Endoscopic sinus surgery
Inspired by an experience with endoscopic paranasal sinus surgery, an endoscope was applied in transsphenoidal pituitary surgery. This endoscopic transsphenoidal technique was used in 45 cases of pituitary neuroendocrine tumors. Using a 4 mm rigid endoscope, the pituitary neuroendocrine tumor is removed through a nostril. A zero-degree endoscope is used for micro-adenomas. A combination of a 0-degree endoscope and a 30-degree endoscope is used for macro-adenomas that have extended to the suprasellar region. Although it is early in experience with a small number of patients, the short-term surgical results have been encouraging with patients' short hospital stay and minimum morbidity. The endoscopic technique that has evolved with Jho and Carrau experience is described with two cases of pituitary neuroendocrine tumors 1).
Intracranial complications of sinusitis are rare but life threatening. Intracranial complications of sinusitis and acute otitis media are best managed in a specialist centre with multidisciplinary input. Concurrent ORL and neurosurgical intervention reduces abscess recurrence and requirement for revision neurosurgery in sinogenic complications and should represent the standard of care. Endoscopic sinus surgery is the ORL modality of choice in experienced hands 2).