Endoscopic Endonasal Transphenoidal Approach for Pituitary Adenomas: Outcomes of Our Center

Abstract

Objectives: Report the results of a consecutive series of patients who underwent an endoscopic endonasal transphenoidal approach (EETA) for resection of a pituitary adenoma. Methods: A retrospective review of patients who underwent EETA at our center between 2010 and 2013, in a collaboration between head and neck surgeons and neurosurgeons, and a description of the technique used. Results: Nineteen patients underwent an EETA for removal of a pituitary adenoma. Decreased visual acuity or a visual field defect was the presenting complaint in 63.2% patients and headache in 26.3%. Nonfunctioning adenoma was the most frequent (52.6%). Sixteen (84.2%) patients had a macroadenoma (>1 cm) and 3 (15.8%) had a microadenoma (<1 cm). The overall postoperative cerebrospinal fluid leak rate was 5.3%. Other perioperative complications were epistaxis (5.3%), postsurgical hematoma (5.3%) with urgent evacuation, and meningitis (5.3%). The rate of gross total ressection was 70% in patients with nonfunctioning adenomas. The remission rate of secretory adenomas was 75%. Of the patients presenting with visual symptoms, 91.7% improved or normalized. Conclusions: EETA is an excellent alternative to other classic approaches for pituitary adenoma, providing similar results with less morbidity. It allows a better panoramic visualization of sellar and parasellar spaces and a better preservation of the normal anatomy and physiology of nasal cavity. This minimally invasive approach is now the standard of care in transasal pituitary surgery. Our outcomes, including remission and complication rates, are comparable with those reported in previous series of endoscopic and microscopic approaches.