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[TSA2016] Sellar & Parasellar Lesions :Key Imaging Features for DDx

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[TSA2016] Basic Principle and Preparation of Endoscopic TSA

Dr. Doosik Kong Samsung Medical Center | Republic of Korea Speciality : Neurosurgery

32:49

Information

Advantages of microscopic TSA
- Comfort & Familiarity to neurosurgeon
- Tree-dimensional view : Pseudo-depth perception in Endoscope
- Easily manipulated zoom and focus features
- Nasal speculum protects the nasal mucosa from injury
- Microscope is out of the surgical field and does not obstruct the entry or maneuvering of
instruments into or out of field
- Don’t need to hold microscope

Traditional Endoscopic TSA
Traditional endoscopic TSA concentrated on safe and wide access
- Cauterization of anterior sphenoid, posterior septum
- Transection of posterior septum
- Removal of rostrum of sphenoid
- Resection of posterior edge of septum
- Enlargement of sphenoidotomy
- Cauterization of Posterior nasal artery

Current Concept of Endoscopic TSA
- You can remove the bone as wide as possible.
- You can preserve the mucosa as much as possible.

Key principle of Endoscopic TSA
- Wide Exposure and Good Visualization.
- Preservation of Anatomy and Function
- Dedicated biopolar coagulator
- Irrigation System

Preparation
1) Nasal stage
- Warm/hot saline(over 40℃) irrigation : prevent mucosal swelling
- 2hr operation time-rule : assoc with mucosal swelling
- Strict I/O balance for long-time surgery

2) Sphenoid Stage
- Anticipation of intrasphenoid septa / Onodi air cell
- Sphenoid mucosa : stripped by gentle maneuver
- Sphenoid opening

Not applicable