Endoscopic endonasal transsphenoidal surgery of 1,166 pituitary adenomas

TLDR

Functional adenoma surgery rarely achieves hormonal remission, so adjuvant therapy is recommended for long‑term control. The study reports outcomes and evaluates the efficacy and safety of pure endoscopic endonasal pituitary surgery. A retrospective review of 1,166 patients undergoing endoscopic endonasal transsphenoidal adenoma removal (Dec 2006–Jun 2013) assessed pre‑ and 3‑month postoperative hormonal status relative to baseline. In 1,166 patients, gross total resection was achieved in 98 % of microadenomas, 92 % of macroadenomas, and 76 % of giant adenomas, with hormonal control in 69 % of ACTH, 66 % of GH, 85 % of PRL, and 86 % of TSH adenomas, while 14.4 % experienced complications (most commonly diabetes insipidus 7 %)—demonstrating that the pure endoscopic approach is safe, efficacious, and minimally invasive.

Abstract

To report the results of a series of patients undergoing pure endoscopic endonasal pituitary surgery and to evaluate the efficacy and safety of this procedure.The data of 1,166 patients that underwent endoscopic endonasal transsphenoidal adenoma removal between December 2006 and June 2013 were retrospectively reviewed. Pre- and postoperative hormonal status (3 months after surgery) were analyzed and compared with the clinical parameters originally presented by the patients. The incidences of tumor removal, hormonal control, and tumor removal complications were retrospectively analyzed.Out of 577 nonfunctioning adenomas, 180 were growth hormone (GH) secreting, 308 prolactin (PRL) secreting, 26 mixed GH/PRL adenomas, 68 adrenocorticotropin secreting, and 7 thyroid-stimulating hormone-secreting adenomas. The gross total removal of pituitary adenomas was achieved in 98 % of microadenomas, 92 % of macroadenomas, and 76 % of giant adenomas. Hormonal control was achieved in 47 (69 %) cases of ACTH adenomas, 119 (66 %) GH adenomas, 262 (85 %) PRL adenomas, and 6 (86 %) TSH adenomas. Postoperative complications were observed in 168 (14.4 %) patients. The most frequent complications were diabetes insipidus (7 %), epistaxis (1.7 %), hyposmia (1.5 %), anterior lobe insufficiency (1.3 %) ,and CSF leaks (0.6 %).The pure endoscopic approach is a safe, efficacious, and minimally invasive technique for the removal of pituitary adenomas. A higher gross total resection rate is vital for non-functional and functional adenomas. For patients with functional adenomas, while hormonal remission is unlikely to be achieved by surgery, the use of adjuvant therapy is advocated to obtain long-term hormonal control.