gms | German Medical Science

Objective: Over the last century pituitary adenoma surgery has undergone a remarkable evolution in surgical technique, approaches and technological adjuncts. In our department the endoscopic approach was introduced as routine in 2004. In this retrospective study we review our experiences with fully endoscopic pituitary surgery of the last 10 years.

Method: Between 2004 and 2012 342 patients were treated via mono- or binostril transsphenoidal approaches. 38 patients were excluded from evaluation because of other histology than a pituitary adenoma, further 21 patients were operated before 2008 via microscopic transsphenoidal approach. The efficacy and safety of 309 surgeries in 283 patients were evaluated. Mean age was 56 years (range 18-91). 43 patients (15,2%) underwent previous surgery.

Results: In our series 52 patients (18,4%) had a micro-, 227 (80,2%) a macro- and 4 (1,4%) a giant adenoma. Intrasellar tumor extension was present in 27,9%, intra- and suprasellar in 56,9%, intra- and parasellar in 3,5% and intra- , supra- and parasellar in 11,7%. Complete endoscopic tumor resection was achieved in 83,6%. The most frequent intraoperative complication was CSF-leak in 18%, uncommom complications were venous bleeding with blood transfusion (5 procedures) and subarachnoid hemorrhage (1 case). Hyposmia and anosmia occurred in 10,6%, permanent Diabetes insipidus in 1,8%. Among 123 patients with preoperative ophthalmological syptoms the investigation revealed unspecific visual field deficits in 40%, bitemporal hemianopia in 31%, visual deterioration in 23%, double vision in 25% and ptosis in 7%. In the postoperative course visual field deficits improved in 76%, 24% were unchanged. Endocrinological parameters were evaluated in 226 cases. 66% of 226 cases had non-functioning adenomas, hormone-secreting tumors were observed in 34%. In this group control of hormone excess was achieved postoperatively in 75%. 60% of 226 cases had a normal function of the pituitary gland before surgery, 30% revealed partial insufficiency and 10% panhypopituitarism. Long-term follow-up showed a normal function in 47%, partial dysfunction in 44% and panhypopituitarism in 9%.

Conclusions: The endoscopic transnasal technique is safe and effective and results in a very satisfactory patient outcome.