부산대학교 도서관

Objective : We have reported the usefulness of a micro-pressure-suction-irrigation system (MPSIS) in the direct transnasal pituitary surgery. This system was, however, less useful for the removal of fibrous pituitary adenomas, especially during transnasal reoperation. Recently, an ultrasonic surgical aspirator with a needle-type probe (OUSA, Olympus Optical Co.) has been developed. We report our preliminarily experiences using MPSIS and OUSA in direct transnasal reoperations for fibrous pituitary adenomas. Methods : MPSIS can effectively dissect the usual soft pituitary adenoma tissue with a rapid flow and remove it by suction by one-hand manipulation. This system is especially useful when it is used in combination with a micromirror or a neuroendoscope for a direct inspection of the eccentric tumor sites, such as for a tumor in the cavernous sinus. We use OUSA for the removal of the remainder of the fibrous adenoma that MPSIS is not able to extirpate. The weight of the handpiece is reduced to 90 g. The needle type M probe has a 171-mm length, a 1.9-mm tip diameter, and a 3.3-mm sheath diameter and produces a tip amplitude of 70 μm. We performed direct transnasal reoperation using MPSIS and OUSA in 4 patients with fibrous nonfunctioning pituitary adenomas. Results : We could fairly reduce the mass in fibrous nonfunctioning adenomas with MPSIS and OUSA. Visual field defects were improved. There was no surgical morbidity of mortality. Conclusion : MPSIS combined with OUSA seems to be useful for the removal of fibrous pituitary adenomas in direct transnasal reoperation.