Trans-sphenoidal Removal of Pituitary Adenoma

Introduction: The purpose of our study was to report the results, outcomes, and complications after trans-sphenoidal surgery of pituitary adenomas.

Material and Methods: During the period from 1995 through 2003, 295 patients with pituitary adenomas were operated by the trans-sphenoidal route in the Neurosurgery Department, Kaunas Medical University Hospital. There were 111 males and 184 females whose mean age was 47.9 years. The interseptal route was used in 234 cases, the sublabial in 19. Forty-two operations were made by endoscopic control. In 62 (21%) cases it was microadenoma and in 233 (79%), macroadenoma.

Results: In 155 (52.5%) patients the tumor was totally removed and in 140 (47.5%), subtotal removal was achieved. One hundred twenty-eight (43.4%) patients had nonfunctioning adenomas, 71 (24.1%) had prolactin-producing adenomas, 67 (22.7%) had somatotropic, 20 (6.8%) had ACTH-producing adenomas, and 9 (3.1%) had other functionally active adenomas. Two patients (0.7%) died after trans-sphenoidal surgery. There were complications after operation in 37 (12.5%) cases: 8 (2.7%) patients had hypopituitarism after surgery; 3 (1%) patients had intrasellar hemorrhagia, in which the sella was reopened and hematoma was evacuated; postoperative liquorrhea was in 2 (0.7%) cases; diabetes insipidus in 3 (1%) cases; blindness in 2 (0.7%) cases; worsening of vision in 6 (2%) cases; sinusitis in 4 (1.4%) cases; and others were not serious rhinological complications.

In the first 100 operations, in 50 cases total removal was achieved; in 50 cases tumor was subtotally removed. In the second 100 cases, 44 tumors were totally removed, 56 were subtotally removed; in the third 100, 61 tumors were totally removed, with 34 subtotal removals achieved.

In first 100 operations there were 15 complicated cases, in the second 100, 14, and in the third 100, 10 complications. In 36 (12.2%) operations intraoperative CSF leak was observed. One hundred twenty-two patients had abnormal vision acuity before operation. At discharge from the hospital after trans-sphenoidal surgery, vision acuity improved in 69 (56.6%) cases. In 127 patients visual fields were impaired preoperatively. After surgery, visual fields improved in 80 (63%) cases.

Conclusions: Trans-sphenoidal surgery is a relatively safe method for pituitary adenoma treatment (mortality only 0.7%). The operative endoscope is useful especially in macroadenoma operations.