Endoscopic endonasal transsphenoidal approach: An additional reason in support of surgery in the management of pituitary lesions

The outcome of endoscopic endonasal transsphenoidal surgery in 10 patients with pituitary adenomas was compared with that of traditional transnasal tr anssphenoidal approach (TTA) in 20 subjects. Among the 10 individuals Subje cted to "pure endoscopy,'' 2 had a microadenoma, 1 an intrasellar macroaden oma 4 had a macroadenoma with suprasellar lar expansion, 2 had a macroadeno ma with supra-parasellar expansion, and 1 a residual tumor; 5 had acromegal y and 5 had a nonfunctioning adenoma (NFA). Among the patients subjected to TTA, 4 had a microadenoma, 2 had an intrasellar macroadenoma, 6 had a macr oadenoma with suprasellar expansion, 4 had a macroadenoma with supra-parase llar expansion, and 4 had a residual tumor; 9 patients had acromegaly, 1 hy perprolactinemia, 1 Cushing's disease, and 9 a NFA. At the macroscopic eval uation, tumor removal was total (100%) after endoscopy in 9 patients and af ter TFA in 14 patients. Six months after surgery magnetic resonance imaging (MRI) confirmed the total tumor removal in 21 of 23 patients (91.3%). Circ ulating growth hormone (GH) and insulin-like growth factor-I (IGF-I) signif icantly decreased 6 months after surgery in all 14 acromegalic patients: no rmalization of plasma IGF-I levels was obtained in 4 of 5 patients after th e endoscopic procedure and in 4 of 9 patients after TTA. Before surgery, pi tuitary hormone deficiency was, present in 14 out of 30 patients: pituitary function improved in 4 patients, remaining unchanged in the other 10 patie nts. Visual field defects were present before surgery in 4 patients, and im proved in all. Early surgical results in the group of 10 patients who under went endoscopic pituitary tumor removal were at least equivalent: to those of standard TTA, with excellent postoperative course. Postsurgical hospital stay was significantly shorter (3.1 +/- 0.4 vs. 6.2 +/- 0.3 days, p < 0.00 1) after endoscopy as compared to TTA.