Clinical study
Endoscopic endonasal pituitary surgery: Surgical and outcome analysis of 50 cases

https://doi.org/10.1016/j.jocn.2006.02.014Get rights and content

Abstract

Objective

Microsurgical transsphenoidal surgery for pituitary tumors has been standard therapy for decades and was established by Harvey Cushing in the early twentieth century. Today, endoscopy is increasingly accepted in the therapy of pituitary lesions. In this retrospective study, we analysed the surgical technique and outcome of 50 patients with pituitary lesions treated with an endoscopic endonasal trans-sphenoidal approach.

Methods

Between January 2004 and July 2005, 50 patients (30 female and 20 male) with pituitary tumors were operated upon using an endoscopic endonasal trans-sphenoidal procedure without nasal speculum or postoperative nasal packing. The follow-up period ranged from 3 to 18 months.

Results

All patients had normal airways through both nostrils immediately after extubation. Postoperative discomfort was minimal and hospitalization was 4–5 days. Three patients developed postoperative transient diabetes insipidus, persisting in one for a further 2 months. Among the 50 patients, total tumor removal was achieved in 47 patients (94%), subtotal in two patients (4%). One patient died intraoperatively due to subarachnoid haemorrhage.

Conclusion

The endoscopic endonasal transsphenoidal approach for removing pituitary lesions is a form of minimally invasive surgery offering excellent postoperative results.

Introduction

The evolution of neurosurgery in this century has passed from the use of wide craniotomies to smaller and smaller approaches (keyhole concept), with the aim of reducing surgical trauma and of improving postoperative outcome.[1], [2] Microsurgical trans-sphenoidal surgery for pituitary tumors has been standard therapy for decades, established by Harvey Cushing in the early twentieth century.[3], [4], [5] Since the introduction of the endoscope, adopted in paranasal sinus surgery through the otorhinolaryngologists[6], [7] and in other neurosurgical procedures,[8], [9], [10], [11] interest has developed regarding its use in transsphenoidal pituitary surgery.[12], [13], [14], [15], [16] Although the microsurgical transsphenoidal approach, via a septal or sublabial incision, has been the operative technique of choice, endoscopy is increasingly accepted to provide a closer detail of the anatomy and wider angles of view.1

The endoscopic endonasal transsphenoidal approach for pituitary lesions avoids the use of a nasal speculum, trans-sphenoidal retractor and postoperative nasal packing.[17], [18] This technique is a minimally invasive and maximally effective neurosurgical treatment for patients with pituitary tumors.

In the present study we analysed the surgical procedure for endoscopic endonasal transsphenoidal surgery and the outcome of 50 patients with tumors of the intra-, para-, and suprasellar regions treated in our department from January 2004 until July 2005.

Section snippets

Patient population

Between January 2004 and July 2005, 54 patients (34 female and 20 male) with pituitary tumors were operated on using endoscope-assisted (4 male patients) and pure endoscopic procedures (50 patients). The mean age was 56 years, ranging from 28 to 84 years. In all patients the target of the surgical therapy was total removal of the pituitary tumor. The follow-up period ranged from 3 to 18 months.

During our learning curve in the first years of experience, the first four patients (2 microadenomas,

Results

Surgery using a totally endoscopic endonasal transsphenoidal technique was performed via a binostril approach as described above in 50 patients. All patients had normal free airways through both nostrils immediately after extubation. This evaluation was performed directly using questionnaires. Postoperative discomfort such as headache, vomiting or dizziness was minimal and hospitalization was 4–5 days. This was evaluated again by direct questionnaires and nursing notes. Three patients developed

Discussion

During the twentieth century transsphenoidal microsurgery has been the procedure of choice for almost all pituitary lesions.[3], [4] In 1987 Griffith and Veerapen first reported an endonasal trans-sphenoidal approach to the sella region, which is now very popular and widely used for trans-sphenoidal surgery, often with endoscopic assistance.19 In the 1990s the endoscope was adopted in pure endoscopic[9], [10], [20] or endoscope-assisted neurosurgical procedures.[8], [11]

Jho and Carrau led this

Conclusion

The endoscopic endonasal transsphenoidal approach for removing pituitary lesions is another form of minimally invasive keyhole neurosurgical technique. It allows in maximal effective treatment with minimal trauma the nasal-sphenoidal-sellar complex.

Acknowledgement

We thank Janice Roberts for help in preparation and revision of this manuscript. We received no financial support to analyse this data and we have no financial interest in any materials or devices described.

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