gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

The transition from microscopic to endoscopic pituitary surgery – a safety analysis

Meeting Abstract

  • Kartik G. Krishnan - Department of Neurosurgery, Johann Wolfgang Goethe University Frankfurt, Germany
  • Volker Seifert - Department of Neurosurgery, Johann Wolfgang Goethe University Frankfurt, Germany
  • Markus Hambek - Deparment of Otorhinolaryngology, Johann Wolfgang Goethe University Frankfurt, Germany
  • Rüdiger Gerlach - Department of Neurosurgery, Johann Wolfgang Goethe University Frankfurt, Germany; Deparment of Neurosurgery, Helios Kliniken GmbH, Erfurt, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1627

doi: 10.3205/10dgnc100, urn:nbn:de:0183-10dgnc1008

Published: September 16, 2010

© 2010 Krishnan 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: The endoscopic transnasal approach (ETA) to lesions of the sella turcica has come into prominence as an alternative to the microscopic approach (MTA) over the last decade – not because of minimal invasiveness, but due to improved visualization. Our aim is to analyze the outcomes of non-secreting pituitary adenomas as pertinent to the extent of tumor resection and relapse, and improvement of visual defects during the transitional stage from the contemporary microscopic through an endoscopic assisted to a pure endoscopic transnasal- transsphenoidal pituitary surgery.

Methods: The morphological (extent of tumor resection and relapse) and functional (visual improvement) outcomes were analyzed in the first 26 cases of non-secreting pituitary adenomas (Hardy Grades I- 6 cases, II- 11 cases, III- 7 cases and IV- 2 cases) after ETA (in 5 cases the operating microscope was used during the initial stages of approach, however not for tumor removal). For comparison, 26 previously operated cases through a pure MTA (same tumor classification as in ETA was taken) were analyzed as the control group.

Results: The overall rate of tumor rest found at the 3 month follow-up MRI was 12% (n=3) in the ETA and 19% (n=5) in the MTA. Tumor regrowth at the 6 month follow-up was observed in none of the ETA and in 7% (n=2) in the MTA group. Visual improvement was noticed in all patients except one with preoperative left eye blindness in the ETA group. Postoperative CSF leaks occurred in 8% (n=2) via ETA and in 4% (n=1) via MTA.

Conclusions: In this patient cohort of non-secreting pituitary adenomas, ETA enables better tumor mass removal than the MTA even during the transitional phase from MTA to ETA. However, the morbidity with ETA is slightly higher in terms of the rate of postoperative CSF leaks. The improved visualization characteristics in ETA will make it a promising technique for the future to treat lesions of the supra, retro and parasellar areas that lie beyond the scope of the operating microscope in institutions undergoing this transitional phase.