The primary objective in the treatment of early rectal cancer is to achieve optimal oncological control while minimizing the long-term impact of therapeutic interventions on patients' quality of life. The current standard of care for most stage I and II rectal cancers involves radical surgery, specifically total mesorectal excision. Although total mesorectal excision is generally curative for early rectal cancers, it can significantly affect patients' quality of life by potentially necessitating a permanent colostomy and causing bowel, bladder, and sexual dysfunction. Given the morbidity associated with radical surgery, alternative approaches to managing early rectal cancer, such as local excision through transanal excision, transanal endoscopic microsurgery, and transanal minimally invasive surgery, have been investigated. If these surgical approaches are applied cautiously to carefully selected cases of early rectal cancer, it is anticipated that these local procedures will achieve comparable oncological outcomes to the established standard of radical surgery, potentially offering superior results regarding morbidity, mortality, and overall quality of life.
, Jun Hyeok Song, Kyu Man Shin Cysticercosis is the most frequent parasitosis of the central nervous system. Often medical treatment does not influence on ventricular or cisternal cysts or doesn't prevent the occurence of complications, such as hydrocephalus. So a considerable group of patients require surgical procedures, especially in cases of neural compression or intracranial hypertension or epilepsy. Recently stereotactic endoscopic removal of intraaxial small lesions using a stereotactic guiding tube and a fine endoscope was reported. We tried to control the symptomatic neurocy-sticercosis using the stereotatic endoscopic system.
We operated 4 cases of neurocysticercosis. Cerebrospinal fluid(CSF)analysis, enhanced com-puterized tomogram(CT) and magnetic resonance image(MRI) scan were performed. There were no specific findings in CSF analysis. CT and MRI scan showed single intraparenchymal lesion in 2 cases, one was cystic and the other was solid, multiple intraventricular cysts with obstructive hydrocephalus in 1 case and mixed type in 1 case. Seizures occured in all patients, partial sensory type in 3 cases who had reciprocal intraparenchymal lesion, generalized type in 1 case who had obstructive hydrocephalus by multple ventricular cysts.
For parenchymal lesions, we planned stereotactic open system endoscopic surgery with variable forceps, laser and suction. Cystic forms were removed successfully but in solid form additional transgyral microscopic removal was needed. In intraventricular lesions, we first placed stereotactic guiding tube via frontal burr hole, then replaced this to 14 Fr peelaway patheter. Through the peelaway catheter we inserted closed system endoscopy and removed the cysts with variable forceps and suctions. All intraparenchymal and intraventricular lesions were removed without specific complications except transient chemical meningitis in one case.
Stereotactic endoscopic surgery make it possible to operate cystic lesions without dege-neration(vesicular stage)wherever they locate.
Surgical approaches to the pituitary adenoma have undergone numerous refinements. Surgery on the pituitary adenoma is increasingly being performed through an endoscopic approach. The aim of this study is to report the results of a consecutive series of patients undergoing pituitary surgery using a pure endoscopic endonasal approach(EEA) and to evaluate the efficacy and safety of this procedure.
We reviewed 24 consecutive patients with pituitary adenoma who underwent purely endoscopic transsphenoidal resection of their lesions. The patients' clinical outcomes, including remission rates, degrees of tumor removal, and complications were evaluated.
Between September 2000 and August 2009, 76 patients with pituitary adenoma were operated on at Ewha University Mokdong Hospital. Of these, 24 patients were operated on using EEA. There were 18 nonfunctioning, 4 growth hormone-secreting, and 2 prolactin-secreting adenomas. Gross total removal was achieved in 62.5% of the cases after surgery. Visual disturbance was seen in 18 patients, which was improved in all patients. The main cause of failure of total removal was invasion to cavernous sinus. The remission results for patients with nonfunctioning adenomas was 83.3% and for functioning adenomas were 83.3%(75% for GH hormone-secreting, 100% for prolactin hormone-secreting), with no recurrence at the time of the last follow-up. Post-operative complications were present in 4(16.7%) cases. Three cases showed immediate postoperative CSF leakage, one case showed transient diabetes insipidus. There was no death related to the procedure in this series.
The endoscopic endonasal approach for resection of pituitary adenomas, provides acceptable results representing a safe alternative procedure to the microscopic approach. This less invasive method, associated with a small number of complications, provides acceptable tumor removal rates and represents an important tool for the achievement of good results in the pituitary surgery.
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