Endoscopic Transsphenoidal Surgery: A Practical Guide

Review by L Flood
Middlesborough, UK

The last two decades have undoubtedly seen a massive increase in the popularity of endoscopic transnasal approaches to the skull base. Pioneering surgeons, who were only grateful to be entering the antrum and not the orbit, have extended its remit way beyond the historical boundaries of the pituitary gland and optic nerves. The recent output of textbooks, especially from this publisher, very much reflects this.

A very nice early message here is the need for early team building and only gradual tackling of increasingly complex surgery. A particularly nice introductory table takes us from level I skills (e.g. sinonasal surgery or small cerebrospinal fluid leaks), to which this reviewer could only have aspired, to level V cerebrovascular surgery (e.g. aneurysms or arteriovenous malformations).

An inevitable chapter on surgical anatomy is brief, clinically orientated, and accompanied by excellent colour illustrations of cadaver dissection and live surgery. For once, sensible labelling has not masked the visual message in what is truly ‘state of the art’ photography. Pre-operative assessment merits a short chapter, but is good on pituitary hormone assessment. The following chapter is entitled ‘Radiological Investigations; A Prerequisite’, which I thought curiously facile. I doubt many would wield an endoscope knowing that the images were unfortunately inaccessible! Never mind. The chapter is great, with excellent illustrations and tutorials on their interpretation and clinical relevance.

The fifth chapter is ‘Pituitary Surgery; Basic Concepts’ (actually over 50 pages), and again this is step-by-step, practical hands-on advice, with flawless photography. Every little mucosal blood vessel is sharply focused and the white balance is correct; this is skilled work and/or superb kit.

Of course, as one moves up the hierarchy of that introductory table, one starts chapter VI on extended trans-sphenoidal surgery (I cannot bear the plural ‘surgeries’). This now takes us into craniopharyngiomas, chordomas, clival meningiomas and the like. Once more, the logical sequence of colour images means we really do not need accompanying videos, they are that good. Chapters on post-operative management and complications are brief, but a good introductory text. ‘Decision Making in Endonasal Skull Base Surgery’ left me wanting much more, as the few pages we did get were really eye-opening. There follows 30 pages, each illustrating a surgical instrument, which I found less convincing and felt could have been shortened. The text abruptly closes with case reports (well, three actually); I would have really enjoyed seeing a closing summary included.

Frankly, I know more about clinical photography than I do about endoscopic trans-sphenoidal surgery, which only increased my enthusiasm for this book. The authors have made an excellent job of what is an attractive introduction to the subject, with concise and well laid out, easy-reading text. This is an excellent reference for any trainee, but also for many a senior, I would imagine.

Amazon Link: Endoscopic Transsphenoidal Surgery: A Practical Guide
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