Abstract
Here we review the technical aspects of our experience with the neuroendoscopic bilateral nostril (binostril) transsphenoidal approach for pituitary adenomas. A total of 42 patients were treated in our hospital from September 2013 to December 2015. Total tumor resection was completed in 31 cases, nearly full resection was achieved in 9 cases, and partial resection was achieved in 2 cases. In most cases clinical symptoms were relieved after surgery. These included 18/22 cases with visual field and vision disorders; 19/25 cases with headaches; 11/15 cases where high baseline PRL returned to normal levels; 6/7 cases where elevated blood GH returned to normal levels; and 2/3 cases where elevated blood ACTH returned to normal levels after surgery. Postoperative complications were observed in 13 patients: 8 cases of diabetes insipidus, 4 cases of cerebrospinal fluid rhinorrhea, and 1 case of subarachnoid hemorrhage. Among the key advantages of the neuroendoscopic binostril transsphenoidal approach for pituitary adenoma resection are its minimally-invasive nature, clear exposure of the operative field, high full-excision rates, improved peri-operative safety, and minor patient trauma with fewer postoperative complications.
Highlights
Pituitary adenomas are common benign tumors of the pituitary gland, accounting for 10% of all intracranial tumors
Endonasal transsphenoidal endoscopy to remove pituitary adenomas was performed in 42 patients from September 2013 to December 2015 in our hospital
Postoperative symptoms improved to varying degrees: 18 of 22 patients with vision disorders and 19 of 25 patients with headaches improved significantly; of 15 patients with increased preoperative PRL, 11 regained normal levels; of 7 patients with elevated blood growth hormone (GH), 6 attained normal levels; of 3 patients with increased blood adrenocorticotropic hormone (ACTH) levels, normal levels were reestablished in 2; among the 4 mixedtype tumor patients, 3 regained normal hormone levels
Summary
Pituitary adenomas are common benign tumors of the pituitary gland, accounting for 10% of all intracranial tumors. Their incidence in unselective autopsies is as high as 20-30% [1]. With the rapid development of the endoscopic technique, endoscopic neurosurgery has become one of the most active fields of neurosurgery, with the transsphenoidal approach through the bilateral nostrils for resection of pituitary adenomas representing perhaps the most mature and widest application of this surgical technique [5]. From September 2013 to December 2014, our hospital conducted 42 cases of pituitary adenoma resection using transsphenoidal endoscopy through the bilateral nostrils and achieved good effect. We perform an in-depth evaluation of this technique and highlight the operating characteristics and clinical outcomes
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