The Endoscopic Diving Technique in Pituitary and Cranial Base Surgery

OBJECTIVE: We used the diving technique to go beyond mere visualization of the surgical field and used it as an important step in removing the lesion itself, improving the optical field, and optimizing visualization with a dynamic fluid film lens. Likewise, having extended endoscopic endonasal surgery to the entire base of the skull and in particular to the sinus cavity, "diving surgery" has proven to be effective in visualizing and dissecting more extended tumors. METHODS: We performed diving surgery in more than 350 surgical procedures to remove lesions in the sellar, sinus cavity, and clival regions. Intrasellar hydroscopy was performed in all cases to check that the lesion was removed completely and to gently dissect any intracavitary residual tumoral tissue. Diving surgery can be performed in the sellar cavity, in the cavernous sinus, and at the level of the posterior cranial fossa in the cavity obtained after clivectomy. RESULTS: The hydrodissection and continuous flushing of the sellar cavity, together with better control of bleeding, allow the surgeon to perform piecemeal removal of the lesion with direct control of the cleavage plane and tumor residue and avoid blind curettage near the pituitary gland. This technique is particularly useful in identifying small infiltrations of the cavernous sinus and in checking the integrity of the pituitary stalk when instruments are introduced into the sella. CONCLUSION: Diving surgery is a useful step in dealing with minor complications that can occur during endonasal endoscopic surgical procedures.