Letter to the Editor: Extended endoscopic endonasal approach (original) (raw)

2012, Journal of Neurosurgery

February 2011), which reported the result of management of selected pituitary adenomas, using an extended endoscopic endonasal approach. The authors presented convincing evidence that such treatment confers greater benefits, as compared with the standard approach. Initial results are promising and may justify a widening of the current classical indications of transsphenoidal surgery for this kind of pituitary adenoma. As I have a special interest in articles that bear on the transnasal approach to the skull base, I was most interested in reading this article, and above all particularly honored to have been quoted on a number of occasions in the article. Indeed, I would like to express my gratitude to the authors. However, I was slightly disappointed to notice that my surgical contribution in performing many of the 92 extended procedures, reported in the article, has been neglected. Indeed, I respectfully point out, just for the pursuit of truth, that the majority of patients have undergone extended endonasal surgeries at the Neurosurgical Department of Federico II University of Naples, between 2003 and 2008 (when I retired), carried out by myself together with Dr. Cavallo (such a tandem surgery needs 2 surgeons to perform a "four hand technique"). It is easily provable by reading what is reported in the papers of references 19 and 21 cited in Patients and Methods, where surgeons are indicated, in contrast to what is reported in the Results of the present article, where the authors state: "…92 EEEAs have been performed by the senior authors… (L.M.C., P.C.)." In such a way they lead to a misconception because this information, in reality, does not adhere to the truth. Nevertheless, I'm sure that it was a misunderstanding, maybe due to a mere oversight on the part of the authors. Otherwise, it would be quite disconcerting, particularly for the fact that 2 of the authors, serving as my alumni, have shared with me, right from the start, the exciting experience of the evolution of endoscopic endonasal pituitary and skull base surgery. Finally, while I congratulate the authors on this timely and excellent paper, which is likely to be very influential, I would exhort them not to forget Newton's old aphorism: "nos quasi nanos gigantium humeris insidientes" (we are as dwarfs on the shoulders of giants, and can see far…, for we have been lifted high by their gigantic grandeur). enrico de diviTiis, M.d.