ENDOSCOPIC PITUITARY SURGERY - AN EARLY EXPERIENCE

BACKGROUND As an element of a minimally invasive management approach, we had developed an endonasal endoscopic transsphenoidal technique for the treatment of pituitary tumors. Initially, four patients were oper ated on via a sublabial, transseptal approach using a fiberoptic rigid endoscope in conjunction with the operating microscope. Encouraged by that experience, our subsequent 11 patients had undergone endonasal e ndoscopic transsphenoidal surgery without the use of a retractor or sp eculum. METHODS Our group of patients included nine females and six ma les, with an age range of 17-88 years (median: 43 years). There were f our microadenomas, four intrasellar macroadenomas, three macroadenomas with suprasellar extension, three invasive macroadenomas involving th e cavernous sinus with suprasellar extension, and one metastatic adeno carcinoma. RESULTS Thirteen patients with pituitary adenomas experienc ed resolution of their symptoms postoperatively. One patient with a re current prolactinoma responded partially following surgery and subsequ ently underwent gamma knife radiosurgery. Two patients were treated wi th post-operative fractionated radiation therapy,on pituitary adenoma in the cavernous sinus, and the other for metastatic adenocarcinoma, r espectively. The first patient, treated via an endonasal endoscopic ap proach for biopsy of the metastatic adenocarcinoma, developed postoper ative cerebrospinal fluid (CSF) leak that was successfully managed wit h endoscopic packing of a fat graft. CONCLUSIONS The endonasal endosco pic transsphenoidal approach facilitates faster postoperative recovery by the avoidance of traditional incision and postoperative nasal pack ing. It offers a panoramic view of the sphenoid sinus and excellent vi sualization of the sellar and suprasellar structures with increased il lumination and magnification. Such visualization provides the potentia l for more complete tumor resection, as well as a better chance of pre serving pituitary function and avoiding neurovascular injury. (C) 1997 by Elsevier Science Inc.