Endoscope-assisted pituitary surgery for functioning and non-functioning pituitary adenomas. The experience of the first 80 patients in a single centre
PL Hanson, SM Joshi, G Alusi, HI Sabin, WM Drake & JP Monson
Introduction: We present the outcome for the first 80 patients undergoing neuronavigationguided, endoscopic transphenoidal surgery in our centre since August 2001. All operations were undertaken by the same neurosurgeon and endoscopic nasal surgeon.
Indications for treatment: Indications for treatment may be divided into: Functioning microadenomas, with the aim of surgical cure while protecting residual pituitary function. Functioning macroadenomas, where reduction of hormonal secretion is sought and protection of surrounding structures particularly the optic chiasm is important. Functionless adenomas imposing a risk to surrounding structures.
Rapid expansion of tumour bulk, for example due to pituitary apoplexy, to preserve surrounding structures. Other parasellar tumours including craniopharyngiomas, Rathke cleft cysts and arachnoid cysts.
Outcomes: This method of surgery was successful in decompressing pituitary mass lesions with suprasellar extension. In the treatment of functioning tumours, of 14 patients with Cushings Disease (2 macroadenomas) 64% were cured or improved. Of 11 patients with Acromegaly 55% achieved safe GH/IGF-I levels. The patient population is representative with the ratio of females to males being 1.12:1, average age 50.36 years (range 1685).
Complications: Three patients suffered intraoperative bleeding controlled endoscopically and one patient died of bronchopneumonia within one month of surgery. All occurred within the initial 14 months of experience. 10 patients required further surgery for tumour removal/CSF leak repair with half occurring within the first 14 months of experience. 17 patients suffered CSF leaks (9 transient).
Conclusions: In skilled hands this method of surgery provides a complementary alternative to conventional transphenoidal microscopic surgery. A learning trend was evident in relation to complication rate.