Direct Transnasal Mini-Invasive Approach for Pituitary Adenoma

Introduction: During the years from 1990 to 2001, in more than 140 cases, the sublabial approach to the sphenoid sinus and sella was the standard extracranial approach for pituitary tumors in our department. Since 2002, we have performed a direct endonasal paraseptal approach. After review of history of pituitary surgery, we would like to stress the advantages, outcomes, and technique of the direct mini-invasive microsurgical route to the pituitary gland.

Materials and Methods: We perform the approach according to Griffith with the modification of Fukushima. After selective adenomectomy, we use the endoscope (Wolf) to obtain the panoramic view of both cavernous sinuses to control radicality. Since December 2003, we have used the image-guided technique (Treon, Medtronic).

Outcomes: Between June 2002 and June 2007, we operated on 43 patients (25 women and 18 men), with mean age of 48 years (range, 21–80 years). Gross total resection was performed in 30 of 43 (70%) cases. Hypopituitarism was detected only in 10 of 43 (23.3%) cases, subnormal function occurred in 4 of 43 (9.3%) cases, normal function was preserved in 29 of 43 (67.4%) cases.

Conclusions: This mini-invasive method for approaching the pituitary adenoma has proven to be less time-consuming and less destructive to normal structures in the nasal cavity than both the sublabial transseptal and endoscopic approaches. Postoperatively, the nasal septum returns to normal position and long-term complications have not been encountered. We use the endoscope-assisted technique for a panoramic view after surgical adenomectomy. The microsurgical technique is safer and more effective for selective adenomectomy than the endoscopic endonasal approach.