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Endoscopic endonasal approach for pituitary adenomas: a series of 555 patients

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Abstract

Purpose

To report the results of a consecutive series of patients who underwent an endoscopic endonasal approach (EEA) for resection of a pituitary adenoma and compare them to previous series of microscopic and endoscopic approaches.

Methods

A retrospective review of clinical and radiographic outcomes of a consecutive series of patients operated at our center between 2002 and 2011 was performed.

Results

555 patients underwent an EEA for removal of a pituitary adenoma. The mean follow up was 3.1 years (range 3 months to 9.5 years); 36 were lost to follow up. Ninety-one (17.5 %) harbored recurrent adenomas. An expanded approach to reach the supra-, para- and infra-sellar spaces was employed in 290 patients (55.9 %). Reconstruction with a nasal septal flap was used in 238 cases (65.6 %). The rate of gross total resection was 65.3 % in the 359 patients with non-functioning adenomas. The remission rates with EEA alone were 82.5 % in the 57 ACTH-secreting adenomas, 65.3 % in the 49 GH-secreting adenomas and 54.7 % in the 53 prolactinomas. Of the 237 patients presenting with visual loss, 190 (80.2 %) improved or normalized, 41 (17.3 %) remained unchanged and 4 (1.7 %) experienced transient visual deterioration due to postoperative apoplexy. In addition, no patient without preexisting visual loss suffered new visual decline. The overall post-operative CSF leak rate was 5 % and this decreased to 2.9 % after the introduction of reconstruction with the naso-septal flap. Two patients (0.3 %) had an ICA injury.

Conclusions

The EEA is a safe and effective way to surgically approach pituitary adenomas, particularly in recurrent tumors, those with supra-sellar extension or cavernous sinus invasion. The remission and complication rates are comparable or favorable compared with those reported in previous series of microscopic and endoscopic approaches.

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Authors and Affiliations

  1. Department of Neurological Surgery, UPMC Presbyterian Hospital, University of Pittsburgh School of Medicine, 200 Lothrop Street, Suite B-400, Pittsburgh, PA, 15213, USA

    Alessandro Paluzzi, Juan C. Fernandez-Miranda, S. Tonya Stefko, Carl H. Snyderman & Paul A. Gardner

  2. Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    S. Tonya Stefko & Carl H. Snyderman

  3. Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    S. Tonya Stefko

  4. Department of Medicine, Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Sue Challinor

Authors
  1. Alessandro Paluzzi
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  2. Juan C. Fernandez-Miranda
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  3. S. Tonya Stefko
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  4. Sue Challinor
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  5. Carl H. Snyderman
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  6. Paul A. Gardner
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Corresponding author

Correspondence to Paul A. Gardner.

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Paluzzi, A., Fernandez-Miranda, J.C., Tonya Stefko, S. et al. Endoscopic endonasal approach for pituitary adenomas: a series of 555 patients. Pituitary 17, 307–319 (2014). https://doi.org/10.1007/s11102-013-0502-4

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