Endoscopic extrapseudocapsular resection of pituitary adenoma using bilateral endonasal approach

Abstract

Objective To explore our surgical experience and clinical outcome of endoscopic extrapseudocapsular resection of pituitary adenoma using bilateral endonasal approach. Methods A retrospective review of clinical data of 254 patients who were treated for pituitary adenoma by endoscopic surgery using bilateral endonasal approach within the time frame of January 2015-December 2016 at Department of Neurosurgery, First Affiliated Hospital of Nanchang University. The patients who experienced extrapseudocapsular resection were selected for general evaluation of surgical outcome and follow-up results. Results A total of 133 cases underwent endoscopic endonasal extrapseudocapsular resection. Among those, 124 (93.2%) cases achieved gross total resection and subtotal resection was achieved in 9 (6.8%) cases. Postoperative improvement of vision and visual field occurred in 61 (84.7%) cases and 42 (73.7%) cases achieved postoperative remission of headache. Among 62 non-functional pituitary adenomas with normal preoperative pituitary function, 42 (67.7%) cases preserved normal pituitary function after operation and the other 20 (32.3%) cases developed partial hypopituitarism. Out of 23 non-functional pituitary adenomas with preoperative partial hypopituitarism, postoperative improvement was reported in 10 (43.5%) cases, persistent hypopituitarism in 10 (43.5%) cases and aggravation in 3 (13.0%) cases. Overall, 44 (91.7%) cases showed biochemical remission in endocrine-active pituitary adenomas after operation. Intraoperative rupture of sellar diaphragm was noted in 52 (39.1%) cases, postoperative CSF (cerebrospinal fluid) leakage in 6 (4.5%) cases, and transient diabetes insipidus (DI) in 27 (20.3%) cases. No death occurred during the follow-up period. Tumor recurrence occurred in 3 (2.4%) cases during the follow-up period lasting for 23.6±7.0 months. Conclusions Endoscopic extrapseudocapsular resection of pituitary adenoma using bilateral endonasal approach could achieve high rate of gross total resection and low rate of tumor recurrence, effectively alleviate the patients’ clinical symptoms, increase surgical remission rate in endocrine-active adenomas with less complications. Key words: Pituitary neoplasms; Natural orifice endoscopic surgery; Pseudocapsular; Transsphenoidal surgery