Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenomas: Evaluation of Consecutive Cases

Background Endoscopic endonasal transsphenoidal surgery has gained increasing acceptance by otolaryngologists and neurosurgeons. In many centers throughout the world, this technique is now routinely used for the same indications as the conventional microsurgical technique to pituitary tumors.

Objective To present a surgical experience of consecutive endoscopic endonasal transsphenoidal resections of pituitary adenomas.

Methods Study of series of consecutive patients with pituitary adenomas submitted to endoscopic endonasal pituitary surgery were evaluated with regard to rate of residual tumor, functional cure, symptoms relief, complications, and tumor size.

Results A total of 247 consecutive patients were evaluated; 81 of them had functioning adenomas, 32 GH-producing tumors, 30 with Cushing’s disease, and 19 prolactinomas. Of these functioning adenomas, 62 were macroadenomas and 19 were microadenomas. One hundred sixty-six cases were nonfunctioning macroadenomas. Of the patients with functioning adenomas, 89% improved. Patients with visual deficits related to optic nerve compression; 88% improved over time. Most of the patients with complaints of headaches improved (86%). Surgical complications occurred in 3% of patients with two carotid lesions, two CSF leaks, and two fatalities, one in a patient with a complicated previous history and one case of vasospasm.

Conclusion Endoscopic endonasal pituitary surgery is a feasible technique yielding good surgical and functional outcomes, low morbidity, and better visualization of surgical field.