The Role and Place of Endoscopic Endonasal Transsphenoidal Technique in Pituitary Surgery

Background: After more than 25 years (more than 7000 cases) of pituitary tumor treatment, we started using the endoscopic endonasal transsphenoidal approach to sellar lesions 5 years ago. We have operated on 740 patients (pituitary adenomas, craniopharyngiomas, chordomas, etc.) using this technique.

Aim: We analyzed the results of surgery in a series of 560 patients with pituitary adenomas (PAs), whose primary treatment mode was an endoscopic endonasal transsphenoidal adenomectomy (EETA).

Methods: We use the endoscopic endonasal monolateral or bilateral approach to the sella and perform tumor removal with a rigid endoscope with 0-, 30-, 45-, and 70-degree lenses without retractor or any postoperative nasal packing.

Results: The EETA method shows less frequent complication rates than the standard transsphenoidal surgery, with the most serious complications affecting <2% of patients in the EETA group.

Conclusion: We currently use EETA in approximately 85% of pituitary cases and in 100% of transsphenoidal cases. We have found that EETA contributes to a decrease of complications in comparison with the standard transnasal microscopic operations. The decrease of complications is ascribed to some advantages provided by EETA, such as panoramic view and good light exposure of the operative field. This allows a precise view of the anatomic structures, which decreases the risk of their damage, facilitates total tumor removal, reveals any CSF leakage, and closes the defect in the tumor capsule. Further improvement can be expected based on the greater experience and new technical developments.