Results of Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas

摘要

Aim. To assess the effectiveness of the endoscopic endonasal transsphenoidal approach in themanagement of pituitary adenomas.Methods: We retrospectively analyzed 152 patients with pituitary adenomas who were operated onbetween January 2003 and December 2011 (85 women and 67 men; mean age = 43 years; follow-up = 6 months- 9 years). The series consists of 49 GH-secreting adenomas (GH = growth hormone), 20 PRL-producingadenomas (PRL = prolactin), 21 mixed GH & PRL-producing adenomas, 8 corticotroph adenomas, one case ofthyrotroph adenoma and 53 non-functioning pituitary adenomas.Results. Among the 20 patients with prolactinomas, 14 patients exhibited normalized prolactin levelspostoperatively. In the acromegalic patients, there were 12 macroadenomas and 58 microadenomas. Among themacroadenomas, endocrinologic remission was observed in 4 cases, minimal improvement in 2 cases and nochanges in 6 cases. Among the microadenomas, endocrinologic remission was observed in 34 cases,improvement in 10 cases, minimal improvement in 4 cases and no changes in 10 cases. When a residual tumor inthe cavernous sinus was identified, gamma-knife surgery was used. The 8 patients with Cushing’s disease hadresolution of hypercortisolism clinically and chemically. The surgery was curative also in the case of thyrotrophadenoma. Postoperative morbidities included cerebrospinal fluid leak in 4 cases (2.63%), temporary diabetesinsipidus in 8 cases (5.26%) and sinusitis in 2 cases (1.31%).Conclusions. The endoscopic endonasal transsphenoidal approach is an effective surgical option forpituitary adenomas. A low incidence of complications has been observed, likely because of the improvedvisualization of the anatomy and the decreased surgical trauma.