Endoscopic transnasal skull base surgery acc. to BETTAG/SCHÄFER

Endoscopic transnasal transsphenoidal pituitary surgery is an advancement of the traditional microsurgical technique. Its advantages include better illumination of the surgical field and controlled tumor resection.

In general, endoscopic transnasal transsphenoidal procedures can be used for all endocrine-active and endocrine-inactive micro and macro adenomas. Pituitary adenomas with far parasellar, suprasellar or retrosellar extension as well as craniopharyngiomas, clival chordomas, and other tumors of the anterior skull base require extended skull base approaches under purely endoscopic control.

Especially in complex tumors and extended skull base approaches, the surgeon must work bimanually. The assistant introduces the endoscope via the upper margin of the main nasal cavity, and irrigation fluid is applied as needed.

To meet these demands, we collaborated with Prof. Bettag and Dr. Schäfer to develop a long, 30 cm version with 0° and 30° directions of view and an outer diameter of 4 mm to complement the THUMFART handle with integrated lens cleaning system and 18 cm telescopes.

Advantages of the surgical technique

This technique features the following advantages compared to the microsurgical standard technique:

Excellent illumination of the surgical field through the application of light close to anatomical structures
High detail resolution thanks to wide-angle optics
Examination of areas that could previously not be inspected thanks to endoscopes with 30° and 45° directions of view
High mobility of the surgical instruments without interference with a nasal speculum
Minimal trauma to mucosa
Better differentiation between tumorous and normal tissue

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