Elsevier

Surgical Neurology

Volume 72, Issue 4, October 2009, Pages 336-340
Surgical Neurology

Pituitary
Fully endoscopic transsphenoidal surgery for functioning pituitary adenomas: A retrospective comparison with traditional transsphenoidal microsurgery in the same institution

https://doi.org/10.1016/j.surneu.2009.04.012Get rights and content

Abstract

Background

The efficacy and the minimally invasive nature of the fully transnasal endoscopic procedure in the treatment of pituitary adenomas and other lesions of the sellar area have been widely reported in the literature. Many authors observed similar results in terms of the correction of hormonal hypersecretion in functioning pituitary adenomas using endoscopic endonasal surgery or the traditional microscopic technique. We report the endocrinologic outcome in 2 series of patients operated on at the same institution for functioning pituitary adenomas using these 2 different techniques.

Methods

This study includes 2 successive series of 60 consecutive patients presenting with a hormonally active pituitary adenoma operated on by the same surgeon. The surgical results obtained in the most recently operated group using a fully endoscopic endonasal technique were compared with those obtained previously using the traditional microsurgical transsphenoidal procedure. The classification of tumors into 4 grades according to Hardy was based on modern MRI and intraoperative findings.

Results

The overall remission rate of hypersecretion was 63% in the endoscopic group compared with 50% in the microsurgical group. The most obvious difference between the 2 groups was observed in noninvasive macroadenomas. In this specific grade of tumors, the remission rate of hypersecretion obtained using endoscopy was 78% compared with 43% using microsurgery. The endocrinologic results achieved for microadenomas were similar in the 2 groups. Postoperative CSF leaks occurred more frequently (6 cases) in the endoscopic group.

Conclusions

In our experience, fully endoscopic transsphenoidal surgery for functioning pituitary adenomas leads to a better endocrinologic outcome for noninvasive macroadenomas compared to the traditional microsurgical technique. However, morbidity with the endoscopic technique was higher in terms of the rate of postoperative CSF leaks.

Introduction

Endoscopy is increasingly used in the transsphenoidal approach to pituitary tumors. Many publications on endonasal endoscopic surgery stress the less invasive nature of this technique but report similar endocrinologic results to those obtained by traditional transsphenoidal microscopic surgery [3], [6], [13], [16], [22], [24], [27]. However, some publications point to a better endocrinologic outcome for functioning adenomas when using endoscopy compared with the results reported in the literature using the traditional technique [10], [17].

We report our experience in 2 successive series of patients operated on for functioning pituitary adenomas using the 2 different techniques to assess whether the use of a fully endoscopic technique has altered the quality of tumor resection.

Section snippets

Materials and methods

In September 2001, we abandoned the classic microsurgical approach to the pituitary gland in favor of the endoscopic procedure. We compared the outcome of the first 60 consecutive cases of hormonally functioning adenomas we operated on using a fully endoscopic endonasal transsphenoidal procedure (group A) with the results obtained previously in the last 60 consecutive cases of functioning adenomas operated on using the traditional microsurgical transsphenoidal technique (group B).

To produce

Results

These 2 series of patients are comparable in terms of age, pathology, and sex distribution. The longer follow-up period in group B is explained by the succession in time of the 2 groups.

Discussion

The aim of our study was to establish whether fully endoscopic surgery could improve the quality of resection of functioning adenomas and to evaluate the complications.

It is generally accepted that using the traditional transsphenoidal approach, success rates are related to tumor size and that less good results are achieved with the more extensive macroadenomas [8], [21], [23]. The invasive nature of the tumor is another factor that adversely influences the results [9], [19].

The first studies

Conclusions

The use of the fully transsphenoidal endoscopic procedure to treat hormonally functioning pituitary adenomas improved our surgical results in terms of the correction of hypersecretion in a recent series of patients compared with our previous experience using the traditional microsurgical approach. This improvement is essentially related to the better results obtained for noninvasive macroadenomas, which became as good as those obtained for microadenomas. In our experience, using the endoscopic

Acknowledgments

The first author would like to thank Prof J Noterman, Prof JL Christiaens, and Prof HK Shahinian for their encouragement to practice pituitary surgery.

References (28)

  • FahlbuschR. et al.

    Transsphenoidal surgery of parasellar pituitary adenomas

    Acta Neurochir (Wien)

    (1988)
  • FrankG. et al.

    The endoscopic versus the traditional approach in pituitary surgery

    Neuroendocrinology

    (2006)
  • GameaA. et al.

    The use of the rigid endoscope in trans-sphenoidal pituitary surgery

    J Laryngol Oto

    (1994)
  • GiustinaA. et al.

    Criteria for cure of acromegaly: a consensus statement

    J Clin Endocrinol Metab

    (2000)
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