Background: The endoscopic transsphenoidal approach to pituitary tumors has become popular and accepted, with minimal postoperative morbidity.
Aim: To document the efficacy and the patients’ safety of endoscopic transsphenoid surgery.
Patients and methods: Summary of 55 consecutive patients with pituitary tumors who underwent endoscopic transsphenoidal surgery at the Department of Neurosurgery, Ibn Sina Teaching Hospital from March 2018 to February 2021. Follow-up is between 6 months and 2 years.
Results: Females represent 52.7% and males 47.3% of the patients. Non-functioning tumors represent 32.7%, while hormones-secreting tumors are 67.7%. In 29 patients (52.7%), the tumors were completely excised. Subtotal excision was performed in seven patients (12.8%), while partial removal was done in 19 patients (34.5%).
Conclusion: Endoscopic transsphenoidal pituitary surgery is a safe approach to pituitary adenomas, avoiding external scars with minimal postoperative morbidity.
Jane JA, Han J, Prevedello DM, et al. Perspectives on endoscopic transsphenoidal surgery. Neurosurg Focus 2005;19(6):1–10. DOI: 10.3171/foc.2005.19.6.3
Liu JK, Das K, Weiss MH, et al. The history and evolution of transsphenoidal surgery. J Neurosurg 2001;95(6):1083–1096. DOI: 10.3171/jns.2001.95.6.1083
Zhang Y, Wang Z, Liu Y, et al. Endoscopic transsphenoidal treatment of pituitary adenomas. Neurol Res 2008;30(6):581–586. DOI: 10.1179/174313208X298110
Honegger J, Grimm F. The experience with transsphenoidal surgery and its importance to outcomes. Pituitary 2018;21(5):545–555. DOI: 10.1007/s11102-018-0904-4
Cappabianca P, Cavallo LM, Colao A, et al. Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg 2002;45(4):193–200. DOI: 10.1055/s-2002-36197
Dusick JR, Esposito F, Mattozo CA, et al. Endonasal transsphenoidal surgery: the patient's perspective - survey results from 259 patients. Surg Neurol 2006;65(4):332–341. DOI: 10.1016/j.surneu.2005.12.010
Eördögh M, Briner HR, Simmen D, et al. Endoscopic unilateral transethmoid- paraseptal approach to the central skull base. Laryngoscope Investig Otolaryngol 2017;2(5):281–287. DOI: 10.1002/lio2.82
Ammirati M, Wei L, Ciric I. Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2013;84(8):843–849. DOI: 10.1136/jnnp-2012-303194
Tumul C, Hemanshu P, Parmod K B, et al. Immediate postoperative complications in transsphenoidal pituitary surgery: a prospective study. Saudi J Anaesth 2014;8(3):335–341. DOI: 10.4103/1658-354X.136424
Ivan C, Ann R, Craig B, et al. Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 1997;40(2):225–237. DOI: 10.1097/00006123-199702000-00001
Friedman M, Caldarelli DD, Venkatesan TK, et al. Endoscopic sinus surgery with partial middle turbinate resection: effects on olfaction. Laryngoscope 1996;106(8):977–981. DOI: 10.1097/00005537-199608000-00012
Rice DH, Kern EB, Marple BF, et al. The turbinates in nasal and sinus surgery: a consensus statement. Ear, Nose Throat J 2003;82(2):82–84. DOI: 10.1177/014556130308200202
Swanson PB, Lanza DC, Vining EM, et al. The effect of middle turbinate resection upon the frontal sinus. Am J Rhinol 1995;9(4):191–196.
Eseonu CI, ReFaey K, Pamias-Portalatin E, et al. Three-hand endoscopic endonasal transsphenoidal surgery: experience with an anatomy-preserving mononostril approach technique. Oper Neurosurg 2018;14(2):158–165. DOI: 10.1093/ons/opx110
HIRSCH O. Successful closure of cerebrospinal fluid rhinorrhea by endonasal surgery. AMA Arch Otolaryngol 1952;56(1):1–12. DOI: 10.1001/archotol.1952.00710020018001
Hadad G, Bassagasteguy L, Carrau RL, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006;116(10): 1882–1886. DOI: 10.1097/01.mlg.0000234933.37779.e4
Kassam AB, Thomas A, Carrau RL, et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Oper Neurosurg 2008;63(suppl_1):ONS44–ONS53. DOI: 10.1227/01.neu.0000297074.13423.f5
Eloy JA, Choudhry OJ, Shukla PA, et al. Nasoseptal flap repair after endoscopic transsellar versus expanded endonasal approaches: is there an increased risk of postoperative cerebrospinal fluid leak? Laryngoscope 2012;122(6):1219–1225. DOI: 10.1002/lary.23285
Zanation AM, Carrau RL, Snyderman CH, et al. Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery. Am J Rhinol Allergy 2009;23(5):518–521. DOI: 10.2500/ajra.2009.23.3378
Charalampaki P, Ayyad A, Kockro RA, et al. Surgical complications after endoscopic transsphenoidal pituitary surgery. J Clin Neurosci 2009;16(6):786–789. DOI: 10.1016/j.jocn.2008.09.002
Wang F, Zhou T, Wei S, et al. Endoscopic endonasal transsphenoidal surgery of 1,166 pituitary adenomas. Surg Endosc 2015;29(6):1270–1280. DOI: 10.1007/s00464-014-3815-0
Zhan R, Ma Z, Wang D, et al. Pure endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary adenomas in the elderly: surgical outcomes and complications in 158 patients. World Neurosurg 2015;84(6):1572–1578. DOI: 10.1016/j.wneu.2015.08.035
Dallapiazza RF, Grober Y, Starke RM, et al. Long-term results of endonasal endoscopic transsphenoidal resection of nonfunctioning pituitary macroadenomas. Neurosurgery 2015;76(1):42–53. DOI: 10.1227/neu.0000000000000563
Banu MA, Szentirmai O, Mascarenhas L, et al. Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks. J Neurosurg 2014;121(4):961–975. DOI: 10.3171/2014.5.JNS132028
Li W, Liu Q, Lu H, et al. Tension pneumocephalus from endoscopic endonasal surgery: a case series and literature review. Ther Clin Risk Manag 2020;16:531–538. DOI: 10.2147/TCRM.S258890
Hannon MJ, Finucane FM, Sherlock M, et al. Disorders of water homeostasis in neurosurgical patients. J Clin Endocrinol 2012;97(5):1423–1433. DOI: 10.1210/jc.2011-3201
Mamelak AN, Carmichael J, Bonert VH, et al. Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases. Pituitary 2013;16(3):393–401. DOI: 10.1007/s11102-012-0437-1
Qari FA, AbuDaood EA, Nasser TA. Diabetes insipidus following neurosurgery at a university hospital in Western Saudi Arabia. Saudi Med J 2016;37(2):156. DOI: 10.15537/smj.2016.2.12848
Sudhakar N, Ray A, Vafidis JA. Complications after trans-sphenoidal surgery: our experience and a review of the literature. Br J Neurosurg 2004;18(5):507–512. DOI: 10.1080/02688690400012459a
Baban MIA, Battaglia P, Mohammed MH, et al. How to preserve the olfaction in harvesting the nasoseptal flap in endoscopic skull base surgery. Oper Tech Otolaryngol-Head Neck Surg 2020;31(2):e7–e12. DOI: 10.1016/j.otot.2020.03.001
Tam S, Duggal N, Rotenberg BW. Olfactory outcomes following endoscopic pituitary surgery with or without septal flap reconstruction: a randomized controlled trial. Int Forum Allergy Rhinol 2013;3(1):62–65. DOI: 10.1002/alr.21069