Artikel
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
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Autoren
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F. Marhold
- Klinik für Neurochirurgie, Medizinische Universität Wien
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S. Wolfsberger
- Klinik für Neurochirurgie, Medizinische Universität Wien
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A. Reitner
- Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Wien
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H. Vierhapper
- Klinische Abteilung für Endokrinologie & Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien
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E. Knosp
- Klinik für Neurochirurgie, Medizinische Universität Wien
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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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.
