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55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

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

Meeting Abstract

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  • corresponding author Joachim Oertel - Klinik für Neurochirurgie, Krankenhaus Hannover Nordstadt, Hannover
  • M. R. Gaab - Klinik für Neurochirurgie, Krankenhaus Hannover Nordstadt, Hannover

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMI.02.03

The electronic version of this article is the complete one and can be found online at:

Published: April 23, 2004

© 2004 Oertel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




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.


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.


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.


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.