Abstract
Objectives:The purpose of the study was to access the efficacy and response of the endoscopic transsphenoidal surgery in pituitary adenomas.Methods:It was descriptive case study, conducted at Neurosurgery Department in collaboration with the Endocrine Unit (Medical Unit-II) Of Jinnah Post Graduate Medical Center Karachi from January 2015 to July 2017. Patients with sellar, supra sellar and para sellar tumors were enrolled in the study. Patients with prolactinoma and recurrent pituitary tumors were excluded. Data was analyzed using SPPS 17.Results:Sixty three patients were included in the study with mean age of 42±8.34 years. There were 40(63.5%) male patients and 23(36.5%) female patients with pituitary adenoma. Headache and visual impairment were the main presentation 55(87.3%) and 56 (88.8%) respectively. Out of all these patients the pituitary adenomas, 51(81%) patients had non secretory and 12 (19%) patients had secretory tumor. Out of these pituitary adenomas 53(84.1%) were macroadenomas and 10(15.9%) were microadenoma. Post operatively marked improvement in the headache was in all 100% patients and vision improved in 54 (96.4%). The most common post operative complication was cerebrospinal fluid (CSF) leak in 10 (15.9%) with 44 (69.8%) having no post complications at all. Mortality was reported to be just 1.6% i-e one patient.Conclusion:The endoscopic transsphenoidal approach for pituitary adenoma is the safest procedure with marked improvement in complications and reduction in patient’s hospital stay.
Highlights
First line therapy for all the pituitary adenoma is surgical resection except for prolactinoma which has excellent response to pharmacological therapy.[1]
In this study we evaluated the advantages and limitation of endoscopic transsphenoidal surgery for pituitary adenoma in a public centre hospital which is one of the very few setups in Pakistan offering this procedure
Pituitary adenomas were classified on the basis of size; 53(84.1%) were macroadenomas (≥1 cm) and 10(15.9%) were microadenomas (
Summary
First line therapy for all the pituitary adenoma is surgical resection except for prolactinoma which has excellent response to pharmacological therapy.[1] Endoscopic transsphenoidal surgery was developed under a minimally invasive surgical strategy This endonasal transsphenoidal endoscopy eliminates needs of sublabial or transseptal incision, use of any transsphenoidal retractor and nasal packing.[2] The transsphenoidal approach for resection of a pituitary adenoma was first performed by Herman Schloffer more than 100 years ago.[3] When compared to the techniques that utilize microscopes, endoscopic surgery permits a wider field of vision, better visualization of the supra and parasellar region and of the neurovascular structures (optic nerves, chiasm, carotid artery, Pak J Med Sci March - April 2018 Vol 34 No 2 www.pjms.com.pk 412 and cavernous sinus).[4] The introduction of the endoscope in the sella turcica brings to light the structures and the normal tissue/tumor interface facilitating the removal of tumor remains. The lateral field of vision is wider; the limitation on movement created by the use of the speculum is avoided.[5]
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