Endoscopic Pituitary Surgery - Considered to Be "Impossible"

Abstract

Giant pituitary adenomas (4cm and above in any diameter) consider a serious surgical problem. In recent years, the recommended treatment for such entities is the endonasal endoscopic reconstructive surgery. The article discusses the results of the technical advantages and limitations of the method of endoscopic endonasal surgery of pituitary adenomas. Material and metod. Author demonstrates pre and postoperative MRI images and discuss the factors affecting surgical outcome. Results. Dominant clinical symptom was visual impairmant, 7 patients (87.5%) and pituitary deficiency 4 patients (50%). One patient (12.5%) applied with pituitary apoplexy. Total resection was done in 5 patients (62.5%). Nearly total resection performed in one patient (12.5%). Partial tumor removal achieved in two patients (25%). Visual improovement was achieved in 7 patients (87.5%). Nothing was changed in one patient (12.5%). The main reason affecting on surgical outcome was multilobar shape of irregular growing adenomas. Cavernous sinüs invasion, size, intraventricular, anterior or posterior elongation has not been estimated the crucial factor on surgical outcome. The main complication was the rhinorrea (one patient, 12.5%) which managed with lumbar drain. Transient diabetes insipidus observed in one patient (12.5%). Discussion. In comparison with conventional transcranial and microscopic methods of treatment of giant pituitary adenomas, endoscopic endonasal surgery is more effective.