Transnasal Endoscopic Pituitary Surgery in GH-Secreting Adenomas

Abstract

Purpose: To study the value of transnasal endoscopy in surgery of growth hormone (GH)- secreting pituitary adenomas. Patients and Methods: Since the last 5 years, 138 patients with pituitary adenomas were treated by purely endoscopy-controlled, binasal, trans-sphenoidal surgery. Among these patients, there were 118 macroadenomas and 20 microadenomas. Ninety-nine tumors were nonsecreting adenomas, 39 tumors were secreting adenomas, and 14 were GH-secreting adenomas. Out of this group, there were 6 micro- and 8 macroadenomas. During surgery, we used endoscopes with 0-degree and 30-degree optics as the only tool for visualization. Results: During surgery, additional use of a microscope was never needed. The C-arm and x-ray could be abandoned in all of the cases. Using endoscopes with different angled optics, the intra-. para-, and suprasellar area could be well visualized. Total tumor resection was possible in all of the 6 GH-secreting microadenomas with normalization of the hormone levels in 5 of 6 patients. Concerning the 8 GH-secreting macroadenomas, total tumor resection and normalization of the hormone levels were possible in 5 of 8 cases. There was no permanent morbidity or mortality due to the endonasal endoscopic approach. Conclusions: Transnasal endoscopic surgery has proven to be not only a safe technique in treating nonsecreting macroadenomas but in secreting micro- and macroadenomas as well. With still a small number of patients being treated endoscopically, the early results in GH-secreting adenomas are as good as the best results reported in the literature using the standard microsurgical approach.