Surgical Results of Pure Endoscopic Endonasal Transsphenoidal Surgery for 331 Pituitary Adenomas: A 15-Year Experience from a Single Institution

• Published in: World neurosurgery Vol. 96; pp. 545 - 555
• Main Authors: Jang, Ji Hwan, Kim, Kyu Hong, Lee, Young Min, Kim, Joon Soo, Kim, Young Zoon
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2016
• Subjects: Adenoma - diagnostic imaging; Adenoma - surgery; Adult; Aged; Cohort Studies; Complication; Efficacy; Endoscopic endonasal transsphenoidal surgery; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Cavity - surgery; Neurosurgical Procedures - methods; Pituitary adenoma; Pituitary Neoplasms - diagnostic imaging; Pituitary Neoplasms - surgery; Postoperative Complications; Progression; Risk; Statistics, Nonparametric; Treatment Outcome; Young Adult; Progression; GH; GTR; DI; MRI; Efficacy; Risk; STR; PA; TTP; Pituitary adenoma; CSF; Endoscopic endonasal transsphenoidal surgery; EETSS; Complication
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.09.051

The aim of this study is to report the results of pure endoscopic endonasal transsphenoidal surgery (EETSS) for pituitary adenomas (PAs) and to evaluate the efficacy and safety of this procedure. In addition, we tried to determine the predicting factors for progression of PAs.
We reviewed the medical records of 331 consecutive patients who underwent pure EETSS of newly diagnosed PAs between April 1998 and December 2014. Demographic, endocrinologic, and radiologic features and their outcomes, complications, and hospital stay durations were retrospectively assessed in these patients.
There were 157 (47.4%) nonfunctioning adenomas and 174 (52.6%) hormone-secreting adenomas. Fifty-one (15.4%) complications were present in 39 patients postoperatively. The frequent complications were temporary and permanent diabetes insipidus (14 and 3 cases, respectively), syndrome of inappropriate antidiuretic hormone secretion (9 cases), and cerebrospinal fluid leaks (6 cases). There was only 1 death (0.3%) related to the procedure in this series. The patient's age (P = 0.047), the tumor size (P = 0.003), and the parasellar growth (P <0.001) were associated with the occurrence of complications on multivariate analysis. Progression occurred in 92 (27.8%) patients and the mean time-to-progression was 23.7 months (range, 3.7–52.4 months) after a mean follow-up period of 68.5 months. In the multivariate analysis, the tumor size (P = 0.021), the extent of surgery (P = 0.012), the Knosp classification (P = 0.002), and the MIB-1 index (P = 0.019) were associated with progression-free survival. The mean duration of hospitalization was 4.4 (±1.6) days.
The pure EETSS of PA provides acceptable and reasonable results representing a safe alternative procedure to the traditional transsphenoidal microscopic approach.