Norman Dott, Gerard Guiot, and Jules Hardy: key players in the resurrection and preservation of transsphenoidal surgery

2012 ◽  
Vol 33 (2) ◽  
pp. E6 ◽  
Author(s):  
Smruti K. Patel ◽  
Qasim Husain ◽  
Jean Anderson Eloy ◽  
William T. Couldwell ◽  
James K. Liu
Keyword(s):  
Transsphenoidal Surgery ◽  
Image Guidance ◽  
Skull Base Surgery ◽  
Sella Turcica ◽  
Harvey Cushing ◽  
Suprasellar Region ◽  
Key Players ◽  
Transsphenoidal Microsurgery ◽  
Binocular Microscope ◽  
Over Time

Developed over a century ago, the transsphenoidal approach to access lesions of the pituitary gland and sella turcica has transformed the field of neurosurgery, largely due to the work of Oskar Hirsch and Harvey Cushing. Furthermore, its use and modification in the early 1900s was perhaps one of Cushing's greatest legacies to skull base surgery. However, Cushing, who had worked relentlessly to improve the transsphenoidal route to the pituitary region, abandoned the approach by 1929 in his pursuit to master transcranial approaches to the suprasellar region. Hirsch and a few other surgeons continued to perform transsphenoidal operations, but they were unable to maintain the popularity of the approach among their peers. During a time when transsphenoidal surgery was on the brink of extinction, a critical lineage of 3 key surgeons—Norman Dott, Gerard Guiot, and Jules Hardy—would resurrect the art, each working to further improve the procedure. Dott, Cushing's apprentice from 1923 to 1924, brought his experiences with transsphenoidal surgery to Edinburgh, Scotland, and along the way, developed the lighted nasal speculum to provide better illumination in the narrow working area. Guiot, inspired by Dott, adopted his technique and used intraoperative radiofluoroscopic technique for image guidance. Hardy, a fellow of Guiot, from Montreal, Canada, revolutionized transsphenoidal microsurgery with the introduction of the binocular microscope and selective adenomectomy. The teachings of these pioneers have endured over time and are now widely used by neurosurgeons worldwide. In this paper, we review the lineage and contributions of Dott, Guiot, and Hardy who served as crucial players in the preservation of transsphenoidal surgery.

Hermann Schloffer and the origin of transsphenoidal pituitary surgery

2012 ◽  
Vol 33 (2) ◽  
pp. E5 ◽  
Author(s):  
Richard F. Schmidt ◽  
Osamah J. Choudhry ◽  
Ramya Takkellapati ◽  
Jean Anderson Eloy ◽  
William T. Couldwell ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Skull Base Surgery ◽  
Sella Turcica ◽  
Pituitary Surgery ◽  
Transsphenoidal Approach ◽  
Harvey Cushing ◽  
Transsphenoidal Pituitary Surgery ◽  
Transsphenoidal Operation ◽  
Technological Limitations ◽  
The University

A little over a century ago, in 1907, at the University of Innsbruck, Hermann Schloffer performed the first transsphenoidal surgery on a living patient harboring a pituitary adenoma. Schloffer used a superior nasal route via a transfacial lateral rhinotomy incision. This was perhaps his greatest academic contribution to neurosurgery. Despite the technological limitations of that time, Schloffer's operation was groundbreaking in that it laid the foundation for future development and refinement of transsphenoidal pituitary surgery, influencing prominent surgeons such as Oskar Hirsch and Harvey Cushing. Even after undergoing multiple modifications and a brief fall into obscurity, the transsphenoidal approach has endured through generations of surgeons and remains the preferred approach for lesions of the sella turcica to this day. Although Schloffer performed primarily abdominal surgery in his practice, his contributions to the transsphenoidal approach have had a lasting impact in the field of pituitary and skull base surgery. The authors review the life and career of Hermann Schloffer, the surgical details of his transsphenoidal operation, and the legacy that it has left on the field of pituitary surgery.

scholarly journals Three types of dural suturing for closure of CSF leak after endoscopic transsphenoidal surgery

2019 ◽  
Vol 131 (5) ◽  
pp. 1625-1631 ◽  
Author(s):  
Takayuki Ishikawa ◽  
Kazuhito Takeuchi ◽  
Yuichi Nagata ◽  
Jungsu Choo ◽  
Teppei Kawabata ◽  
...  
Keyword(s):  
Skull Base ◽  
Transsphenoidal Surgery ◽  
Skull Base Surgery ◽  
Sella Turcica ◽  
High Flow ◽  
Anterior Skull Base ◽  
Csf Leak ◽  
Dural Defect ◽  
Csf Leakage ◽  
Dural Suturing

OBJECTIVETranssphenoidal surgery (TSS) is commonly used for anterior skull base surgery, especially in the sella turcica (sellar) region. However, because of its anatomical position, CSF leakage is a major complication of this approach. The authors introduced a new grading reconstruction strategy for anterior skull base surgery with continuous dural suturing in 2013. In this paper the authors report on their methods and results.METHODSAll patients with sellar or anterior skull base lesions that were removed with TSS or extended TSS by a single neurosurgeon between April 2013 and March 2017 at Nagoya University Hospital and several cooperating hospitals were retrospectively identified. Three methods of suturing dura were considered, depending on the dural defect.RESULTSThere were 176 TSS cases (141 conventional TSS cases and 35 extended endoscopic TSS cases) and 76 cases of Esposito’s grade 2 or 3 intradural high-flow CSF leakage. In the high-flow CSF leak group, there were 3 cases of CSF leakage after the operation. The rates of CSF leakage after surgery corresponding to grades 2 and 3 were 2.9% (1/34) and 4.7% (2/42), respectively.CONCLUSIONSDural suturing is a basic and key method for reconstruction of the skull base, and continuous suturing is the most effective approach. Using this approach, the frequency of cases requiring a nasoseptal flap and lumbar drainage can be reduced.

Fluoroscopic Frameless Stereotaxy for Transsphenoidal Surgery

Neurosurgery ◽  
2001 ◽  
Vol 48 (6) ◽  
pp. 1302-1308 ◽  
Author(s):  
John A. Jane ◽  
Kamal Thapar ◽  
Tord D. Alden ◽  
Edward R. Laws
Keyword(s):  
Transsphenoidal Surgery ◽  
Image Guidance ◽  
Operative Time ◽  
Sella Turcica ◽  
Setup Time ◽  
Lateral View ◽  
Control Group ◽  
Computer Assisted ◽  
Frameless Stereotaxy ◽  
X Rays

Abstract OBJECTIVE To assess the value of frameless fluoroscopy-guided stereotactic transsphenoidal surgery using the FluoroNav Virtual Fluoroscopy System (Medtronic Sofamor Danek, Inc., Memphis, TN). METHODS Twenty consecutive patients undergoing transsphenoidal surgery for sellar lesions were assigned to transsphenoidal surgery with or without computer-assisted fluoroscopic image guidance using the FluoroNav system. Prospective data regarding patient age, sex, lesion characteristics, operative time, and treatment cost were obtained. RESULTS Although patients in the FluoroNav group were, on average, 17 years younger than the patients in the control group, more patients with recurrent adenomas were treated in the image guidance group. No other significant differences between the groups were found. FluoroNav provided accurate, continuous information regarding the anatomic midline trajectory to the sella turcica as well as anatomic structures (e.g., sella, sphenoid sinus) in the lateral view. No patient required reversion to intraoperative videofluoroscopy. No statistically significant differences were found with regard to preincision setup time, operative time, or cost. FluoroNav allowed procedures to be performed with significantly fewer x-rays being taken. CONCLUSION Fluoroscopic computer-assisted frameless stereotaxy furnishes accurate real-time information with regard to midline structures and operative trajectory. Although it is useful in first-time transseptal transsphenoidal surgery, its primary benefit is realized in recurrent surgery.

Harvey Cushing and Oskar Hirsch: early forefathers of modern transsphenoidal surgery

2005 ◽  
Vol 103 (6) ◽  
pp. 1096-1104 ◽  
Author(s):  
James K. LIU ◽  
Aaron A. Cohen-Gadol ◽  
Edward R. Laws ◽  
Chad D. Cole ◽  
Peter Kan ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Sphenoid Sinus ◽  
Sella Turcica ◽  
Future Generations ◽  
Content Type ◽  
Harvey Cushing ◽  
Transnasal Surgery ◽  
Sublabial Approach ◽  
First Time ◽  
Fine Print

✓ The transnasal transsphenoidal approach is the preferred route for removal of most lesions of the sella turcica. The concept of transnasal surgery traversing the sphenoid sinus to reach the sella has existed for nearly a century. A comprehensive historical overview of the evolution of transsphenoidal surgery has been reported previously. In the present vignette, the authors focus on transsphenoidal surgery in the early 1900s, particularly on the methods advocated by Harvey Cushing and Oskar Hirsch, two prominent pituitary surgeons who pioneered the transsphenoidal technique. Cushing championed the sublabial approach, whereas Hirsch was the master of the endonasal route. Coincidentally, both surgeons independently performed the submucous septal resection for the first time on June 4, 1910. Although Cushing's and Hirsch's approaches were predicated on the work of their predecessors, their transsphenoidal procedures became the two most popular techniques and, for future generations of pituitary surgeons, laid the foundation for modern transsphenoidal surgery. In this comparative analysis, the authors compare the operative nuances of the approaches of Cushing and Hirsch and describe the contributions of these pioneers to modern transsphenoidal surgery.

scholarly journals Drainage or Packing of the Sella? Transsphenoidal Surgery for Primary Pituitary Abscess: Report of Two Cases

2009 ◽  
Vol 2009 ◽  
pp. 1-3
Author(s):  
Soichi Oya ◽  
Junichiro Kumai ◽  
Taku Shigeno
Keyword(s):  
Cerebrospinal Fluid ◽  
Transsphenoidal Surgery ◽  
Sella Turcica ◽  
Cerebrospinal Fluid Leak ◽  
Anterior Wall ◽  
Rare Clinical Entity ◽  
Pituitary Abscess ◽  
Abscess Drainage ◽  
Postoperative Course ◽  
Fluid Leak

The detailed surgical procedure of the transsphenoidal surgery for pituitary abscess has scarcely been described previously because it is a very rare clinical entity. The authors reported two cases of primary pituitary abscess. In case 1, the anterior wall of the sella turcica was reconstructed with the vomer bone after irrigating the abscess cavity, but the sella was not packed by fat for fear of the persistent infection by devascularized tissues. This led to the postoperative meningocele, the cerebrospinal fluid leak, and bacterial meningitis despite the successful abscess drainage. In case 2, tight sellar packing and reconstruction of the sellar wall were performed to avoid these postoperative complications, which resulted in complete drainage and uneventful postoperative course. Although accumulation of more cases is obviously needed to establish the definitive surgical technique in pituitary abscess surgery, our experience might suggest that packing of the sella is not impeditive for postoperative sufficient drainage.

From ‘Sustainability’ to ‘Competitive Industry’

2015 ◽  
Author(s):  
Gillian Doyle
Keyword(s):  
Film Industry ◽  
Competitive Industry ◽  
Key Players ◽  
Set Up ◽  
The Moment ◽  
Over Time ◽  
The Way

Although from the moment the Film Council was set up, it was clear that the intention was to found an organisation focused on bringing ‘sustainability’ to the British film industry, the Council gradually retreated from this term in favour of a wider set of priorities and the way in which it articulated its mission also gradually shifted. Drawing on a wealth of original interviews with senior politicians, film executives, independent producers, industry experts and leading filmmakers, this chapter examines the key players, forces and assumptions which drove the Film Council’s agenda, how the weighting of priorities shifted over time and why the Council’s sense of mission changed over its lifetime.

Utility of the Nasoseptal “Rescue” Flap Approach: Analysis of 125 Consecutive Patients and Implications for Routine Transsphenoidal Surgery

2019 ◽  
Vol 34 (2) ◽  
pp. 269-275
Author(s):  
Zachary J. Cappello ◽  
Dennis M. Tang ◽  
Christopher R. Roxbury ◽  
Brian C. Lobo ◽  
Hamid Borghei-Razavi ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Cleveland Clinic ◽  
High Flow ◽  
Low Flow ◽  
Csf Leak ◽  
Nasoseptal Flap ◽  
The Mean ◽  
Csf Leaks

Introduction The nasoseptal flap (NSF) is the reconstructive workhorse for endoscopic skull base surgery (ESBS). However, there is morbidity associated with its use and it is not always required for reconstruction. The bilateral nasoseptal “rescue” flap (NSRF) technique offers a quicker alternative to upfront NSF harvest, yet permits the use of a tailored NSF if needed after the defect has been created. The utility and implications of this strategy have not been well studied. Methods We retrospectively analyzed 125 consecutive transsphenoidal cases where an NSRF approach was used from January 2015 to October 2017 at the Cleveland Clinic. Records were analyzed for conversion to NSF, outcomes, and reconstruction-related complications. Results The mean age of patients included in the study was 51 years, with 51% females. NSRF was converted to full NSF in only 16% of cases. Rationale for conversion included an unanticipated high-flow (7) or low-flow (12) cerebrospinal fluid (CSF) leak and an exposed internal carotid artery (1). NSRF was utilized and converted to formal NSF in 3 patients who had previous remote transsphenoidal surgery. One patient who had an NSRF without a full NSF raised had a postoperative CSF leak; however, no CSF leaks or flap ischemia was noted for those who had full NSFs raised, even in revision surgery. Conclusion NSRF approach provides the reliability and flexibility of vascularized reconstruction, without the perioperative disadvantages of an upfront NSF harvest. The low and successful conversion rate to NSF demonstrates the utility of this strategy which should be incorporated into the standard approach for routine transsphenoidal surgery.

Accuracy and feasibility of a dedicated image guidance solution for endoscopic lateral skull base surgery

2018 ◽  
Vol 275 (4) ◽  
pp. 905-911 ◽  
Author(s):  
Christoph Rathgeb ◽  
Lukas Anschuetz ◽  
Daniel Schneider ◽  
Cilgia Dür ◽  
Marco Caversaccio ◽  
...  
Keyword(s):  
Skull Base ◽  
Image Guidance ◽  
Skull Base Surgery ◽  
Lateral Skull Base

scholarly journals Complications of the Transsphenoidal Approach to Sellar Lesions

1991 ◽  
Vol 18 (4) ◽  
pp. 463-466 ◽  
Author(s):  
Kesava Reddy ◽  
Derek Fewer ◽  
Michael West
Keyword(s):  
Transsphenoidal Surgery ◽  
Intraventricular Hemorrhage ◽  
Internal Carotid ◽  
Preventive Measures ◽  
False Aneurysm ◽  
Sella Turcica ◽  
Major Morbidity ◽  
Mortality And Morbidity ◽  
Sellar Lesions ◽  
Thalamic Infarction

ABSTRACT:Transsphenoidal surgery is currently performed extensively for lesions of the sella turcica. The mortality and morbidity of this surgical approach are minimal, and the results satisfactory overall. Only a few studies have addressed the complications of this approach. The authors present a retrospective study of 200 transsphenoidal procedures in 196 patients over an eleven year period. There was one death due to meningitis. Major morbidity consisted of intraventricular hemorrhage in three patients, false aneurysm of the internal carotid artery in one patient and thalamic infarction in another patient. Minor morbidity details are presented. The pathogenesis of the most serious of these complications along with possible preventive measures are discussed.

Sign in / Sign up

Export Citation Format

Share Document