Endoscopic endonasal transsphenoidal surgery for pituitary adenomas: evaluation of results and technical aspects

Abstract

Introduction: The endoscopic surgery has been increasingly accepted for the treatment of pituitary adenomas. There is still controversy regarding the benefits of this new technique. A new surgical approach must be safe and effective. Objective: Analyze the results and technical aspects of the endoscopic endonasal transsphenoidal approach for pituitary adenomas. Method: Retrospective study of 30 consecutive patients that underwent endoscopic endonasal resection of pituitary adenomas with a follow up from 24 to 67 months. Results: There were 18 women and 12 men, mean age 44 years (range 17-65 yr). Among the 30 patients, 23 had macroadenomas and 7 microadenomas. Twelve patients had non-functioning tumors, 9 had ACTH-secreting tumors, and 8 had GH-secreting tumors and 1 prolactinoma. Complete resection and hormonal control was achieved in all microadenomas. Macroadenomas were completely removed in 6 patients, subtotal resection in 6 and partial resection in 11. Three patients had diabetes insipidus and 5 had CSF leaks treated with lumbar drainage. Conclusion: The endonasal endoscopic approach for pituitary microadenomas and macroadenomas restricted to the sella is effective and safe. Macroadenomas with suprasellar extensions and cavernous sinus invasion may require endoscopic extended approaches for complete removal. The endoscopic endonasal transsphenoidal approach offers excellent visualization of anatomical structures and preserves the nasal cavity.