gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Endoscopic transsphenoidal surgery of pituitary adenomas: Results of a single-center series of 73 cases

Endoskopische transsphenoidale Resektion von Hypophysenadenomen: Ergebnisse einer Single-Center Serie von 73 Hypophysenadenomen

Meeting Abstract

  • corresponding author F. Marhold - Klinik für Neurochirurgie, Medizinische Universität Wien
  • S. Wolfsberger - Klinik für Neurochirurgie, Medizinische Universität Wien
  • A. Reitner - Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Wien
  • H. Vierhapper - Klinische Abteilung für Endokrinologie & Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien
  • E. Knosp - Klinik für Neurochirurgie, Medizinische Universität Wien

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.03.03

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

Published: May 30, 2008

© 2008 Marhold 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.



Objective: After a stepwise learning process from microscopic via endoscope-assisted microscopic surgery, we have been performing the transsphenoidal approach with a purely endoscopic technique since 2003. We present the results of our single-center series of consecutively resected pituitary adenomas via a purely endoscopic approach.

Methods: This prospective study collected the data of 73 patients with pituitary adenomas, who were consecutively treated at our department with the endoscopic transsphenoidal technique. A standard endonasal transsphenoidal mononostril approach was performed with a 0° degree 4 mm rigid endoscope. For tumor resection in the supra- and parasellar areas, 30 and 45° lenses were applied as necessary. All interventions were aided by neuronavigation using image fusion of computed tomography, contrast-enhanced T1-weighted magnetic resonance (MR) imaging and MR angiography.

Results: Of the 73 pituitary adenomas, 48 were non-functioning and 25 were hormonally active adenomas.

Immunocytochemistry revealed 35 null cell adenomas, 11 gonadotropinomas and 2 silent ACTH adenomas of all non-functioning adenomas. On follow-up MRI scans, no residual tumor was detected in 70% of these patients.

After operation 34 patients (73%) showed no hypopituitarism, interestingly 8 patients (17%) were found to have an improvent of their hypopituitarism, 4 patients (9%) showed additional pituitary insufficency.

Of the 12 prolactinomas 7 patients (64%) could be cured and 4 (36%) had a significant decrease of their serum prolactin levels. One patient failed to show up for follow-up.

9 patients (75%) with acromegaly could be cured and 3 patients (25%) showed a significant decrease of their serum growth hormone- and somatomedin C levels. 2 (17%) of these could be cured with subsequent gamma knife radiosurgery.

One Cushing patient showed a significant decrease of his serum ACTH levels. Of all endocrinologically active adenomas, 75% showed no residual tumor on MRI follow-up examination.

The incidence of postoperative CSF leak was 2%, permanent diabetes insipidus occurred in 4%, epistaxis in 3%. We had no ICA-lesion and no meningitis.

Conclusions: Our approach of learning endoscopic transsphenoidal procedures step by step from microsurgical resection is a safe and effective method. Detailed analysis of our data shows results comparable with the literature. However, long-term follow-up analysis will be necessary to clarify whether the endoscopically improved visualization and illumination of adenoma parts hidden to the microscope ultimately leads to better results of transsphenoidal pituitary surgery.