Hypophysis surgery with or without endoscopy

Objective: Hardy's operation with microscope has long been the standard met hod for pituitary adenoma. But a new approach via the nasal cavity using an endoscope has been adopted recently. In this study, the postoperative outc ome as well as the preoperative evaluation of endoscopic hypophysectomy and non-endoscopic one were compared at our faculty. Methods We performed the non-endoscopic transnasal hypophysectomy on 18 patients and the endoscopic transnasal hypophysectomy on thirteen patients who had a pituitary lesions from February 1996 to October 1999. As to these patients the situations fro m preoperation through postoperation such as chief complaints, serum hormon e level, final diagnosis, tumor size, as well as operating time or blond lo ss during the operation were discussed precisely. Then the merits and demer its of endoscopic hypophysectomy were discussed. Result: Five PRL-producing adenoma, three GH-producing adenoma, nine non-functioning adenoma, and two ACTH or TSH-producing adenoma were included in this discussion as endoscop ic group. The age of non-endoscopic group are from 23 to 73 (49.4 in averag e), and they include ten males and eight females. On the other hand three P RL-producing adenoma, two GH-producing adenoma, two non-functioning adenoma , and one Rathke's cyst were included in this discussion as endoscopic grou p. Tile age of endoscopic group are from 19 to 73 (49.1 in average), and th ey include seven males and six females. As to non-endoscopic group the bloo d loss during each operation is 568 mi and operating time is 256 min in ave rage. For endoscopic group the blood loss is 296 mi and operating time is 2 33 min in average. Conclusion: By microsurgery in the pituitary operation w ith endoscopy, the minimal invasive surgery becomes possible by reducing bl ood loss and shortening operating time. During the operation cooperation be tween neurosurgeon and ENT surgeon is indispensable in order to perform hyp ophysectomy smoothly. The development of optical better aids and operation instruments for endonasal hypophysectomy is desired in the future. The navi gation system was more useful than X-ray fluoroscopy to obtain the detailed information. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.