Surgical Outcome of Pure Endonasal Transsphenoidal Approach for Pituitary Tumors

  • Abu Bakar Yasin Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore – Pakistan
  • Rizwan Ahmed Khan
  • Khalid Mahmood Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore – Pakistan
Keywords: Endoscopic binarial trans-sphenoidal approach, Pituitary adenoma, Giant adenoma

Abstract

Objective:  To determine the frequency of complete tumor excision by endoscopic skull base (transsphenoidal) approach in pituitary adenoma patients presenting to a neurosurgical department.

Materials & Methods:  This descriptive case series was conducted at the Department of Neurosurgery Unit II, Lahore General Hospital Lahore from May 2019 to November 2019. The study included60 patients with pituitary adenoma from the outpatient department who qualified for the inclusion criteria. All patients went through the endoscopic binarial transsphenoidal approach for pituitary adenectomy. All patients were treated according to the department protocols and were followed for 6 weeks to determine the outcome i.e. no residual tumor left as determined by Magnetic Resonance Imaging.

Results:  The mean age of pituitary adenoma patients studied was 50.02 ± 8.2 years. 43 patients (71.7%) were male.56 patients (93.3%) showed complete resection on MRI using the endoscopic binarial transsphenoidal approach. The outcome was not affected by patients' gender and age. Tumor size significantly affected the outcome i.e. complete resection.

Conclusion:  It is concluded that the endoscopic skull base (transsphenoidal) approach for excision of pituitary adenomas gives desirable results as depicted by 93.3% success rate in terms of complete resection of the tumor. We did not observe a significant effect of patients' gender and age on the clinical outcome in the studied sample of the population.

References

1. HofstetterCp, Shin Bj, Mubita L, Huang C, AnandVk, BoockvarJa, Et Al. Endoscopic EndonasalTranssphenoidal Surgery For Functional Pituitary Adenomas. Neurosurg Focus 2011;30 (4):E10, Doi: 10.3171/2011.1.Focus10317
2. LengLz, Brown S, AnandVk, Schwartz Th. ‘Gasket-Seal’ Watertight Closure In Minimal-Access Endoscopic Cranial Base Surgery. Neurosurgery 2008; 62(5 Suppl 2):342–343.
3. SchabergaMr, AnandaVk, SchwartzbTh, Cobb W. Microscopic Versus Endoscopic Transnasal Pituitary Surgery. Current Opinion In Otolaryngology & Head And Neck Surgery 2010, 18:8–14
4. Fatemi N, DusickJr, De PaivaNeto Ma, Kelly Df. The Endonasal Microscopic Approach For Pituitary Adenomas And Other Parasellar Tumors: A 10-Year Experience. Neurosurgery 2008; 63 (4 Suppl 2):244–256.
5. TheodosopoulosPv, Leach J, Kerr Rg, Zimmer La, Denny Am, Guthikonda B, Et Al. Maximizing The Extent Of Tumor Resection During Transsphenoidal Surgery For Pituitary Macroadenomas: Can Endoscopy Replace Intraoperative Magnetic Resonance Imaging? J Neurosurg 2010;112:736–743
6. Tabaee A, AnandVk, Barrón Y, HiltzikDv, Brown Sm, Kacker A, Et Al. Endoscopic Pituitary Surgery: A Systematic Review And Meta-Analysis. J Neurosurg 2009;111:545–554
7. DehdashtiAr, Ganna A, Karabatsou K, Gentili F. Pure Endoscopic Endonasal Approach For Pituitary Adenomas: Early Surgical Results In 200 Patients And Comparison With Previous Microsurgical Series. Neurosurgery 2008; 62:1006–15
8. Gsponer J, De Tribolet N, DéruazJp, Et Al. Diagnosis, Treatment, And Outcome Of Pituitary Tumors And Other Abnormal Intrasellar Masses. Retrospective Analysis Of 353 Patients. Medicine (Baltimore) 1999; 78:236-9.
9. Saeger W, LüdeckeDk, Buchfelder M, Et Al. Pathohistological Classification Of Pituitary Tumors: 10 Years Of Experience With The German Pituitary Tumor Registry. Eur J Endocrinol 2007; 156:203-8.
10. Fernandez A, Karavitaki N, WassJa. Prevalence Of Pituitary Adenomas: A Community-Based, Cross-Sectional Study In Banbury (Oxfordshire, Uk). ClinEndocrinol (Oxf) 2010; 72:377-382.
11. Dekkers Om, Pereira Am, Roelfsema F. Observation Alone After Transsphenoidal Surgery For Nonfunctioning Pituitary Macroadenoma. J ClinEndocrinolMetab 2006; 91:1796-802.
12. Ferrante E, Ferraroni M, Castrignanò T. Non-Functioning Pituitary Adenoma Database: A Useful Resource To Improve The Clinical Management Of Pituitary Tumors. Eur J Endocrinol 2006; 155:823-8.
13. Brady Z, Garrahy A, Carthy C, O’Reilly MW, Thompson CJ, Sherlock M, et al. Outcomes of endoscopic transsphenoidal surgery for Cushing’s disease. BMC Endocr Disord. 2021;21(1):36
14. Gondim JA, Almeida JP, de Albuquerque LAF, Gomes E, Schops M, Ferraz T. Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center. Neurosurg Focus. 2010;29(4):E7
15. Gondim JA, Ferraz T, Mota I, Studart D, Almeida JPC, Gomes E, et al. Outcome of surgical intrasellar growth hormone tumor performed by a pituitary specialist surgeon in a developing country. Surg Neurol. 2009;72(1):15–9; discussion 19.
16. D’Haens J, Van Rompaey K, Stadnik T, Haentjens P, Poppe K, Velkeniers B. Fully endoscopic transsphenoidal surgery for functioning pituitary adenomas: a retrospective comparison with traditional transsphenoidal microsurgery in the same institution.
Surg Neurol. 2009;72(4):336–40
17. Jang JH, Kim KH, Lee YM, Kim JS, Kim YZ. Surgical results of pure endoscopic endonasal transsphenoidal surgery for 331 pituitary adenomas: A 15-year experience from a single institution. World Neurosurg. 2016;96:545–55.
Published
2021-09-30
Section
Original Articles