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Evaluation of the 3-Dimensional Endoscope in Transsphenoidal Surgery

Barkhoudarian, Garni MD*; Del Carmen Becerra Romero, Alicia MD, PhD; Laws, Edward R. MD§

doi: 10.1227/NEU.0b013e31828ba962
Instrumentation Assessment

BACKGROUND: Three-dimensional (3-D) endoscopy is a recent addition to augment the transsphenoidal surgical approach for anterior skull-base and parasellar lesions. We describe our experience implementing this technology into regular surgical practice.

OBJECTIVE: Retrospective review of clinical factors and outcomes.

METHODS: All patients were analyzed who had endoscopic endonasal parasellar operations since the introduction of the 3-D endoscope to our practice. Over an 18-month period, 160 operations were performed using solely endoscopic techniques. Sixty-five of these were with the Visionsense VSII 3-D endoscope and 95 utilized 2-dimensional (2-D) high-definition (HD) Storz endoscopes. Intraoperative and postoperative findings were analyzed in a retrospective fashion.

RESULTS: Comparing both groups, there was no significant difference in total or surgical operating room times comparing the 2-D HD and 3-D endoscopes (239 minutes vs 229 minutes, P = .47). Within disease-specific comparison, pituitary adenoma resection was significantly shorter utilizing the 3-D endoscope (surgical time 174 minutes vs 147 minutes, P = .03). These findings were independent of resident or fellow experience. There was no significant difference in the rate of complication, reoperation, tumor resection, or intraoperative cerebrospinal fluid leaks. Subjectively, the 3-D endoscope offered increased agility with 3-D techniques such as exposing the sphenoid rostrum, drilling sphenoidal septations, and identifying bony landmarks and suprasellar structures.

CONCLUSION: The 3-D endoscope is a useful alternative to the 2-D HD endoscope for transnasal anterior skull-base surgery. Preliminary results suggest it is more efficient surgically and has a shorter learning curve. As 3-D technology and resolution improve, it should serve to be an invaluable tool for neuroendoscopy.

ABBREVIATION: HD, high definition

*Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California;

Department of Neurosurgery and Skull Base Surgery, Hospital Ernesto Dornelles, Porto Alegre, Brazil;

§Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts

Correspondence: Garni Barkhoudarian, MD, Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Saint John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA, 90404. E-mail:

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Received August 29, 2012

Accepted February 5, 2013

Copyright © by the Congress of Neurological Surgeons