Surgical Results of 201 Consecutive Cases of Pituitary Adenoma: Personal Experience by Endoscopic Endonasal Transsphenoidal Approach

Abstract

PURPOSE : Microscopic TSA is well known for the pituitary adenoma and endonasal approach is recommended not to injure nasal mucosa and septum. Endoscopic endonasal TSA is introduced not to make any destruction of nasal septum and provide close panoramic view of sella and parasellar anatomy. However there are some limitations in the endoscopic surgery to remove macroadenoma extending suprasellar space and cavernous sinus. We reviewed the results of pituitary microadenomas and macroadenomas by endoscope without microscope.

MATERIALS AND METHODS : Endoscopic endonasal TSA for pituitary adenomas was performed in 201 patients from 1996 to 2008: 74 male and 127 female, Age was 46.6 years(9-75 years). Follow up was done for 67.95 months(1-156 months). 74 prolactinomas, 25 GH secreting adenomas, 13 ACRH secreting adenomas and 89 nonfunctiong tumors. 65 microadenomas and 136 macroadenomas.

RESULTS : Reoperation was done in the cases of significant decrease of hormone, remained mass and recurred tumor. 7 cases were operated within 2 or 7 day after first surgery. 10 cases were operated 2 or 6 years after surgery. Total cases of reoperation was 17(8.5%): 8(10.8%) prolactinomas, 3(12%) GH secreting adenomas, 1(7.7%) ACTH secreting adenoma and 5(5.6%) nonfunctiong adenomas. 4(6.2%) microadenomas and 13(9.6%) macroadenomas. 7(3.5%) macroadenomas were treated with gamma knife after surgery. Temporary diabetes insipidus was noticed in 50 cases and permanent DI was 3 cases. Repair for CSF rhinorrhea was done in 2 cases. Two patients was suffered from meningitis. One patient showed pneumocephalus and pineal abscess. Oculomotor nerve palsy was observed in one case. Postoperative intratumoral bleeding was developed in one case and transcranially removed.

CONCLUSION : Microadenomas was well controlled by endoscopic surgery. Although there were several cases for reoperation in the macroadenomas, endoscopic endonasal TSA made minimal complications and additional gamma knife surgery is recommended for remained macroadenomas.