Endoscopic Endonasal Transsphenoidal Approach for Pituitary Adenomas (Our Experience in Avoiding Complications)

Background: The endoscope was used in trans-sphenoidal surgery for sellar lesions by Gerard Guiot more than 40 years ago. Interest in endonasal endoscopic transsphenoidal surgery has increased. Objectives: This article presents our experience in the endoscopic trans-sphenoidal approach of the first sixty cases performed in our hospital, analyzing the pathology causing the surgery, the difficulties and complications found and the development of the procedures. Patients and Methods: A retrospective study of the first sixty cases of pituitary adenomas operated via endonasal trans-sphenoidal endoscopy that was carried out between 2008 and 2014. Results: In sixty cases of pituitary adenomas operated via endonasal trans-sphenoidal endoscopy, there were fourty five females and fifteen males, with a mean age of 54 y (18 to 65 years). Macroadenoma was present in fifty patients and microadenomas in ten patients. Nonfunctioning adenoma was present in 32 cases while 18 cases had prolactinomas and 10 cases had GH-producing tumors. MRI was done 3 and 6 months after the surgery. It was shown that total resection was achieved in 70% of the cases, subtotal in 18.3% and partial resection in 11.6%. In ten patients (16.6%) a cerebrospinal fluid (CSF) leak occurred postoperatively. Five cases achieved resolution using conservative measures, while another five required surgery to control the fistula. Three cases were died (5%), two cases died from meningitis and the third case didn t recover after surgery for pituitary apoplexy. Conclusion: For most pituitary tumors, endoscopic endonasal transsphenoidal approach is the most appropriate route. It provides excellent exposure of the sella and adequate working space. There is less postoperative pain with short hospital stay and minimal complications. As time has passed and our surgical experience has increased, complications have become fewer.