Outcomes following Purely Endoscopic, Extended Endonasal Resection of Nonpituitary Seller and Suprasellar Lesions: A Case Series

Introduction: The use of endoscope for the management of nonpituitary seller and suprasellar lesions is not new. The better magnification and illumination provided by the endoscope gives a better outcome than microscopic transsphenoidal approach.

Objectives: The purpose of the study is to find the outcome of endoscope approaches to different types of nonpituitary seller and suprasellar lesions.

Methods: We did 37 cases of pituitary surgery by an endoscopic extended endonasal approach from July 2008 to March 2014. Among them, 20 cases of craniopharyngioma, 12 cases of tuberculum selle meningioma, and 5 cases of clival chordoma were included.

Results: Among 37 cases,15 were males and 22 were females. Ages vary from 10 to 60 years. Gross total removal was done in 25 cases, subtotal in 6 cases, near total in 4 cases, and partial removal was done in 2 cases. Visual improvement was satisfactory. Postoperative visual acuity and visual field was improved in almost all the cases except one case of tuberculum selle meningioma where patient developed blindness following surgery. Temporary DI developed in all cases of craniopharyngioma, over all six cases of meningitis, three cases of VP shunt done, there was two cases of CSF leak, one case of pneumocephalus, and one case of hyponatremia in craniopharyngioma. The average duration of follow-up was 20 months. One patient was required re-exploration to correct visual deterioration in the immediate postoperative period.

Conclusion: Endoscopic endonasal pituitary surgery now become a gold standard surgery for most of the seller and suprasellar lesions because of its better advantages in relation to microscopic surgery and less complications and less hospital stay.