Download PDF
Minim Invasive Neurosurg 2005; 48(6): 348-354
DOI: 10.1055/s-2005-915635
Original Article
© Georg Thieme Verlag Stuttgart · New York

Fully Endoscopic Endonasal vs. Transseptal Transsphenoidal Pituitary Surgery

M.  S.  Kabil1 , J.  B.  Eby1 , H.  K.  Shahinian1
  • 1Skull Base Institute, Los Angeles, CA, USA
Further Information

Publication History

Publication Date:
23 January 2006 (online)

    Permissions and Reprints

Abstract

A long-term retrospective study of 300 patients who underwent fully endoscopic endonasal pituitary adenoma resection between November 1998 and October 2004. The patients' records as well as the data obtained from postoperative follow-up visits was used to determine outcomes. Additionally, the data were then compared to mean values calculated from several transseptal-transsphenoidal reports. From a total of 300 pituitary adenomas, 139 (46 %) were hormonally active, while 161 (54 %) were non-functioning. Mean follow-up period was 38.2 months. The average length of hospital stay (LOS) was 1.4 days. All patients had postoperative magnetic resonance imaging (MRI) studies to assess residual or recurrent disease; all patients with hormonally active tumors had additional postoperative hormonal studies. Remission, being defined as no hormonal or radiological evidence of recurrence within the time-frame of the follow-up, was demonstrated in 127/134 (95 %) of enclosed and 144/166 (87 %) of invasive adenomas. A comparison of fully endoscopic endonasal vs. transseptal-transsphenoidal remission results revealed an improved outcome using the fully endoscopic endonasal technique: ACTH (86 % vs. 81 %), PRL (89 % vs. 66 %) and GH (85 % vs. 77 %). The remission rate for non-functioning adenomas was 149/161 (93 %). Additionally, we noted a marked reduction in complications related to the endoscopic procedure. Our results conclude that the fully endoscopic endonasal technique is a safe and effective method for removal of pituitary adenomas providing more complete tumor removal and reducing complications.

Key words

Pituitary surgery - endoscopic - microsurgery - transsphenoidal

References

  • 1 Aron D C, Tyrrell J B, Wilson C B. Pituitary tumors: Current concepts in diagnosis and management.  Western J Med. 1995;  162 340-352
    PubMedGoogle Scholar
  • 2 Freda P U, Wardlaw S L. Clinical review 110: Diagnosis and treatment of pituitary tumors.  J Clin Endocr Metabol. 1999;  84 3859-3866
    PubMedGoogle Scholar
  • 3 Barkan A L, Halasz I, Dornfeld K J, Jaffe C A, Friberg R D, Chandler W F, Sandler H M. Pituitary irradiation is ineffective in normalizing plasma insulin-like growth factor I in patients with acromegaly.  J Clin Endocr Metabol. 1997;  82 3187-3191
    CrossrefPubMedGoogle Scholar
  • 4 Powell J, Wardlaw S, Post K, Freda P U. Outcome of radiotherapy for acromegaly using normalization of IGF-I level to define cure. Proc. 81st Annual Meeting of the Endocrine Society. San Diego, CA 1999
    Google Scholar
  • 5 Bushe K A, Halves E. Modified technique in transsphenoidal operations of pituitary adenomas.  Acta Neurochir. 1978;  41 163-175
    CrossrefPubMedGoogle Scholar
  • 6 Maira G, Anile C, De Marinis L, Barbarino A. Prolactin-secreting adenomas: surgical results and long-term follow-up.  Neurosurgery. 1989;  24 736-743
    PubMedGoogle Scholar
  • 7 Smallridge R C, Martins A N. Transsphenoidal surgery for prolactin-secreting pituitary tumors: a study of 28 cases and review of the literature.  Southern Med J. 1982;  75 963-968
    PubMedGoogle Scholar
  • 8 Randall R V, Laws E R, Abboud C F, Ebersold M J, Kao P C, Scheithauer B W. Transsphenoidal microsurgical treatment of prolactin-producing pituitary adenomas. Results in 100 patients.  Mayo Clinic Proc. 1983;  58 108-121
    PubMedGoogle Scholar
  • 9 Mampalam T J, Tyrrell J B, Wilson C B. Transsphenoidal microsurgery for Cushing disease. A report of 216 cases.  Ann Intern Med. 1988;  109 487-493
    PubMedGoogle Scholar
  • 10 Comtois R, Beauregard H, Somma M, Serri O, Aris-Jilwan N, Hardy J. The clinical and endocrine outcome to transsphenoidal microsurgery of nonsecreting pituitary adenomas.  Cancer. 1991;  68 860-866
    CrossrefPubMedGoogle Scholar
  • 11 Tyrrell J B, Lamborn K R, Hannegan L T, Applebury C B, Wilson C B. Transsphenoidal microsurgical therapy of prolactinomas: initial outcomes and long-term results.  Neurosurgery. 1999;  44 254-261; discussion: 261 - 263
    CrossrefPubMedGoogle Scholar
  • 12 Jankowski R, Auque J, Simon C, Marchal J C, Hepner H, Wayoff M. Endoscopic pituitary tumor surgery.  Laryngoscope. 1992;  102 198-202
    PubMedGoogle Scholar
  • 13 Helal M Z. Combined micro-endoscopic trans-sphenoid excisions of pituitary macroadenomas.  Eur Arch Otorhinolaryng. 1995;  252 186-189
    PubMedGoogle Scholar
  • 14 Jho H D, Carrau R L. Endoscopy assisted transsphenoidal surgery for pituitary adenoma. Technical note.  Acta Neurochir. 1996;  138 1416-1425
    CrossrefPubMedGoogle Scholar
  • 15 Jarrahy R, Berci G, Shahinian H K. Assessment of the efficacy of endoscopy in pituitary adenoma resection.  Arch Otolaryng Head Neck Surg. 2000;  126 1487-1490
    PubMedGoogle Scholar
  • 16 Jarrahy R, Suh R, Berci G, Shahinian H K. Endoscopic pituitary surgery: an in vivo model for endonasal transsphenoidal hypophysectomy.  J Laparosc Adv Surg Techn. 1999;  9 211-219
    PubMedGoogle Scholar
  • 17 Jarrahy R, Shahinian H K. Surgical Management of Pituitary Tumors. In: Endocrinology, DeGroot LJ, Jameson JL. eds. Philadelphia, PA: WB Saunders 2000: pp 343-353
    Google Scholar
  • 18 Hardy J. Transphenoidal microsurgery of the normal and pathological pituitary.  Clin. Neurosurg 1969;  16 185-217
    PubMedGoogle Scholar
  • 19 Boggan J E, Tyrrell J B, Wilson C B. Transsphenoidal microsurgical management of Cushing's disease. Report of 100 cases.  J Neurosurg. 1983;  59 195-200
    PubMedGoogle Scholar
  • 20 Wilson C B. A decade of pituitary microsurgery. The Herbert Olivecrona lecture.  J Neurosurg. 1984;  61 814-833
    PubMedGoogle Scholar
  • 21 Tagliaferri M, Berselli M E, Loli P. Transsphenoidal microsurgery for Cushing's disease.  Acta Endocrin (Copenh). 1986;  113 5-11
    PubMedGoogle Scholar
  • 22 Ross D A, Wilson C B. Results of transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma in a series of 214 patients.  J Neurosurg. 1988;  68 854-867
    PubMedGoogle Scholar
  • 23 Verlaat J W, Nortier J W, Hendriks M J, Bosma N J, Graamans K, Lubsen H, Vasen H F, Thijssen J H, Croughs R J. Transsphenoidal microsurgery as primary treatment in 25 acromegalic patients: results and follow-up.  Acta Endocrin (Copenh). 1988;  117 154-158
    PubMedGoogle Scholar
  • 24 Yang S Y, Zhu T, Zhang J N, Sun Y S. Transsphenoidal microsurgical management of pituitary adenomas.  Microsurgery. 1994;  15 754-759
    CrossrefPubMedGoogle Scholar
  • 25 Abosch A, Tyrrell J B, Lamborn K R, Hannegan L T, Applebury C B, Wilson C B. Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: initial outcome and long-term results.  J Clin Endocrin Metabol. 1998;  83 3411-3418
    CrossrefPubMedGoogle Scholar
  • 26 Ebersold M J, Quast L M, Laws E R, Scheithauer B, Randall R V. Long-term results in transsphenoidal removal of nonfunctioning pituitary adenomas.  J Neurosurg. 1986;  64 713-719
    CrossrefPubMedGoogle Scholar
  • 27 Ciric I, Ragin A, Baumgartner C, Pierce D. Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience.  Neurosurgery. 1997;  40 225-236; discussion: 236 - 227
    CrossrefPubMedGoogle Scholar
  • 28 Marie P. Sur deux cas d'acromegalie; Hypertrophie singuliere non congenitale des extremites superieures, inferieures et cephalique.  Rev Medicine. 1886;  6 297-333
    PubMedGoogle Scholar
  • 29 Horsley V. Disease of the pituitary gland.  Br Med J. 1906;  1 323
    PubMedGoogle Scholar
  • 30 Schloffer H. Frage der Operationen an der Hypophyse.  Beitr Klin Chir. 1906;  50 767-817
    PubMedGoogle Scholar
  • 31 Hardy J. Trans-sphenoidal approach to the pituitary gland. In: Neurosurgery, Wilkins RH, Rengachary SS. eds. New York: MacGraw-Hill 1996: pp 1375-1384
    Google Scholar
  • 32 Welbourn R B. The evolution of transsphenoidal pituitary microsurgery.  Surgery. 1986;  100 1185-1190
    PubMedGoogle Scholar
  • 33 Cushing H. Surgical experience with pituitary disorders.  JAMA. 1914;  63 1515-1525
    PubMedGoogle Scholar
  • 34 Cushing H. Pituitary Body, Hypothalamus and Parasympathetic Nervous System. Springfield, IL: Charles C. Thomas 1932
    Google Scholar
  • 35 Guiot G. Hypophysaire. Paris: Masson 1958
    Google Scholar
  • 36 Guiot G, Thebaul B. L'Extirpation des adenomas hypophysaires par voie trans-shpenoidale.  Neuro Chirugie. 1959;  1 133
    PubMedGoogle Scholar
  • 37 Hardy J. L'Exerese des adenomas hyophysaires par voie trans-shenoidale.  Union Med Can. 1962;  91 933
    PubMedGoogle Scholar
  • 38 Hardy J, Vezina J L. Transsphenoidal neurosurgery of intracranial neoplasm.  Adv Neurol. 1976;  15 261-274
    PubMedGoogle Scholar
  • 39 Jho H D, Carrau R L, Ko Y, Daly M A. Endoscopic pituitary surgery: an early experience.  Surg Neurol. 1997;  47 213-22; discussion: 222 - 223
    Google Scholar
  • 40 Gamea A, Fathi M, el-Guindy A. The use of the rigid endoscope in trans-sphenoidal pituitary surgery.  J Laryngol Otol. 1994;  108 19-22
    PubMedGoogle Scholar
  • 41 Spencer W R, Das K, Nwagu C, Wenk E, Schaefer S D, Moscatello A, Couldwell W T. Approaches to the sellar and parasellar region: anatomic comparison of the microscope versus endoscope.  Laryngoscope. 1999;  109 791-794
    PubMedGoogle Scholar
  • 42 Jho H D, Carrau R L. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients.  J Neurosurg. 1997;  87 44-51
    CrossrefPubMedGoogle Scholar
  • 43 Carrau R L, Jho H D, Ko Y. Transnasal-transsphenoidal endoscopic surgery of the pituitary gland.  Laryngoscope. 1996;  106 914-918
    PubMedGoogle Scholar
  • 44 Heilman C B, Shucart W A, Rebeiz E E. Endoscopic sphenoidotomy approach to the sella.  Neurosurgery. 1997;  41 602-607
    CrossrefPubMedGoogle Scholar
  • 45 Sheehan M T, Atkinson J L, Kasperbauer J L, Erickson B J, Nippoldt T B. Preliminary comparison of the endoscopic endonasal vs the sublabial transseptal approach for clinically nonfunctioning pituitary macroadenomas.  Mayo Clin Proc. 1999;  74 661-670
    CrossrefPubMedGoogle Scholar
  • 46 Landolt A M. Complication and pitfalls of transsphenoidal pituitary surgery.  Neurosurgeons. 1984;  4 395-404
    PubMedGoogle Scholar
  • 47 Laws Jr  ER, Kern E B. Complications of trans-sphenoidal surgery.  Clin Neurosurg. 1976;  23 401-416
    PubMedGoogle Scholar
  • 48 Ahuja A, Guterman L R, Hopkins L N. Carotid cavernous fistula and false aneurysm of the cavernous carotid artery: complications of transsphenoidal surgery.  Neurosurgery. 1992;  31 774-778
    CrossrefPubMedGoogle Scholar
  • 49 Black P M, Zervas N T, Candia G L. Incidence and management of complications of transsphenoidal operation for pituitary adenomas.  Neurosurgery. 1987;  20 920-924
    CrossrefPubMedGoogle Scholar

Hrayr K. Shahinian, M. D., FACS 

Skull Base Institute ·

8635 West Third Street, Suite 1170W ·

Los Angeles,

CA 90048 ·

USA

Phone: +1-310-691-8888

Fax: +1-310-691-8877

Email: team@skullbaseinstitute.com