Endoscopic Transsphenoidal Endonasal Approach for Large Pituitary Adenoma with Extrasellar Extension

Introduction: The transsphenoidal route is a direct and rapid extracerebral approach to the sellar region, and, therefore, it is the most widely used technique for the processes involving this area. Since its introduction in 1907, it has been subjected to tremendous developments. The endoscope, which is the latest innovation in the field of optical instrumentation, allows the surgeon's eyes to penetrate the depth and width of the access route.

Methods: From December 2003 to December 2007, we operated on 61 patients with large pituitary adenomas, 13 of which were giant adenomas (32 men and 29 women). Twelve patients had hormonally active tumors (8 GH, 2 prolactinoma, 2 ACTH), and 49 had tumors that were not hormonally active. Most patients presented with visual disturbances.

Results: Total excision was achieved in 50 patients. Of the 12 patients with active adenomas, 9 were cured and 3 had residual activity. Three patients developed recurrence, 2 developed postoperative bleeding, and 3 had postoperative CSF rhinorrhea. Eighty-five percent of patients with visual disturbances showed improvement.

Conclusion: The minimum traumatization of the nasal cavity without nasal retractor, the optical advantages of endoscopic visualization in anatomical orientation and tumor removal, and the early postoperative improvement of the patients without nasal packing are obvious advantages of the endoscopic binostril technique.