that endocrinologist use is
136:
1496:
1461:
1025:Endoscopic Endonasal Transsphenoidal Surgery
925:
923:
921:
919:
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818:(OGM), tuberculum sellae meningiomas (TSM),
748:
644:
556:
1428:
1312:
1022:
467:
459:in the cervical spine region. The anterior
1005:
772:
599:
1576:
1479:
1295:
1203:
1069:
904:
879:
848:
789:could be removed, and that 2/3 of normal
455:, inflammatory lesions of the clivus, or
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1220:
810:Endoscopic techniques vs open techniques
640:Different approaches to specific regions
471:
125:The surgery was pioneered in Algeria by
1041:
938:Practical Endoscopic Skull Base Surgery
201:because they increase the secretion of
166:in two ways: controlling the levels of
150:Areas of interest for surgical planning
92:History of endoscopic endonasal surgery
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1263:
1132:(2 Suppl): 379–89, discussion 379–89.
536:is involved in the approach, with the
434:
935:
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960:
940:. San Diego, CA: Plural Publishing.
13:
1657:Surgical procedures and techniques
1138:10.1227/01.neu.0000156548.30011.d4
1052:, Cushing H, Hirsch O (Dec 2005).
447:. This approach is used to remove
14:
1668:
1160:
1101:(3) (18 ed.). Archived from
1027:. Austria: Springer-Verlag/Wien.
303:
387:
157:
1462:Dhandapani S, et a (Dec 2020).
1455:
86:
1481:10.1016/j.clineuro.2020.106411
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980:
954:
695:Approach to suprasellar region
337:Pituitary inflammatory disease
247:, changes in facial features,
1:
989:"Endoscope air water channel"
841:
801:3-D approach vs 2-D approach
359:Chiasmatic and Hypothalamic
53:minimally invasive technique
49:Endoscopic endonasal surgery
21:Endoscopic endonasal surgery
7:
1071:10.3171/jns.2005.103.6.1096
293:adrenocorticotropic hormone
283:hormone replacement therapy
271:thyroid-stimulating hormone
10:
1673:
1614:10.1016/j.wneu.2011.07.011
1449:10.1016/j.otot.2011.09.002
1414:10.1016/j.wneu.2013.08.028
1379:10.1016/j.wneu.2011.08.040
137:Endoscopic instrumentation
1569:10.1007/s11102-013-0508-y
749:Skull base reconstruction
645:Approach to sellar region
557:Transpterygoidal approach
411:Visually evoked potential
371:Tuber Cinereum Hamartomas
35:
25:
20:
468:Transsphenoidal approach
881:10.3171/foc.2005.19.6.4
773:Pituitary gland surgery
600:Transethmoidal approach
407:Reduced visual activity
383:of the trigeminal nerve
261:pharmacological therapy
1188:10.1055/s-0034-1371522
1023:de Divitiis E (2003).
836:Endoscopic Ear Surgery
705:intercavernous sinuses
477:
273:. This tumor leads to
1506:Allergy and Rhinology
1468:Clin Neurol Neurosurg
1288:10.1055/s-2006-959337
707:is exposed. When the
475:
281:analogues, a type of
255:, visual changes, or
127:Bouyoucef Kheireddine
1229:Acta Neurochirurgica
738:Postchiasmal Lesions
404:Visual field defects
333:Rathke's cleft cysts
295:(ACTH) and leads to
828:cerebrospinal fluid
759:cerebrospinal fluid
732:Prechiasmal Lesions
657:until the sphenoid
547:third cranial nerve
435:Transnasal approach
413:(VEP) abnormalities
1602:World Neurosurgery
1408:(1–2): e281–e290.
1402:World Neurosurgery
1367:World Neurosurgery
1336:10.1002/lary.22475
1241:10.1007/BF01401976
832:diabetes insipidus
822:(CRA), and clival
820:craniopharyngiomas
779:craniopharyngiomas
688:arachnoid membrane
478:
398:chiasmatic cistern
396:tumors invade the
350:Craniopharyngiomas
297:Cushing's syndrome
199:sexual dysfunction
176:pituitary adenomas
1642:Endocrine surgery
1518:10.1002/alr.20036
1034:978-3-211-00972-7
947:978-1-59756-060-3
936:Anand VK (2007).
701:tuberculum sellae
164:pharmacologically
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574:sphenoidal sinus
217:(CAB) acting as
103:Maximilian Nitze
39:edit on Wikidata
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1105:on 4 April 2015
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1064:(6): 1096–104.
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795:cavernous sinus
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721:pituitary stalk
717:pituitary gland
697:
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620:of the ethmoid
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590:pterygoid fossa
578:cavernous sinus
563:maxillary sinus
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551:pituitary stalk
522:cavernous sinus
470:
437:
432:
417:Color blindness
390:
376:Arachnoid cysts
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275:hyperthyroidism
257:hypopituitarism
172:pituitary gland
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139:
115:transsphenoidal
108:eustachian tube
99:Philipp Bozzini
94:
89:
81:pituitary gland
55:used mainly in
42:
12:
11:
5:
1670:
1660:
1659:
1654:
1649:
1644:
1628:
1627:
1608:(2): 329–341.
1592:
1563:(4): 349–356.
1539:
1495:
1454:
1443:(3): 206–214.
1427:
1392:
1373:(2): 273–274.
1357:
1330:(2): 452–459.
1311:
1262:
1235:(1–4): 76–82.
1219:
1182:(4): 247–254.
1159:
1116:
1085:
1040:
1033:
1004:
979:
953:
946:
903:
846:
845:
843:
840:
811:
808:
802:
799:
774:
771:
755:cranial cavity
750:
747:
746:
745:
735:
696:
693:
671:sphenoid sinus
646:
643:
641:
638:
628:wall or small
618:encephaloceles
610:sphenoid sinus
601:
598:
586:temporal fossa
582:sphenoid sinus
558:
555:
482:Harvey Cushing
469:
466:
453:chondrosarcoma
436:
433:
431:
428:
427:
426:
419:
414:
408:
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389:
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384:
378:
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352:
347:
344:
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335:
330:
324:
305:
304:Neuroradiology
302:
301:
300:
289:ACTH-secreting
286:
264:
233:growth hormone
226:
159:
156:
151:
148:
138:
135:
120:Axel Perneczky
93:
90:
88:
85:
61:otolaryngology
44:
43:
36:
33:
32:
31:Otolaryngology
29:
23:
22:
9:
6:
4:
3:
2:
1669:
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1415:
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1298:
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1234:
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1189:
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1063:
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1044:
1036:
1030:
1026:
1019:
1017:
1015:
1013:
1011:
1009:
994:
990:
987:Kreo (2014).
983:
968:
964:
961:Kreo (2014).
957:
949:
943:
939:
932:
930:
928:
926:
924:
922:
920:
918:
916:
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899:
895:
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869:
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856:
854:
852:
847:
839:
837:
833:
829:
825:
821:
817:
807:
798:
796:
792:
791:macroadenomas
788:
787:microadenomas
784:
780:
770:
767:
762:
760:
756:
743:
739:
736:
733:
730:
729:
728:
726:
725:ethmoidectomy
722:
718:
714:
710:
706:
702:
692:
689:
684:
680:
676:
675:sella turcica
672:
668:
664:
660:
656:
652:
637:
635:
631:
627:
626:ethmoid sinus
623:
619:
615:
611:
607:
606:frontal sinus
597:
595:
591:
587:
583:
579:
575:
571:
570:ethmoid sinus
567:
564:
554:
552:
548:
543:
539:
535:
531:
527:
523:
519:
515:
511:
506:
503:
499:
495:
491:
490:sella turcica
487:
483:
474:
465:
462:
458:
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450:
446:
442:
424:
420:
418:
415:
412:
409:
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402:
401:
399:
395:
388:Ophthalmology
382:
379:
377:
374:
372:
369:
367:
364:
362:
358:
356:
353:
351:
348:
345:
343:
339:
336:
334:
331:
329:
328:macroadenomas
325:
323:
322:microadenomas
319:
318:
317:
315:
311:
298:
294:
290:
287:
284:
280:
276:
272:
268:
267:TSH-secreting
265:
262:
258:
254:
250:
246:
245:hyperhidrosis
242:
239:enlargement,
238:
234:
230:
227:
224:
220:
216:
212:
208:
207:bromocriptine
204:
200:
196:
192:
188:
187:prolactinomas
184:
183:PRL-secreting
181:
180:
179:
177:
173:
169:
165:
158:Endocrinology
155:
147:
145:
144:colonoscopies
134:
132:
128:
123:
121:
116:
111:
109:
104:
100:
84:
82:
78:
77:sphenoid bone
74:
70:
66:
62:
58:
54:
50:
40:
34:
30:
28:
24:
19:
16:
1652:Neurosurgery
1605:
1601:
1595:
1560:
1556:
1542:
1509:
1505:
1498:
1471:
1467:
1457:
1440:
1436:
1430:
1405:
1401:
1395:
1370:
1366:
1360:
1327:
1324:Laryngoscope
1323:
1282:(1): 73–78.
1279:
1275:
1265:
1232:
1228:
1222:
1179:
1175:
1129:
1126:Neurosurgery
1125:
1119:
1107:. Retrieved
1103:the original
1098:
1088:
1061:
1057:
1043:
1024:
996:. Retrieved
992:
982:
971:. Retrieved
966:
956:
937:
871:
867:
813:
804:
783:optic chiasm
776:
763:
752:
742:hypothalamus
737:
731:
709:optic chiasm
698:
682:
648:
603:
594:petrous apex
560:
526:petrous apex
507:
486:Oskar Hirsch
479:
438:
391:
307:
288:
279:somatostatin
266:
229:GH-secreting
228:
182:
161:
153:
140:
124:
112:
95:
87:Introduction
73:nasal cavity
57:neurosurgery
48:
47:
15:
1549:Goldberg JD
1058:J Neurosurg
1050:Couldwell W
969:(in French)
816:meningiomas
713:optic nerve
634:meningiomas
514:transplanum
394:suprasellar
355:Meningiomas
346:Empty Sella
249:soft tissue
241:arthropathy
223:antagonists
215:cabergoline
211:quinagolide
191:infertility
131:Faiza Lalam
1636:Categories
1512:(1): 2–8.
1474:: 106411.
1276:Skull Base
1109:3 December
998:2022-04-22
973:2022-04-22
842:References
679:dura mater
665:where the
592:, and the
580:, lateral
549:, and the
457:metastasis
425:impairment
381:Neurinomas
366:Germinomas
342:metastasis
340:Pituitary
326:Pituitary
320:Pituitary
251:swelling,
69:skull base
1647:Endoscopy
1557:Pituitary
1196:2193-6331
1154:264924552
874:(6): E3.
824:chordomas
630:olfactory
449:chordomas
443:, or the
253:headaches
203:prolactin
170:that the
65:endoscope
27:Specialty
1622:22501020
1587:24014055
1534:20651117
1526:22311834
1490:33338824
1422:23994073
1387:22120287
1352:34402474
1344:22253060
1306:17603646
1257:22891605
1214:25093148
1146:15794834
1080:16381201
898:43877814
890:16398480
838:or EES.
622:osteomas
584:, infra
445:odontoid
423:motility
259:. Since
219:dopamine
213:(CV) or
168:hormones
1578:4214071
1297:1852577
1249:3407478
1205:4108492
766:cadaver
683:en bloc
663:rostrum
632:groove
624:of the
614:ethmoid
608:to the
518:cistern
498:rostrum
361:gliomas
1620:
1585:
1575:
1532:
1524:
1488:
1420:
1385:
1350:
1342:
1304:
1294:
1255:
1247:
1212:
1202:
1194:
1152:
1144:
1078:
1031:
993:DKNews
967:DKNews
944:
896:
888:
715:, and
667:mucosa
659:ostium
655:choana
651:septum
572:, the
566:ostium
542:clivus
538:clivus
534:clivus
530:clivus
502:septum
494:ostium
461:septum
441:clivus
310:lesion
197:, and
1530:S2CID
1369:. 2.
1348:S2CID
1253:S2CID
1150:S2CID
894:S2CID
723:. An
510:sella
392:Some
314:tumor
237:acral
221:(D2)
195:gonad
178:are:
59:and
51:is a
37:[
1618:PMID
1583:PMID
1522:PMID
1486:PMID
1418:PMID
1383:PMID
1340:PMID
1302:PMID
1245:PMID
1210:PMID
1192:ISSN
1142:PMID
1111:2013
1076:PMID
1029:ISBN
942:ISBN
886:PMID
524:and
484:and
421:Eye
129:and
113:The
75:and
1610:doi
1573:PMC
1565:doi
1514:doi
1476:doi
1472:200
1445:doi
1410:doi
1375:doi
1332:doi
1328:122
1292:PMC
1284:doi
1237:doi
1200:PMC
1184:doi
1134:doi
1066:doi
1062:103
876:doi
312:or
185:or
1638::
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1581:.
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1441:22
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1406:82
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1381:.
1371:77
1346:.
1338:.
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1314:^
1300:.
1290:.
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1233:92
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1198:.
1190:.
1180:75
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1162:^
1148:.
1140:.
1130:56
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1074:.
1060:.
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1007:^
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906:^
892:.
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872:19
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41:]
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