Endoscopic Transsphenoidal approach for extrasellar extended Pituitary Macroadenomas, Surgical outcome.

Abstract

Abstract Words: 246 Background: Transsphenoidal approaches usually are the preferred method for treatment of pituitary tumors because of a lower risk of complications. Recently, endoscope has been introduced as an alternative and effective tool in transsphenoidal surgery. This study was conducted at Al-Azhar University Hospitals and Nasr City Health Insurance Hospital to evaluate the role of endoscope in dealing with pituitary tumors with suprasellar and parasellar extensions. Patients and methods: A total of 32 cases with pituitary adenoma with extrasellar extension were included. All cases were clinically and radiologically assessed. Pituitary hormones were also assessed. The endoscopic transsphenoidal endonasal procedure was performed for all included cases by the same surgical team. Results: The mean age of the included cases was 41.35 years. The mean size of pituitary lesions was 39.15 mm. Total resection was achieved in 22 cases (68.8%) while subtotal resection was achieved in 10 cases (31.2%). Complications included vascular injury (6.25%), visual deterioration (9.4%), deterioration of consciousness (9.4%), transient diabetes insipidus (6.25%), hydrocephalus (6.25%) and sinonasal symptoms (15.6%). There was a significant improvement of visual symptoms after surgery. Follow up showed a decrease in the number of cases having endocrinopathy although it was not significant (p = 0.052). Conclusion: Endoscopic transsphenoidal surgery is the preferred method for removal of the pituitary tumors because it provides better visualization and makes the orientation in the operative field easier and safer than the microscopic transsphenoidal approach. Also, we recommend to work in combination with E.N.T. to achieve the best results.