Endoscopic Transsphenoidal Pituitary Surgery: Result, Safety, and Cost Effectiveness in 134 Consecutive Cases

Objective: Pituitary surgery is being performed increasingly using an endoscopic transsphenoidal approach. Here, we report a series of patients undergoing pituitary surgery using an endoscopic transsphenoidal approach and evaluate the safety, cost effectiveness, and short-term outcomes of this procedure.

Methods: We reviewed the data on 134 consecutive patients who underwent endoscopic transsphenoidal surgery at one university hospital over a 5-year period between July 2007 and December 2011. Hospital stay and postoperative outcomes, including but not limited to cerebrospinal fluid leaks and diabetes insipidus, were retrospectively assessed.

Results: Of the 134 patients included in the study, the majority had pituitary adenomas. More than 70% of patients were discharged within 24 hours of surgery, and the hospital length of stay averaged 1.5 days, with a range of 1 to 5 days. Postoperative MRI studies after 3 month to 1 year showed tumor resection rate was over 80%. Four patients had diabetes insipidus after surgery, which was temporary in four (2.9%) and permanent in two (1.6%). We used the mucosa and bone graft technique to achieve a high successful rate for repair of intraoperative CSF leak, without fat graft. Postoperative cerebrospinal fluid leak requiring placement of a lumbar drain was seen in four cases (2.9%). Cystic lesions have slightly increased rate of CSF leak compared with solid lesions. Delayed syndrome of inappropriate antidiuretic hormone secretion developed in two patients (1.6%) 1 week after surgery, and late-onset epistaxis was seen in one case (0.7%). No postoperative infections or mortality was seen in this series.

Conclusions: The results of our study support the safety and cost effectiveness of the endoscopic transsphenoidal approach for pituitary surgery. The mucosa and bone graft technique has a highly successful rate for repair of intraoperative CSF leak, without fat graft.