Article
Endoscopic endonasal transsphenoidal approach to pituitary lesions: experience with 132 procedures
Endoskopisch endonasaler Zugang zu sellären Läsionen: Erfahrungen mit 132 Eingriffen
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Authors
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J. Oertel
- Klinik für Neurochirurgie, Krankenhaus Hannover Nordstadt, Klinikum Hannover
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H. Schroeder
- Klinik für Neurochirurgie, Ernst-Moritz-Arndt-Universität Greifswald
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M. Gaab
- Klinik für Neurochirurgie, Krankenhaus Hannover Nordstadt, Klinikum Hannover
| Published: | May 4, 2005 |
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Outline
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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. Besides reduced nasolabial problems, an increased radicality in the resection of pituitary lesions could be observed.
Methods
Between October 2000 and December 2004, 127 patients (60 males, 67 females, mean age 58 yrs [range 23-83 yrs]) underwent 132 endoscopic endonasal transsphenoidal procedures for a pituitary lesion. All patients were followed prospectively. Special attention was paid to surgical radicality, symptom relief, tumour recurrence, and postsurgical nasal complaints.
Results
Tumours consisted of 98 endocrine inactive macroadenomas, 17 acromegaly lesions, 5 Rathke’s cleft cysts, 5 prolactinomas, and 2 Cushing diseases. Visual deficits were the presenting symptom in 117 cases (88%). Hormonal activity was the leading symptom in 15 cases (12%). Mean surgical time was 111 min (range 57 – 220 min). In 99 cases of all patients (75%) 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 90 cases when intended (91%). Preoperative visual deficits improved in 103 (88%), a worsening was recorded in one 55 year-old woman (1%). Recurrent tumour growth was observed in 5 younger patients (4%) and subsequent surgery was required. There was no mortality. There were 2 cases of meningitis (2%) and 4 cases of CSF leakage (3%). In two cases (2%), conversion to microsurgery was required for recurrent bleeding. Two patients (2%) complained postoperatively of nasal congestion or reduced nasal air flow, however no complaints were considered to be severe.
Conclusions
The authors consider the transnasal endoscopic approach safe and successful for pituitary lesions with high radicality and only minor complications. In contrast to microsurgery alone, the various endoscopes allow a look “around the corner” to secure radical tumour removal. In contrast to the nasolabial approach, only minimal nasal complaints were reported.
