Endoscopic Pituitary Surgery: Experience with 4,000 Patients

Now endoscopic endonasal approach is main surgical approach in treatment of pituitary adenomas (p.a.).

Material: We analyzed 4,000 patients with p.a. who underwent endoscopic endonasal transsphenoidal adenomectomy (EETA) for the past 11 years. Only 19% p.a. in our series was endosellar, other had parasellar extension. A total of 77% of the patients had large (more 3cm) and giant (more than 6 cm) tumors. The distribution of p.a. by their hormonal activity: 32% - GH-secreting, 5% - PRL-secreting, 3% - ACTH-secreting, 60% – nonfunctioning p.a. The visual disturbances are revelation at 68% patients.

Results: Tumor removal was total in 78% patients. Hormonal status was normalized in 73% cases. The improvement of visual functions or without dynamics was observed at 96% patients. Postoperative complications (including CSF-leak, meningitis, nasal bleeding, new neurological deficits) occurred in 4%.

Conclusion: Advantages of EETA: the panoramic view of an operative wound, good light exposure of operative field. That allows precisely view the basic anatomic structures, to lower risk of their damage, radically remove a tumor, to reveal CSF-leakage and to close defect in tumor capsule. The EETA is less traumatic, is more easy transferred by the patients, that reduces period of rehabilitation and term of hospitalization of the patients. This approach allowed removal of p.a. with a small-size sella, adenomas with secondary nodes, p.a. with a narrow neck between their superior and basal parts, and giant tumors (over 60 mm). Postoperative results show, that the designated advantages of a EETA allow to improve quality of surgical treatment of p.a.