ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL SURGERY - EXPERIENCE WITH 50 PATIENTS

An endoscope was used in transsphenoidal surgery and eventually replac ed the operating microscope as the tool for visualization. This study focuses on 50 patients (28 females and 22 males) with a median age of 38 years (range 14-88 years). Initially, four patients underwent opera tion via a sublabial-transseptal approach using a rigid endoscope in c onjunction with an operating microscope. The 38 subsequent operations were performed through a nostril using only rigid endoscopes. Forty-fo ur patients had pituitary adenomas and six had various other lesions. Thirteen patients had microadenomas, 16 had intrasellar macroadenomas, nine had macroadenomas with suprasellar extension and six had invasiv e macroadenomas involving the cavernous sinus. When patients had recur rent pituitary adenomas and 25 had hormone-secreting adenomas (eight p atients with Gushing's disease and 17 patients with prolactinomas). Am ong the right patients with Cushing's disease, seven had resolution of hypercortisolism clinically and chemically. Of the 17 patients with p rolactinomas. 10 improved clinically with normal serum prolactin level s, four improved clinically with elevated serum prolactin levels, and three had residual tumors in the cavernous sinus. Among the 19 patient s with nonsecreting adenomas, 16 underwent total resection and three s ubtotal resection leaving residual tumor in the cavernous sinus. Posto peratively, ail patients who had undergone endonasal endoscopic surger y had unobstructed nasal airways with minimal discomfort. More than ha lf of the patients required only an overnight hospitalization.