Endoscopic endonasal transsphenoidal surgery: Analysis of the first 120 cases in the training hospital setting
Togay Muderris1, Omer Faruk Turkoglu2, Ergun Sevil3, Fatih Gul4, Mahmut Ferat5
1Bozyaka Eğitim ve Araştırma Hastanesi KBB Kliniği, İzmir, Türkiye
2Ankara Atatürk Eğitim ve Araştırma Hastanesi KBB Kliniği, Ankara, Türkiye
3Karaman Devlet Hastanesi KBB Kliniği, Ankara, Türkiye
4Yıldırım Beyazıt Üniversitesi Tıp Fakültesi Kulak Burun Boğaz Anabilim Dalı, Ankara, Türkiye,
529 Mayıs Devlet Hastanesi Beyin Cerrahisi Kliniği, Ankara, Türkiye
Keywords: Endoscopic, pituitary, transsphenoidal.
Abstract
OBJECTIVE: In this study, we report our experience on endoscopic endonasal transsphenoidal surgery among the first 120 consecutive patients and aimed to evaluate the efficacy and safety of the endoscopic two-surgeon, four-hand technique.
METHODS: We retrospectively reviewed the first 120 consecutive patients (67 females, 53 males; mean age 43.14 years; range, 16 to 79 years) who were operated with pure endoscopic endonasal transsphenoidal approach at Ankara Atatürk Training and Research Hospital between January 2011 and January 2015. Tumor removal was performed using the endoscopic binostril bimanual technique. Surgical technique, pathology, intra- and postoperative complications, and surgical outcomes were analyzed.
RESULTS: A total of 91 lesions (76%) were reported as macroadenoma. Functioning pituitary adenomas were found in 81 patients (68%). Of these cases, 28 were prolactinomas (35%), 35 were growth hormone (GH)-secreting tumors (44%), and the remainings were adrenocorticotropic hormone (ACTH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyroid-stimulating hormone (TSH)-secreting adenomas. Postoperative complications included transient hyposmia in four patients (3%) and diabetes insipidus in eight patients (6%), while two of them required permanent vasopressin therapy. Four patients (3%) anterior pituitary dysfunction and postoperative cerebrospinal fluid (CSF) leak occurred in six patients (5%). One of them suffered from meningitis.
CONCLUSION: Our study results highlight the value of the collaborative endoscopic endonasal approach as a safe and effective procedure for the management of pituitary tumors. Although an experienced team is required to obtain most favorable results, excellent outcomes can be achieved with two-surgeon, four-hand technique even in new skull base programs.