Endoscopic endonasal approach for pituitary adenomas: a series of 555 patients
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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.
A retrospective review of clinical and radiographic outcomes of a consecutive series of patients operated at our center between 2002 and 2011 was performed.
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.
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.
KeywordsAcromegaly Adenoma Cushing’s disease Endoscopy Pituitary Prolactinoma Transsphenoidal
- 11.Alahmadi H, Dehdashti AR, Gentili F (2012) Endoscopic endonasal surgery in recurrent and residual pituitary adenomas after microscopic resection. World Neurosurg 77(3–4):540–547Google Scholar
- 24.Tyrrel JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB (1999) Transsphenoidal microsurgical therapy of prolactinomas: initial outcomes and long-term results. Neurosurgery 44(2):254–261; discussion 261–263Google Scholar
- 28.Shin SS, Tormenti MJ, Paluzzi A, Rothfus WE, Chang YF, Zainah H, Fernandez-Miranda JC, Snyderman CH, Challinor SM, Gardner PA (2012) Endoscopic endonasal approach for growth hormone secreting pituitary adenomas: outcomes in 53 patients using 2010 consensus criteria for remission. Pituitary. (Epub ahead of print)Google Scholar
- 29.Rivera-Serrano CM, Snyderman CH, Gardner P, Prevedello D, Wheless S, Kassam AB, Carrau RL, Germanwala A, Zanation A (2011) Nasoseptal “rescue” flap: a novel modification of the nasoseptal flap technique for pituitary surgery. Laryngoscope 121(5):990–993. doi:10.1002/lary.21419 PubMedCrossRefGoogle Scholar
- 30.Chee GH, Mathias DB, James RA, Kendall-Taylor P (2001) Transsphenoidal pituitary surgery in Cushing’s disease: can we predict outcome? Clin Endocrinol (Oxf) 54(5):617–626Google Scholar
- 31.Scanlon MF, Peters JR, Thomas JP, Richards SH, Morton WH, Howell S, Williams ED, Hourihan M, Hall R (1985) Management of selected patients with hyperprolactinaemia by partial hypophysectomy. Br Med J (Clin Res Ed) 291(6508):1547–1550Google Scholar
- 32.Pereira AM, van Aken MO, van Dulken H, Schutte PJ, Biermasz NR, Smit JW, Roelfsema F, Romijn JA (2003) Long-term predictive value of postsurgical cortisol concentrations for cure and risk of recurrence in Cushing’s disease. J Clin Endocrinol Metab 88(12):5858–5864Google Scholar
- 33.Beauregard C, Truong U, Hardy J, Serri O (2003) Long-term outcome and mortality after transsphenoidal adenomectomy for acromegaly. Clin Endocrinol (Oxf) 58(1):86–91Google Scholar
- 34.Cho DY, Liau WR (2002) Comparison of endonasal endoscopic surgery and sublabial microsurgery for prolactinomas. Surg Neurol 58(6):371–375; discussion 375–376Google Scholar
- 35.Hofmann BM, Fahlbusch R (2006) Treatment of Cushing’s disease: a retrospective clinical study of the latest 100 cases. Front Horm Res 34:158–184Google Scholar
- 36.Maira G, Anile C, De Marinis L, Barbarino A (1990) Prolactin-secreting adenomas--surgical results. Can J Neurol Sci 17(1):67–70Google Scholar
- 37.Ciric I, Ragin A, Baumgartner C, Pierce D (1997) Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40(2):225–236; discussion 236–237Google Scholar