Effectiveness of Endoscopic Endonasal Transsphenoidal Surgery Using a Neuronavigation: Clinical Results of 178 Pituitary Adenomas

Manabu Shirakawa

doi:10.21767/2171-6625.100071

Abstract

Title: Effectiveness of endoscopic endonasal transsphenoidal surgery using a neuronavigation: Clinical results of 178 pituitary adenomas Background: The present study assesses endoscopic endonasal transsphenoidal surgery using neuronavigation for pituitary adenoma. Methods and findings: Data were analyzed from 178 consecutive patients with pituitary adenomas who underwent endoscopic endonasal transsphenoidal surgery using neuronavigation between April 2007 and May 2014. Rates of gross total removal and overall hormone remission in patients with microadenomas were 64% (114/178) and 90.9% (30/32), respectively. However, the rate of hormonal remission was lower for macroadenomas that produce growth hormone 64.3% (9/14). The rate of complications was 2.1% (4/178) including two patients with anterior pituitary insufficiency and one each with vision deterioration and permanent diabetes insipidus. Conclusion: Rates of complete removal and hormone remission were higher and complication rates were lower after endoscopic endonasal transsphenoidal surgery using neuronavigation to treat pituitary adenoma.

Highlights

When surgically treating patients with pituitary adenoma, higher rates of removal without complications and remission of hormone abnormalities are important
Data were analyzed from 178 consecutive patients with pituitary adenomas who underwent endoscopic endonasal transsphenoidal surgery using neuronavigation between April 2007 and May 2014
Rates of complete removal and hormone remission were higher and complication rates were lower after endoscopic endonasal transsphenoidal surgery using neuronavigation to treat pituitary adenoma

Summary

Introduction

When surgically treating patients with pituitary adenoma, higher rates of removal without complications and remission of hormone abnormalities are important. Endonasal endoscopic surgery is replacing microscopic transsphenoidal surgery (TSS) that has historically been the standard approach to removing pituitary adenomas [1], as the first line procedure due to improvements in endoscope devices. By only using traditional TSS, there are some difficult cases such as conchal type of sphenoid sinus and complex septum. For such cases, recently it has been reported that neuronavigation system is useful as auxiliary method to overcome, even though the number of cases were small [2,3,4]. The aim of the present study was to elucidate the effectiveness of this endoscopic TSS using neuronavigation system compared to traditional endoscopic TSS. The present study assesses endoscopic endonasal transsphenoidal surgery using neuronavigation for pituitary adenoma

Objectives

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Results

Discussion

Conclusion