Article
Transsphenoidal microsurgery with endoscopic assistance is an effective procedure to treat pathologies of the sellar region
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Authors
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Dag Moskopp
- Klinik für Neurochirurgie, Vivantes-Klinikum im Friedrichshain, Berlin
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Yawen Wang
- Klinik für Neurochirurgie, Vivantes-Klinikum im Friedrichshain, Berlin
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Stefanie Hammersen
- Klinik für Neurochirurgie, Vivantes-Klinikum im Friedrichshain, Berlin
| Published: | May 21, 2013 |
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Outline
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Objective: It has become a matter of debate whether to treat sellar pathologies microsurgically, endoscopically or by a combination of both. After the personal experience of 400 transsphenoidal cases from a Cushing's approach, we prospectively analyzed the following 125 cases treated by microsurgery and endoscopic assistance with special regard to the normalization ratio of hormone active tumors.
Method: All patients were operated microsurgically by the senior authors with all options of endoscopic assistance. Special accuracy proved to be necessary to clarify the exact localization of ACTH-omas, including the sampling from inferior petrous sinus after 100 µg CRH. Clinical follow-up was done systematically (pre-op, post-op: 2w, 3m, 6m, 1y, 2ys, 5ys). Endocrine normalization was judged as follows - for acromegaly: IGF1 normal and GH <1 ng/ml after oral intake of 75 g of glucose; for Cushing: normal values for ACTH and cortisol at 7h on the first POD without substitution and normal concentration of cortisol in 24-h urine collection; TSH-oma and PRL-oma: normal values for TSH and PRL. - The first post-op MR was performed after 3 months.
Results: Neuropathology of the 125 patients with sellar pathology was as follows: endocrine inactive adenomas 47, endocrine active adenomas 41, others 37. Patients with endocrine activity presented as: acromegaly 24, Cushing's disease 10, PRL-oma 6, TSH-microadenoma 1. Indications to operate on PRL-omas were: peracute bleeding into the tumor 2, psychosis from medication 2, obvious resistence to D2-agonists 2. The ratio of normalization disclosed to be - for acromegaly 21/24, for Cushing's disease 8/10; for PRL-oma 6/6; for TSH-oma 1/1.
Overall side effects: Hyposmia 6%, hematoma of nasal septum 3%, re-op for liquorrhea – 0 for native case, and 2% for recurrences; temporary sixth nerve palsy in one case of ACTH-oma within the cavernous sinus. Visual disturbance improved post-op in nine out of ten cases.
Conclusions: Especially with respect to the normalization ratio of endocrine active pituitary adenomas, transsphenoidal microsurgery with endoscopic assistance remains a valid procedure, and can be offered with comparably tolerable side effects.
