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 14 years.

Methods: Between 2004 and 2017, 597 patients were treated via mono- or binostril transsphenoidal approaches. 79 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 524 surgeries in 497 patients were evaluated. Mean age was 56 years (range 15–91). 70 patients (14,1%) underwent previous surgery.

Results: In our series 82 patients (16,4%) had a micro-, 403 (81,1%) a macro- and 12 (2,4%) a giantadenoma. Intrasellar tumor extension was present in 26,64%, intra- and suprasellar in 49,3%, intra- and parasellar in 5,76%, intra-, supra- and parasellar in 14,51%, infrasellar in 0,39% and other tumor extension in 3,73%. Complete endoscopic tumor resection was achieved in 77,6%. The most frequent intraoperative complication was CSF-leak in 21%, uncommom complications were venous bleeding with blood transfusion (5 procedures) and subarachnoid hemorrhage (1 case). Hyposmia and anosmia occurred in 7,3%, permanent Diabetes insipidus in 1,6%. Among 212 patients with preoperative ophthalmological syptoms the investigation revealed unspecific visual field deficits in 39%, bitemporal hemianopia in 25%, visual deterioration in 22,6%, double vision in 21,1% and ptosis in 5,7%. In the postoperative course visual field deficits improved in 74%, 26% were unchanged. Endocrinological parameters with detailed stimulation tests were evaluated in 463 cases. 68,3% had non-functioning adenomas, hormone-secreting tumors were observed in 31,6%. In this group control of hormone excess was achieved postoperatively in 74%. 49% of 463 cases had a normal function of the pituitary gland before surgery, 39% revealed partial insufficiency and 6% panhypopituitarism. Long term follow-up showed a normal function in 47,5%, partial dysfunction in 38% and panhypopituitarism in 6,9%.

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