Trans-nasal Trans-sphenoidal Endoscopic Hypophysectomy

Abstract

Advances in optics, miniaturization, and endoscopic instrumentation have revolutionized surgery in the past decades. Current progress in the field of endoscopy promises to further this evolution: endoscopic telescopes and instruments have improved upon the optical and technical limitations of the microscope, and require an even less invasive approach to the sella. The minimally invasive endoscopic pituitary surgery is performed through the natural nasal pathway without any incisions and is performed via Trans-nasal Trans-sphenoidal approach. Pituitary surgery is traditionally within the realm of the neurosurgeon. However, since the introduction of the endoscopic transnasal transsphenoidal approach to the sella turcica for resection of pituitary adenoma, otolaryngologists have been active partners in the surgical management of these patients. Otolaryngologists have lent their expertise in nasal and sinus surgery, assisting the neurosurgeon with the operation. The otolaryngologist has the advantage of familiarity with the techniques and instruments used to gain exposure of the sella turcica by transnasal approach. Hence, the otolaryngologist provides the exposure, and the neurosurgeon resects the tumour. Such collaboration has resulted in decreased rates of complication and morbidity. We hereby discuss our experience of treating 72 cases of pituitary tumour by endoscopic trans-nasal trans-sphenoidal approach. In our study, conducted from 2005 to 2016, the mean age of patients was 32.5 years (18-56 years), Male and female ratio was 1.3:1.0, MRI was done in all the cases, CT scan was done in 94.44 % cases, 9.72% cases had Intra op./ Post op. complications which were managed successfully. Subtotal resection could be done in 6.94% cases, recurrence was seen in 7.46% cases and lumbar drain was required in 4.17 % cases. Average hospital stay was 4.4 days and average surgery time was 120 minutes. Close follow-up was maintained for an average period of 09 months. In our experience of 10 years, adopting the endoscope heightens the surgeons' visualization of pituitary tumors, thus no external incision, no nasal packing and minimal stay with minimal complications. Endoscopic transsphenoidal approach is the less traumatic route to the sella turcica, avoiding brain retraction, and also permitting good visualization, with lower rates of morbidity and mortality.