Uninostril Endonasal Endoscopic Management of Pituitary Adenomas

Introduction: Endoscopic endonasal approaches to the sellar floor in management of pituitary adenomas are becoming increasingly popular. In our retrospective case series, we describe our transition from a binostril to a uninostril approach in managing these lesions. Surgical, radiographic and endocrinological outcomes are analyzed.

Methods: Retrospective analysis includes 22 patients with pituitary adenomas, 11 of which were treated with binostril approach and 11 of which were treated with uninostril approach between March 2012 and February 2013. There were 14 female and 8 male patients with a mean age of 47.62 years (range 16–78 years). Three surgeries were reoperations following prior endonasal pituitary surgery. Fourteen (14) patients presented with visual symptoms and 7 presented with signs of pituitary apoplexy.

Results: Pituitary adenomas included 21 macroadenomas (> 1 cm) and 1 microadenoma with widest mean tumor diameter 26.69 ± 13.11mm (range 0.7cm – 6.6 cm). Eleven adenomas were hormonally active (5 PRL, 1 ACTH, 1 FSH, 1 GH, 2 GH & PRL, 1 TSH & PRL). Fourteen were found to invade or compress adjacent cerebral structures. Complications included 3 post operative CSF leaks, 2 cases of sinusitis 1 pulmonary embolism. Two patients had residual tumors that required gamma-knife radiosurgery.

Conclusions: The change in operative technique to a uninostril approach provides a safe, less invasive, fast option in managing pituitary adenomas while still providing adequate visualization of the sella. Our case series indicates that complication rates are relatively low and are further reduced by placement of a fat graft to prevent post-operative CSF leak.