Surgical Outcomes of Endoscopic Transsphenoidal Pituitary Surgery

Authors

  • Mumtaz Ali Ali Institute of Neurosciences, Irfan General Hospital, Peshawar
  • Ramzan Hussain Ali Institute of Neurosciences, Irfan General Hospital, Peshawar
  • Hanif Ur Rahman Ali Institute of Neurosciences, Irfan General Hospital, Peshawar
  • Sajid Razzaq Ali Institute of Neurosciences, Irfan General Hospital, Peshawar
  • Abdur Raheem Department of Neurosurgery, Lady Reading Hospital, Peshawar – Pakistan
  • Muhammad Aneeq
  • Yasir Ashraf Ali Institute of Neurosciences, Irfan General Hospital,Peshawar
  • Jabir Shah

DOI:

https://doi.org/10.36552/pjns.v29i1.1063

Keywords:

Adenoma, Endoscopic trans-sphenoidal, Microscopic trans-sphenoidal, Pituitary adenoma

Abstract

Introduction: Pituitary adenoma are common benign tumors of the brain and causes significant symptoms due to hormonal imbalances (mostly functional pituitary adenoma) and their mass effect on surrounding structures (majority of nonfunctional pituitary adenoma). The aim of this study was to find out the surgical outcomes of endoscopic trans-sphenoidal approach in terms of safety, effectiveness, per-op and post-op complications and relieve of symptoms.

Methodology: This study was conducted at Ali Institute of Neurosciences and Irfan General Hospital, Peshawar, from April 2019 to April 2021. Patients diagnosed with pituitary adenomas (confirmed by MRI) and treated with the endoscopic trans-sphenoidal approach were included. Demographic data was collected, and outcomes were assessed post-surgery and at 6-month follow-up. Data were analyzed using SPSS version-26.

Results: The majority of participants were male (65%) with a mean age of  31 years (range 22-28). Most patients presented with headaches (76%) and visual disturbances (60%), while 53% had hormonal imbalances. Post-surgery  100% reported headache relief  87% showed visual  improvements measured by Humphrey perimeter and visual acuity tests, and 97% had favorable endocrinological outcomes based on hormonal profile assessments.

Conclusion: When treating pituitary adenoma, the endoscopic trans-sphenoidal approach is a safe and successful surgical technique that is linked to better patient results and satisfaction. Complications from the operation include intercavernous sinus hemorrhage, diabetes insipidus, hypopituitarism and CSF leakage.

Keywords: Adenoma, Endoscopic trans-sphenoidal, Microscopic trans-sphenoidal, Pituitary adenoma

References

References:

Hauser BM, Lau A, Gupta S, Bi WL, Dunn IFJFie. The epigenomics of pituitary adenoma. 2019;10:290. doi: 10.3389/fendo.2019.00290.

Lim CT, Korbonits MKJEP. Update on the clinicopathology of pituitary adenomas. 2018;24(5):473-88. doi: 10.4158/EP-2018-0034

Sharifi G, Sabahi M, Amin A, Dilmaghani NA, Nejad AM, Davoudi Z, et al. Patterns of extrasellar invasive growth of pituitary adenomas with normal sellar cavity size. 2021;209:106942. doi: 10.1016/j.clineuro.2021.106942

Gan L, Ma J, Feng F, Wang Y, Cui J, Guo X, et al. The predictive value of suprasellar extension for visual function evaluation in Chinese patients with nonfunctioning pituitary adenoma with optic chiasm compression. 2018;116:e960-e7. doi: 10.1016/j.wneu.2018.05.141

Ntali G, Wass JAJP. Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas. 2018;21(2):111-8. doi: 10.1007/s11102-018-0869-3

Shijo K, Yoshimura S, Mori F, Yamamuro S, Sumi K, Oshima H, et al. Pituitary apoplexy accompanying temporal lobe seizure as a complication. 2020;138:153-7. doi: 10.1016/j.wneu.2020.02.148

Jamaluddin MA, Patel BK, George T, Gohil JA, Biradar HP, Kandregula S, et al. Endoscopic Endonasal Approach for Giant Pituitary Adenoma Occupying the Entire Third Ventricle: Surgical Results and a Review of the Literature. 2021;154:e254-e63. doi: 10.1016/j.wneu.2021.07.022

Kang BM, Oh HJ, Ryu KH, Ahn JM. Treatment of pituitary adenoma with spontaneous cerebrospinal rhinorrhea using nasoseptal flap, two case reports. Surgical neurology international. 2022;13:262. doi: 10.25259/SNI_61_2022

Hayashi Y, Sasagawa Y, Oishi M, Kita D, Tanaka S, Ueda F, et al. Directional regulation of extrasellar extension by sellar dura integrity and intrasphenoidal septation in pituitary adenomas. 2019;122:e130-e8. doi: 10.1016/j.wneu.2018.09.127

Araujo-Castro M, Berrocal VR, Pascual-Corrales EJH. Pituitary tumors: epidemiology and clinical presentation spectrum. 2020;19(2):145-55. doi: 10.1007/s42000-019-00168-8

Almeida JP, Sanchez MM, Karekezi C, Warsi N, Fernández-Gajardo R, Panwar J, et al. Pituitary apoplexy: results of surgical and conservative management clinical series and review of the literature. 2019;130:e988-e99. doi: 10.3389/fendo.2019.00290

Tampourlou M, Fountas A, Ntali G, Karavitaki NJP. Mortality in patients with non-functioning pituitary adenoma. 2018;21(2):203-7. doi: 10.1007/s11102-018-0863-9

Melmed S, Kaiser UB, Lopes MB, Bertherat J, Syro LV, Raverot G, et al. Clinical Biology of the Pituitary Adenoma. Endocrine Reviews. 2022. doi: 10.1210/endrev/bnac010

Mehta GU, Lonser RR. Management of hormone-secreting pituitary adenomas. Neuro-Oncology. 2016;19(6):762-73. doi: 10.1093/neuonc/now130

Banskota S, Adamson DJB. Pituitary Adenomas: From Diagnosis to Therapeutics. 2021;9(5). doi: 10.3390/biomedicines9050494

Herse P. Pituitary macroadenoma: a case report and review. Clinical and experimental optometry. 2014;97(2):125-32. doi: 10.1111/cxo.12099

Salama MM, Rady MRJEJoN. Transcranial approaches for pituitary adenomas: current indications and clinical and radiological outcomes. 2021;36(1). doi.org/10.1186/s41984-021-00117-x

Micko A, Agam MS, Brunswick A, Strickland BA, Rutkowski MJ, Carmichael JD, et al. Treatment strategies for giant pituitary adenomas in the era of endoscopic transsphenoidal surgery: a multicenter series. 2021;136(3):776-85. doi: 10.3171/2021.1.JNS203982

Chaudhary V, Bano S. Imaging of the pituitary: Recent advances. Indian journal of endocrinology and metabolism. 2011;15 Suppl 3(Suppl3):S216-23. doi: 10.4103/2230-8210.84871

Araujo-Castro M, Cancela AA, Vior C, Pascual-Corrales E, Berrocal VRJFiO. Radiological Knosp, Revised-Knosp, and Hardy–Wilson Classifications for the Prediction of Surgical Outcomes in the Endoscopic Endonasal Surgery of Pituitary Adenomas: Study of 228 Cases. 2021;11. doi: 10.3389/fonc.2021.807040

Rutkowski M, Chang K, Cardinal T, Du R, Tafreshi A, Donoho D, et al. Development and clinical validation of a grading system for pituitary adenoma consistency. 2020;134(6):1800-7. doi: 10.3171/2020.4.JNS193288

Acitores Cancela A, Rodríguez Berrocal V, Pian H, Martínez San Millán JS, Díez JJ, Iglesias PJH. Clinical relevance of tumor consistency in pituitary adenoma. 2021;20(3):463-73. doi: 10.1007/s42000-021-00302-5

Ortiz LD, Syro LV, Scheithauer BW, Rotondo F, Uribe H, Fadul CE, et al. Temozolomide in aggressive pituitary adenomas and carcinomas. 2012;67:119-23. doi: 10.6061/clinics/2012(sup01)20

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Published

2025-03-01

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