Endoscopic endonasal transsphenoidal surgery of 1,166 pituitary adenomas

Abstract

AimTo report the results of a series of patients undergoing pure endoscopic endonasal pituitary surgery and to evaluate the efficacy and safety of this procedure.Materials and methodsThe data of 1,166 patients that underwent endoscopic endonasal transsphenoidal adenoma removal between December 2006 and June 2013 were retrospectively reviewed. Pre- and postoperative hormonal status (3 months after surgery) were analyzed and compared with the clinical parameters originally presented by the patients. The incidences of tumor removal, hormonal control, and tumor removal complications were retrospectively analyzed.ResultOut of 577 nonfunctioning adenomas, 180 were growth hormone (GH) secreting, 308 prolactin (PRL) secreting, 26 mixed GH/PRL adenomas, 68 adrenocorticotropin secreting, and 7 thyroid-stimulating hormone-secreting adenomas. The gross total removal of pituitary adenomas was achieved in 98 % of microadenomas, 92 % of macroadenomas, and 76 % of giant adenomas. Hormonal control was achieved in 47 (69 %) cases of ACTH adenomas, 119 (66 %) GH adenomas, 262 (85 %) PRL adenomas, and 6 (86 %) TSH adenomas. Postoperative complications were observed in 168 (14.4 %) patients. The most frequent complications were diabetes insipidus (7 %), epistaxis (1.7 %), hyposmia (1.5 %), anterior lobe insufficiency (1.3 %) ,and CSF leaks (0.6 %).ConclusionThe pure endoscopic approach is a safe, efficacious, and minimally invasive technique for the removal of pituitary adenomas. A higher gross total resection rate is vital for non-functional and functional adenomas. For patients with functional adenomas, while hormonal remission is unlikely to be achieved by surgery, the use of adjuvant therapy is advocated to obtain long-term hormonal control.

Causes for 30‐Day Readmission following Transsphenoidal Surgery

“…4,[13][14][15][16][17][18][19][20][21][22][23] Previously reported rates of readmission range from 0.7% to 1.8% for epistaxis, 2.9% to 6.4% for hyponatremia, and 0.6% to 4% for CSF leak. [13][14][15][16][17][18][19]23 As clinical management of each complication varies among health care systems, it is difficult to extrapolate our 30-day readmission rate to estimate the associated costs at other institutions. Similarly, as surgical technique also varies among surgeons, it is difficult to estimate the overall average 30-day readmission rate among all hospitals based on this study alone.…”

ICAR: endoscopic skull‐base surgery

“…Overall postoperative CSF leak and bacterial meningitis rates in 9 recent large endoscopic pituitary adenoma series (all with over 200 patients) have ranged from 0.6% to 5%, and 0% to 3.4%, respectively. NSF usage in these series ranges from 1% to 43% and planned lumbar CSF drainage from 0.6% to 21.7% …”

Characteristics and management of sinonasal paragangliomas: a systematic review

“…Although a majority of the cases reported non‐endoscopic approaches, multiple studies have shown a trend toward the endoscopic approach in order to maximize exposure. This is especially true in academic centers . Additional studies have shown the safety and efficacy of endoscopic approaches for the removal of sinonasal tumors .…”