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Endoscopic endonasal transsphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center

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Abstract

Pituitary tumors are challenging tumors in the sellar region. Surgical approaches to the pituitary have undergone numerous refinements over the last 100 years. The introduction of the endoscope have revolutionized pituitary surgery. The aim of this study is to report the results of a consecutive series of patients undergoing pituitary surgery using a pure endoscopic endonasal approach and to evaluate the efficacy and safety of this procedure. We reviewed the data of 228 consecutive patients who underwent endonasal transsphenoidal adenoma removal over an 10-year period. Pre- and post-operative hormonal status (at least 3 months after surgery) were analyzed and compared with clinical parameters presented by the patients. Tumor removal rate, endocrinological outcomes, and complications were retrospectively assessed in 228 patients with pituitary adenomas who underwent 251 procedures between December 1998 and December 2007. There were 93 nonfunctioning adenomas, 58 growth hormone-secreting, 41 prolactin-secreting, 28 adrenocorticotropin hormone secreting, 7 FSH-LH secreting and 1 thyroid-stimulating hormone-secreting adenomas. Gross total removal was achieved in 79.3% of the cases after a median follow-up of 61.5 months. The remission results for patients with nonfunctioning adenomas was 83% and for functioning adenomas were 76.3% (70.6% for GH hormone-secreting, 85.3% for prolactin hormone-secreting, 71.4% for ACTH hormone-secreting, 85.7% for FSH-LH hormone-secreting and 100% for TSH hormone-secreting), with no recurrence at the time of the last follow-up. Post-operative complications were present in 35 (13.9%) cases. The most frequent complications were temporary and permanent diabetes insipidus (six and two cases, respectively), syndrome of inappropriate antidiuretic hormone secretion (two cases) and CSF leaks (eight cases). There was no death related to the procedure in this series. The endoscopic endonasal approach for resection of pituitary adenomas, provides acceptable results representing a safe alternative procedure to the microscopic approach. This less invasive method, associated with a small number of complications, provides excellent tumor removal rates and represents an important tool for the achievement of good results in the pituitary surgery, mainly for the complete removal of large adenomas.

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References

  1. Schloffer H (1906) Zur frage der Operationen an der Hypophyse. Beitr Klin Chir 50:767–817

    Google Scholar 

  2. Hirsch O (1910) Endonasal method of removal of hypophyseal tumors. With a report of two successful cases. JAMA 55:772–774

    Google Scholar 

  3. Halstead AE (1910) Remarks on the operative treatment of tumors of the hypophysis. With the report of two cases operated on by an oro-nasal method. Surg Gynecol Obstet 10:494–502

    Google Scholar 

  4. Rosegay H (1981) Cushing’s legacy to transsphenoidal surgery. J Neurosurg 54:448–454

    Article  CAS  PubMed  Google Scholar 

  5. Cushing H (1912) The Pituitary Body and Its Disorders: Clinical States Produced by Disorders of the Hypophysis Cerebri. JB Lippincott, Philadelphia, pp 296–305

    Google Scholar 

  6. Cushing H (1914) The Weir Mitchell Lecture. Surgical experiences with pituitary disorders. JAMA 63:1515–1525

    Google Scholar 

  7. Zada G, Kelly DF, Cohan P, Wang C, Swerdloff R (2003) Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions. J Neurosurg 98:350–358

    Article  PubMed  Google Scholar 

  8. Liu JK, Das K, Weiss MH, Laws ER Jr, Couldwell WT (2001) The history and evolution of transsphenoidal surgery. J Neurosurg 95:1083–1096

    Article  CAS  PubMed  Google Scholar 

  9. Hardy J (1969) Transsphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg 16:185–217

    CAS  PubMed  Google Scholar 

  10. Guiot G (1973) Transsphenoidal approach in surgical treatment of pituitary adenomas. General principles and indications in nonfunctioning adenomas. In: Kolher PO, Ross GT (eds) Diagnosis and treatment of pituitary tumors, vol 303. Excepta Medica Congress Series, Amsterdam, pp 159–178

    Google Scholar 

  11. Messerklinger W (1970) Endoscopy of the nose. Monatsschr Ohrenheilkd Laryngorhinol 104:451–456

    CAS  PubMed  Google Scholar 

  12. Kennedy DW, Cohn ES, Papel ID, Holliday MJ (1984) Transsphenoidal approach to the sella the Johns Hopkins experience. Laryngoscope 94:1066–1074. doi:10.1288/00005537-198408000-00015

    Article  CAS  PubMed  Google Scholar 

  13. Draf W (1991) Endonasal micro-endoscopic frontal sinus surgery the Fulda concept. Operative Tech Otolaryngol Head Neck Surg 2:234–240

    Article  Google Scholar 

  14. Jankovsky R, Auque J, Simon CMJC, Hepner H, Wayoff M (1992) Endoscopic pituitary surgery. Laryngoscope 102:198–202

    Google Scholar 

  15. Jho H, Carrau R (1996) Endoscopy assisted transsphenoidal surgery for pituitary adenoma. Acta Neurochir (Wien) 138:1416–1425. doi:10.1007/BF01411120

    Article  CAS  Google Scholar 

  16. Jho H, Carrau R (1997) Endoscopic endonasal transsphenoidal surgery: experience with fifty patients. J Neurosurg 87:44–51

    Article  CAS  PubMed  Google Scholar 

  17. Cappabianca P, Alfieri A, de Divitiis E (1998) Endoscopic endonasal transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS). Minim Invasive Neurosurg 41:66–73. doi:10.1055/s-2008-1052019

    Article  CAS  PubMed  Google Scholar 

  18. Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH et al (2006) A novel reconstructive technique following endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116:1881–1885. doi:10.1097/01.mlg.0000234933.37779.e4

    Article  Google Scholar 

  19. Melmed S, Casanueva F, Cavagnini F, Chanson P, Frohman LA, Gaillard R, Ghigo E, Ho K, Jaquet P, Kleinberg D, Lamberts S, Laws E, Lombardi G, Sheppard MC, Thorner M, Vance ML, Wass JA, Giustina A (2005) Consensus statement: medical management of acromegaly. Eur J Endocrinol 153:737–740. doi:10.1530/eje.1.02036

    Article  CAS  PubMed  Google Scholar 

  20. Jho HD, Carrau RL, Ko Y, Daly MA (1997) Endoscopic pituitary surgery: an early experience. Surg Neurol 7:213–223. doi:10.1016/S0090-3019(96)00452-1

    Article  Google Scholar 

  21. Cappabianca P, Cavallo LM, de Divitiis E (2004) Endoscopic endonasal transsphenoidal surgery. Neurosurgery 55:933–940. doi:10.1227/01.NEU.0000137330.02549.0D

    Article  PubMed  Google Scholar 

  22. Perneczky A, Fries G (1998) Endoscope-assisted brain surgery: part 1—evolution, basic concept, and current technique. Neurosurgery 42:219–224. doi:10.1097/00006123-199802000-00001

    Article  CAS  PubMed  Google Scholar 

  23. Fries G, Perneczky A (1998) Endoscope-assisted brain surgery: part 2—analysis of 380 procedures. Neurosurgery 42:226–231; discussion 231–232. doi:10.1097/00006123-199802000-00008

    Article  CAS  PubMed  Google Scholar 

  24. Dehdashti AR, Ganna A, Karabatsou K, Gentili F (2008) Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery 62:1006–1017. doi:10.1227/01.neu.0000325862.83961.12

    Article  PubMed  Google Scholar 

  25. Koren I, Hadar T, Rappaport ZH, Yaniv E (1999) Endoscopic transnasal transsphenoidal microsurgery versus the sublabial approach for the treatment of pituitary tumors: endonasal complications. Laryngoscope 109:1838–1840

    Article  CAS  PubMed  Google Scholar 

  26. Cho D-Y, Liau W-R (2002) Comparison of endonasal endoscopic surgery and sublabial microsurgery for prolactinomas. Surg Neurol 58:371–376. doi:10.1016/S0090-3019(02)00892-3

    Article  PubMed  Google Scholar 

  27. Sheehan MT, Atkinson JLD, Kasperbauer JL, Erickson BJ, Nippoldt TB (1999) Preliminary comparison of the endoscopic transnasal versus the sublabial transseptal approach for clinically nonfunctioning pituitary macroadenomas. Mayo Clin Proc 74:661–670. doi:10.4065/74.7.661

    Article  CAS  PubMed  Google Scholar 

  28. Tabaee A, Anand VK, Barrón Y, Hiltzik DH, Brown SM, Kacker A, Mazumdar M, Schwartz TH (2008) Predictors of short-term outcomes following endoscopic pituitary surgery. Clin Neurol Neurosurg 2:119–122

    Google Scholar 

  29. Frank G, Pasquini E, Farneti G, Mazzatenta D, Sciarretta V, Grasso V, Faustini Fustini M (2006) The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinology 83:240–248. doi:10.1159/000095534

    Article  CAS  PubMed  Google Scholar 

  30. Jain AK, Gupta AK, Pathak A, Bhansali A, Bapuraj JR (2008) Endonasal transsphenoidal pituitary surgery: is tumor volume a key factor in determining outcome? Am J Otolaryngol 29(1):48–50. doi:10.1016/j.amjoto.2007.01.006

    Article  PubMed  Google Scholar 

  31. Jho HD (2001) Endoscopic transsphenoidal surgery. J Neurooncol 54:187–195. doi:10.1023/A:1012969719503

    Article  CAS  PubMed  Google Scholar 

  32. Kabil MS, Eby JB, Shahinian HK (2005) Fully endoscopic endonasal versus transseptal transsphenoidal pituitary surgery. Minim Invasive Neurosurg 48:348–354. doi:10.1055/s-2005-915635

    Article  CAS  PubMed  Google Scholar 

  33. Shen CC, Wang YC, Hua WS, Chang CS, Sun MH (2000) Endoscopic endonasal transsphenoidal surgery for pituitary tumors. Chin Med J Taipei 63:301–310

    CAS  Google Scholar 

  34. Davis DH, Laws ER Jr, Ilstrup DM, Speed JK, Caruso M, Shaw EG, Abboud CF, Scheithauer BW, Root LM, Schleck C (1993) Results of surgical treatment for growth hormone-secreting pituitary adenomas. J Neurosurg 79:70–75

    Article  CAS  PubMed  Google Scholar 

  35. Freda PU, Wardlaw SL, Post KD (1998) Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly. J Neurosurg 89:353–358

    Article  CAS  PubMed  Google Scholar 

  36. Sheaves R, Jenkins P, Blackburn P, Huneidi AH, Afshar F, Medbak S, Grossman AB, Besser GM, Wass JA (1996) Outcome of transsphenoidal surgery for acromegaly using strict criteria for surgical cure. Clin Endocrinol (Oxf) 45:407–413. doi:10.1046/j.1365-2265.1996.8370847.x

    Article  CAS  Google Scholar 

  37. Gondim JA, Ferraz T, Mota I, Studart D, Almeida JP, Gomes E, Schops M (2009) Outcome of surgical intrasellar growth hormone tumor performed by a pituitary specialist surgeon in a developing country. Surg Neurol 72:15–29; discussion 19

    Google Scholar 

  38. Charpentier G, de Plunkett T, Jedynak P, Peillon F, Le Gentil P, Racadot J, Visot A, Derome P (1985) Surgical treatment of prolactinomas. Short- and long-term results, prognostic factors. Horm Res 22:222–227. doi:10.1159/000180098

    Article  CAS  PubMed  Google Scholar 

  39. Derome P (1985) Surgical treatment of prolactinomas. Short and long-term results, prognostic factors. Horm Res 22:222–227. doi:10.1159/000180098

    Article  PubMed  Google Scholar 

  40. Scanlon MF, Peters JR, Thomas JP, Richards SH, Morton WH, Howell S et al (1985) Management of selected patients with hyperprolactinaemia by partial hypophysectomy. Br Med J (Clin Res Ed) 291:1547–1550

    Article  CAS  Google Scholar 

  41. Fahlbusch R, Buchfelder M, Muller OA (1986) Transsphenoidal surgery for Cushing’s disease. J R Soc Med 79:262–269

    CAS  PubMed  Google Scholar 

  42. Hammer GD, Tyrrell JB, Lamborn KR, Applebury CB, Hannegan ET, Bell S, Rahl R, Lu A, Wilson CB (2004) Transsphenoidal microsurgery for Cushing’s disease: initial outcome and long-term results. J Clin Endocrinol Metab 89:6348–6357. doi:10.1210/jc.2003-032180

    Article  CAS  PubMed  Google Scholar 

  43. Netea-Maier RT, van Lindert EJ, den Heijer M, van der Eerden A, Pieters GF, Sweep CG, Grotenhuis JA, Hermus AR (2006) Transsphenoidal pituitary surgery via the endoscopic technique: results in 35 consecutive patients with Cushing’s disease. Eur J Endocrinol 154:675–684. doi:10.1530/eje.1.02133

    Article  CAS  PubMed  Google Scholar 

  44. Cappabianca P, Cavallo LM, Colao A, de Divitiis E (2006) Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 97:293–298

    Google Scholar 

  45. de Divitiis E, Cappabianca P, Cavallo M (2003) Endoscopic endonasal transsphenoidal approach to the sellar region. In: de Divitiis E, Cappabianca P (eds) Endoscopic Endonasal Transsphenoidal Surgery. Springer, Wien, pp 91–130

    Google Scholar 

  46. Ciric I, Ragin A, Baumgartner C, Pierce DB (1997) Complications of transsphenoidal surgery: results of a national survey, review of the literature and personal experience. Neurosurgery 40:225–237. doi:10.1097/00006123-199702000-00001

    Article  CAS  PubMed  Google Scholar 

  47. Semple PL, Laws ER Jr (1999) Complications in a contemporary series of patients who underwent transsphenoidal surgery for Cushing’s disease. J Neurosurg 91:175–179

    Article  CAS  PubMed  Google Scholar 

  48. Gondim J, Schops M, Tella OI Jr (2003) Transnasal endoscopic surgery of the sellar region: study of the first 100 cases. Arq Neuropsiquiatr 61:836–841. doi:10.1590/S0004-282X2003000500024

    PubMed  Google Scholar 

  49. Cappabianca P, Divitiis E (2004) Endoscopy and transsphenoidal surgery. Neurosurgery 54:1043–1050. doi:10.1227/01.NEU.0000119325.14116.9C

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Brazil

    Jackson A. Gondim, João Paulo C. de Almeida & Lucas Alverne F. de Albuquerque

  2. School of Medicine, Federal University of Ceara, Fortaleza, Brazil

    Michele Schops, João Paulo C. de Almeida & Lucas Alverne F. de Albuquerque

  3. Department of Ear, Nose and Throat Surgery, General Hospital of Fortaleza, Fortaleza, Brazil

    Erika Gomes

  4. Department of Endocrinology, General Hospital of Fortaleza, Fortaleza, Brazil

    Tânia Ferraz & Francisca Andréa C. Barroso

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  1. Jackson A. Gondim
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  2. Michele Schops
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  3. João Paulo C. de Almeida
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  4. Lucas Alverne F. de Albuquerque
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Correspondence to Jackson A. Gondim.

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Gondim, J.A., Schops, M., de Almeida, J.P.C. et al. Endoscopic endonasal transsphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center. Pituitary 13, 68–77 (2010). https://doi.org/10.1007/s11102-009-0195-x

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