Endoscopic Surgery for Pituitary Adenomas: Outcome and Analysis of Over 125 Consecutive Cases from a Prospective Database

A prospective database of our series of 125 consecutive patients was analyzed based on patient presentation, endocrine evaluation, ophthalmological data, surgical resection, closure techniques, complications, and outcomes. The group consisted of 96% macroadenomas and 4% microadenomas. In total, 78% were nonfunctional and 22% were functional adenomas. On presentation, 58% of patients had visual loss, of which 90% experienced visual improvement postoperatively. Normal vision was restored in 71%, and vision was improved significantly in 19% of all patients. There were no cases of visual deterioration as a result of surgery. Transient diabetes insipidus occurred in 9.6% of patients. Aside from temporary cortisol replacement, no new endocrinopathies were identified postoperatively. There were three cases of postoperative cerebrospinal fluid rhinorrhea, only one of which required reoperation for repair. Total resection was achieved in 70% of patients, near-total resection in 25%, and partial resection in 5%, by radiographic criteria.

Endoscopic transnasal surgery is an effective means of treating pituitary adenomas with minimal complications. We compare the data of our early experience versus our later experience in order to describe the refinements in surgical approach, repair techniques, and lessons learned during the development of our endoscopic procedure.