gms | German Medical Science

Objective: The endonasal endoscopic approach has been established for perisellar tumor surgery over the last decades. A higher resection rate and decreased complication rate is expected. Here, the authors analyzed their series of transnasal endoscopic perisellar surgery for identification of pituitary gland tissue and its role for postoperative hormonal insufficiency.

Method: Between January 2011 and August 2013, 60 patients with preoperative intact pituitary function received endoscopic endonasal transsphenoidal procedures for intrasellar pathologies. The patients were prospectively followed. Special attention was paid to intraoperative identification of gland tissue, surgical complications and radicality, hormonal insufficiency and medical substitution.

Results: Thirteen percent (8 of 60 patients) showed a persisting pituitary insufficiency. In this patient cohort, five patients (62.5%) with new postoperative endocrinologic deficits had a partial pituitary insufficiency leading to substitution of thyroxin and hydrocortisone. Two patients were substituted with thyroxin, hydrocortisone and sexual hormones and one patient with thyroxin, hydrocortisone and ADH. In analysis with Fisher's exact test, there was a high significant correlation between the identification of the pituitary gland intraoperatively and normal pituitary function postoperatively (p<0.005). On follow-up MRI, radical tumour resection was seen in 92% (55 of 60 patients).

Conclusions: The endoscopic technique has been shown to be safe in sellar lesions. A high radicality and only minor complications were observed. This study indicates that preservation of pituitary gland tissue is well possible in endoscopic transsphenoidal surgery. The intraoperative identification and preservation of gland tissue is a positive predictor of postoperative normal hormonal pituitary function.