Endoscopic and Endoscopic-Assisted Transsphenoidal Surgery for Pituitary Adenomas

Endoscopes have been used for transsphenoidal surgery for more than 15 years and have became very popular. Because of the confined area and the potential risks of this surgery, special training to handle the endoscope is mandatory. The question arose whether the introduction of endoscopic surgery should be stepwise. We followed a stepwise procedure from microsurgery to endoscopic-assisted microsurgery (series 1) and from endoscopic-assisted to purely endoscopic surgery (series 2) to overcome these problems.

We describe the differences in these techniques, as well as their goals, and compare the results of both techniques. We analyzed 136 endoscopic-assisted operations (series 1) and 100 purely endoscopic procedures (series 2). In both series, we had no mortality, no cerebral complications, and no optic lesions. The rate of CSF leaks requiring reoperations was higher in the endoscopic-assisted series (6% vs. 4% during endoscopic surgery). In 7% of endoscopically assisted and 11% of purely endoscopically treated cases, we had postoperative diabetes insipidus.

The cure rate in this short follow-up period (defined as no tumor on MRI or cure from hormonal hypersecretion) was statistically the same in both series (82% and 83%).

In conclusion, endoscopic surgery of the sella and beyond the sella seems to be promising and challenging. The results are comparable to microsurgery, but purely endoscopic surgery, although it seems to be more demanding to begin with, may offer more possibilities.