Endoscopic Transsphenoidal Endonasal Approach for Large Pituitary Adenoma with Extraparasellar Extension

Objective: The transsphenoidal route is a direct and rapid extracerebral approach to the sellar region; therefore, it is the most widely used technique for the processes involving this area. Since its introduction in 1907, it has been subjected to tremendous developments. The endoscope is the latest innovation in the field of optical instrumentation; it allows the “surgeon's eye” to penetrate the depth and width of the access route.

Methods: Over 4 years, from December 2003 to December 2010, we operated on 97 patients (51 men, 46 women) with large pituitary adenomas, 18 with giant adenomas. Fifteen patients had hormone-active tumors (10 GH, 4 prolactinoma, 1 ACTH), and most patients presented with visual disturbances.

Results: Total excision was achieved in 86 patients. Of the 15 patients with active adenoma, 11 were cured. Six patients developed recurrence, two developed postoperative bleeding, and four had postoperative CSF rhinorrhea. Eighty percent of patients with visual disturbances showed improvement.

Conclusion: The minimum traumatization of the nasal cavity without nasal retractor, the optical advantages of the endoscopic visualization in anatomical orientation and tumor removal, and the early postoperative improve of the patients without nasal packing are obvious advantages of the endoscopic binostril technique.