Mononostril endoscopic endonasal approach for pituitary surgery.

BACKGROUND: Most surgical teams currently consider that endoscopy has become the "gold standard" technique for the transsphenoidal approach to pituitary surgery. Pituitary adenomas are commonly benign tumours and should benefit from the least invasive approach. METHOD: In Foch Hospital, from 2006 to 2020, 2835 patients with pituitary adenomas were treated with a mononostril endoscopic endonasal approach. Here we describe the fine details of the nasal, sphenoidal and sellar steps of this technique. CONCLUSION: Complete preservation of the nasal corridor, luxation of the nasal septum and tailored sellar bone resection are essential for safe resection of pituitary adenomas.

BIS values during resuscitation: the role of the suppression ratio (case report).

We report a case during which it was simultaneously recorded usual Bispectral Index (BIS) values and elevated suppression ratio (SR) during resuscitation maneuvers. A 52-year-old woman, scheduled for a suspension laryngoscopy, required cardio-pulmonary resuscitation due to an anaphylactic shock secondary to the administration of succinylcholine. Post-crisis analysis of the BIS trace showed both BIS numbers consistent with an adequate level hypnosis and an increase in SR. Simultaneous hypnotic BIS values and an elevated SR is striking as SR quantifies electroenceph- alographic suppression. Clinicians must remember that SR is one of the parameters incorporated into BIS and must take SR into account even when the BIS is within the target range.

Impact of the modality of mechanical ventilation on bleeding during pituitary surgery: A single blinded randomized trial.

BACKGROUND: Bleeding modifies the surgeon's view of the field during transsphenoidal endoscopic pituitary surgery. Since ventilation can alter venous return, we compared the effect of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) on intraoperative bleeding. METHODS: Eighty-six patients were randomized to VCV or PCV in this single blinded study; comparisons concerned 42 in the PCV group and 43 in the VCV group. RESULTS: Intraoperative bleeding, the primary endpoint, did not differ between groups whether analysis focused on 7 levels of the score, from minimal bleeding to bleeding with significant change in the conduct of surgical procedure (P = .89) or on a stratification into 3 categories, mild, moderate, and major (P = .47). Median [interquartile range] peak airway pressure was lower in the PCV group (13.5 [12.5-15] vs 16.3 [14.4-19.1] cm H2O, P < .001) while mean airway pressures were similar (P = .08). Means ±â€ŠSD of tidal volumes were lower in the VCV group when expressed as absolute values (470.6 ±â€Š84 vs 434.7 ±â€Š71.7 ml, P = .05) or as tidal volume/theoretical ideal weight ratio (6.7 [6.5-7] vs 7.2 [6.9-7.9], P < .001). The 2 groups were similar for postoperative complications and number of patients cured. CONCLUSION: In conclusion, ventilation mode does not influence intraoperative bleeding during transsphenoidal pituitary surgery. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01891838; July 3, 2013.