Artikel
Endoscopic endonasal transsphenoidal approach for pituitary lesions: Results after 77 procedures with special reference to geriatric patients
Endoskopisch-endonasaler transsphenoidaler Zugang zu intrasellären Läsionen: Ergebnisse nach 77 Eingriffen unter besonderer Berücksichtigung geriatrischer Patienten
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Autoren
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Joachim Oertel
- Klinik für Neurochirurgie, Krankenhaus Hannover Nordstadt, Hannover
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M. R. Gaab
- Klinik für Neurochirurgie, Krankenhaus Hannover Nordstadt, Hannover
| Veröffentlicht: | 23. April 2004 |
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Gliederung
Text
Objective
The direct endonasal approach in conjunction with the endoscopic technique could combine a minimization of nasolabial tissue trauma with an advanced endoscopic view in the surgery of pituitary lesions. To evaluate the peculiar risks for surgery in geriatric patients, the present abstracts focuses on the outcome of patients of at least 70 years of age in comparison with younger patients within the same prospectively followed series.
Methods
Between October 2000 and November 2003, 72 patients (33 males, 39 females, mean age 56 yrs [range 23-83 yrs]) received 77 endoscopic endonasal transsphenoidal procedures for a pituitary lesion. Of these patients, 17 were aged 70 or older at the time of surgery. All patients were prospectively followed. Special attention was paid to surgical radicality, symptom relieve, tumour recurrence, and postsurgical nasal complaints.
Results
Tumours consisted of 53 endocrine inactive macroadenomas (14 of these in the geriatric group), 15 acromegaly lesions (3 of these in the geriatric group), 4 Rathke’s cleft cysts, 3 prolactinomas, and 2 Cushing diseases. Visual deficits were the presenting symptom in 63 cases (82%) and 14 of the geriatric group (82%). Hormonal activity was the leading symptom in 14 and 3 cases respectively (both 18%). In 58 cases of all patients (75%) and in 10 of the geriatric patients (59%) radical tumour resection was intended at surgery. On follow-up (2 weeks to 2 years; mean 1.04 year), MRI revealed radical tumour resection in 53 (91%) and 8 cases (80%) respectively. Preoperative visual deficits improved in 55 (87%) and 12 patients (86%), a worsening was recorded in one 55 year-old woman (1.5%). Recurrent tumour growth was observed in 5 younger patients (6%) and subsequent surgery was required. There was no mortality. There were 1 case of meningitis (1.5%) and 2 cases of CSF leakage (3%). However, none of these complications occurred in the geriatric group. Two patients (3%) with one patient being in the geriatric group (6%) complained postoperatively of nasal congestion or reduced nasal air flow, however no complaints were considered to be severe.
Conclusions
In all, the authors consider the transnasal endoscopic approach as safe and successful for pituitary lesions with a high radicality and only minor complications. In contrast to the nasolabial approach, only minimal nasal complaints were reported. For the aged patients, this procedure can be considered safe and successful with good outcome similar to younger patients.
