Pure Single Nostril Endoscopic Endonasal Transsphenoidal Hypophisectomy for Pituitary Adenoma: Clinical Series of 50 Cases

Introduction: Endoscopes are now used for transsphenoidal pituitary surgery and eventually replaced the use of operating microscope. Endoscopic Endonasal Transsphenoidal Hypophysectomy (EETH) surgery for pituitary adenoma has now increasingly accepted by most neurosurgeons in many centers throughout the world. This study evaluates a series of consecutive EETH performed since 2012 in our center

Objectives: The aim of the study was to analyze the outcome and the surgical technique to enlighten advantages and limitations of this procedure.

Methods: All patients underwent a pre- and postoperative evaluation of neurological status, hormonal investigations and magnetic resonance imaging. Surgical time, post-surgical complications, post operative diabetes insipidus, and post operative length of stay (LOS) were considered, based on medical records.

Result: EETH was done in 50 cases of pituitary adenoma. The average surgical time in 44 cases required less than 3 hours. Bleedings during the surgery were minimal; they were less than 50 cc in 11 cases, and 50 – 200 cc in 30 cases and 9 cases that over 200 cc. Post-operative LOS of most patients was 7 – 14 days and 9 patients can be discharged within 7 days. Post operative transient diabetes insipidus occurred in 23 patients. Re-operation was done in 6 patients. Those was due to post operative hemorrhage and profuse cerebrospinal fluid leakage in 4 and 2 cases respectively.

Conclusion: EETH procedure resulted in a safe, effective, and well-tolerated procedure. From our experience, we conclude that EETH should be considered to be complementary rather than alternative: the endonasal endoscopic can be advantageous in selected cases