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Endoscopic endonasal approach for pituitary adenomas: Results from a multidisciplinary management

Abstract:

Background: Endoscopic endonasal approach (EEA) has gained increasing acceptance in the world; however, pituitary adenomas require multidisciplinary management for good outcomes. The aim of this study is to report the results of this management of a consecutive series of patients who underwent a purely endoscopic endonasal approach for pituitary adenomas resection in our hospital and compare them to other series. Methods: A retrospective review of clinical and radiographic records of 80 consecutive patients with pituitary adenomas who were operated on using an EEA between 2011 and 2019 was performed. The patientś clinical, ophthalmologic, endocrinologic and radiographic outcomes were evaluated. Results: 57% were women and 43% men. The age ranged from 10 to 79 years. 72 tumours (90%) were macroadenomas; in 19 patients (23.75%) the cavernous sinus was invaded. There were 58 non-functioning adenomas and 17 growth hormone secreting, 4 prolactin-secreting, and 1 thyroid-stimulating hormone-secreting adenomas. Gross total resection was achieved in 76.2% of tumours without cavernous sinus invasion. Of the 53 patients presenting with visual loss, 47 (88.6%) improved or normalized. The remission rates with EEA alone were 58% in the GH-secreting adenomas and 75% in the prolactinomas group. Complications included CSF leak in 12.5%, new hormonal deficit in 18.75%, epistaxis in 6.25%, sella hematoma in 3.75% and neuroinfection in 1 patient (1.25%). We did not have mortality. The follow-up was from 6 to 87 months. Conclusions: A multidisciplinary management is required for the adequate treatment of pituitary adenomas. With good surgical training, the EEA is safe and effective around the world. Our results are similar compared with those reported in previous series of microscopic or endoscopic approaches.