Endoscopic endonasal transsphenoidal surgery: predictors for disease control in a consecutive series of pituitary adenomas

Mostafa Ismail,Jean D’Haens,Olaf Michel,Balegh Abdelhak

doi:10.4103/1012-5574.186523

Abstract

Abstract Endoscopic endonasal transsphenoidal surgery for pituitary lesions has been predestined and evolved since its incipient description. However, tumour size and extrasellar extensions of pituitary adenomas remain a challenge for disease control (DC) after surgery. This study was conducted to evaluate the predictors that determine the early outcome in a consecutive series of pituitary adenomas operated using an endoscopic transsphenoidal approach. Sixty-five consecutive pituitary adenomas presenting over a 36-month period subjected to excision through an entirely endoscopic transsphenoidal approach were reviewed. DC, based on the extent of tumour resection and endocrinological remission, was evaluated according to the recent radiological and hormonal consensus criteria. Of 65 pituitary adenomas operated, 24 were endocrinally nonfunctioning and 41 were functioning adenomas. The follow-up duration ranged from 3 to 33 months. The overall DC was 67.7% as measured using total tumour resection and endocrinal cure. Cavernous sinus invasion, suprasellar extension and revision surgery negatively influenced DC of pituitary adenomas. Postoperative complications related to surgical resection of adenomas were seen in 12 cases (18.5%) − mainly, cerebrospinal fluid leakage, anterior pituitary insufficiency, and diabetes insipidus. This study reports standards for DC in a short follow-up series of purely endoscopic pituitary surgeries and identifies pituitary lesions associated with preoperative predictors that can influence postoperative outcome. These results authenticate the efficacy and safety of endoscopic endonasal transsphenoidal surgery in the treatment of pituitary adenomas, providing favourable DC for both functioning and nonfunctioning pituitary adenomas.

Highlights

Transsphenoidal surgery is the most widely used surgical approach in the treatment of pituitary tumours since the 1960s due to its adequate surgical outcome [1]
Surgical resection was the first-line treatment in growth hormone (GH)-secreting and adrenocorticotrophic-stimulating hormone-secreting adenomas, whereas it was indicated in prolactinomas with failed or nontolerable medical therapy
In nonfunctioning pituitary adenomas (NFPAs) (n=24), surgical resection was indicated in the presence of headache, visual deficits or impaired pituitary function (Table 1)

Summary

Introduction

Transsphenoidal surgery is the most widely used surgical approach in the treatment of pituitary tumours since the 1960s due to its adequate surgical outcome [1]. The tendency of pituitary macroadenomas for extrasellar extension through the diaphragm sellae into the suprasellar cistern or into the cavernous sinus [10] makes total resection of these tumours challenging [9]. The purpose of current study was to validate the short-term effectiveness of the endoscopic endonasal approach as regards DC in a consecutive series of functioning (FPA) and nonfunctioning pituitary adenomas (NFPAs), with a specific focus on the preoperative predictors for total. Tumour size and extrasellar extensions of pituitary adenomas remain a challenge for disease control (DC) after surgery. This study was conducted to evaluate the predictors that determine the early outcome in a consecutive series of pituitary adenomas operated using an endoscopic transsphenoidal approach. Postoperative complications related to surgical resection of adenomas were seen in 12 cases (18.5%) − mainly, cerebrospinal fluid leakage, anterior pituitary insufficiency, and diabetes insipidus

Methods

Results

Discussion

Conclusion