gms | German Medical Science

Objective: Surgical approaches to the pituitary have undergone numerous refinements over the last 100 years. The endoscopic technique which has revolutionized pituitary surgery was introduced routinely in our department in 2004. The aim of this retrospective study is to report the results of patients undergoing pituitary surgery using the endoscopic endonasal approach.

Method: Between 2004 and November 2012 287 patients underwent endoscopic transsphenoidal pituitary adenoma removal in our department. The approach was performed mononostril or binostril. Mean age was 56 years (range 18-88). The efficacy and safety of this procedure were evaluated.

Results: In our series 50 patients had a micro- and 237 a macroadenoma. Intrasellar tumor extension was present in 79, intra- and suprasellar in 170, intra- and parasellar in 7 and intra-, supra- and parasellar in 31 cases. Using the mononostril or binostril endoscopic approach no surgery had to be converted into the conventional microsurgical technique. Advantages of endoscopic technique are the light intensity, panoramic view, use of angled optics and no necessity of nasal packing. Among 123 patients with subjective ophthalmological deficits the investigation revealed a bitemporal hemianopia in 31%, unspecific visual field deficits in 40%, visual deterioration in 23%, double vision in 25% and ptosis in 7%. Visual deficits improved postoperatively in 76%, 24% were unchanged. Because of patient acquisition and the follow-up-period of at least 1 year endocrinological parameters were evaluable in 226 cases. Non-functioning adenomas were observed in 66%, hormone-secreting tumors in 34%. In this subgroup hormonal control was achieved in 75%. Preoperatively 60% of 226 cases had a normal function of the pituitary gland, 30% revealed partial insufficiency and 10% panhypopituitarism. The follow-up investigation showed a normal function in 47%, partial insufficiency in 44% and panhypopituitarism in 9%. The most frequent intraoperative complication in the total collective of 287 cases was CSF-leak in 16%, uncommon complications were venous bleeding with blood transfusion in 3 cases and subarachnoid hemorrhage in 1 case. Complications in connection with endoscopic techniques did not occur. 4 patients complained about anosmia. Complete tumor resection was achieved in 80%.

Conclusions: Our results conclude that the endoscopic endonasal technique with its advantages is a safe and effective method for removal of pituitary adenomas and results in a high patient satisfaction.