Endoscopic endonasal transsphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center

Abstract

Pituitary tumors are challenging tumors in the sellar region. Surgical approaches to the pituitary have undergone numerous refinements over the last 100 years. The introduction of the endoscope have revolutionized pituitary surgery. The aim of this study is to report the results of a consecutive series of patients undergoing pituitary surgery using a pure endoscopic endonasal approach and to evaluate the efficacy and safety of this procedure. We reviewed the data of 228 consecutive patients who underwent endonasal transsphenoidal adenoma removal over an 10-year period. Pre- and post-operative hormonal status (at least 3 months after surgery) were analyzed and compared with clinical parameters presented by the patients. Tumor removal rate, endocrinological outcomes, and complications were retrospectively assessed in 228 patients with pituitary adenomas who underwent 251 procedures between December 1998 and December 2007. There were 93 nonfunctioning adenomas, 58 growth hormone-secreting, 41 prolactin-secreting, 28 adrenocorticotropin hormone secreting, 7 FSH-LH secreting and 1 thyroid-stimulating hormone-secreting adenomas. Gross total removal was achieved in 79.3% of the cases after a median follow-up of 61.5 months. The remission results for patients with nonfunctioning adenomas was 83% and for functioning adenomas were 76.3% (70.6% for GH hormone-secreting, 85.3% for prolactin hormone-secreting, 71.4% for ACTH hormone-secreting, 85.7% for FSH-LH hormone-secreting and 100% for TSH hormone-secreting), with no recurrence at the time of the last follow-up. Post-operative complications were present in 35 (13.9%) cases. The most frequent complications were temporary and permanent diabetes insipidus (six and two cases, respectively), syndrome of inappropriate antidiuretic hormone secretion (two cases) and CSF leaks (eight cases). There was no death related to the procedure in this series. The endoscopic endonasal approach for resection of pituitary adenomas, provides acceptable results representing a safe alternative procedure to the microscopic approach. This less invasive method, associated with a small number of complications, provides excellent tumor removal rates and represents an important tool for the achievement of good results in the pituitary surgery, mainly for the complete removal of large adenomas.

THERAPY OF ENDOCRINE DISEASE: Surgery in microprolactinomas: effectiveness and risks based on contemporary literature

“…Mortini and coworkers in a series of 69 patients operated on in a single center by two surgeons (21) showed postoperative remission rate 75% (off DA for at least 2 months). Lower postoperative remission rates (40 -63%) have been reported in three series with, however, small number of patients (5,27,32) affecting the estimation of the relevant rates (25,26,27). Most studies with mean/median follow-up period ranging between 12 and 84 months suggest that recurrence of the hyperprolactinaemia is observed between 0 and 13% of the cases (15,16,17,20,23).…”

Clinical and laboratorial characterization and post-surgical follow-up of 87 patients with non-functioning pituitary macroadenomas

“…However, there has been a trend towards using transnasal endoscopy in healthcare services in Brazil [25][26][27] and abroad 28,29 . One of the advantages of using an endoscope would be the better viewing and resection of residual tumors due to the possibility of introducing the endoscope into the sella turcica and suprasellar region, which would facilitate the surgical cure 29 .…”

“…Moreover, this might prevent bleeding in the cavernous sinus and lesions in the internal carotid artery 28 . These advantages would not be possible with the surgical microscope [26][27][28][29] . However, in operations on functioning tumors, Barbosa et al 25 found no statistical differences in the results obtained with the two techniques.…”

“…However, in operations on functioning tumors, Barbosa et al 25 found no statistical differences in the results obtained with the two techniques. Total or near total removal of 83% of 93 nonfunctioning adenomas operated using solely the endonasal technique has recently been described 26 . Similar results were obtained with a small sample of 30 patients 27 .…”

“…Meningitis was caused by liquoric fistula. Using only the endonasal technique, the presence of fistula has been described as 3.5 26 and 16% 27 . Of the cases, 77% were operated with this technique.…”