The Effectiveness of Endoscopic Endonasal Surgery for Pituitary Adenomas: Clinical Outcomes and Postoperative Complications at a Single Institution

Background: The endoscopic endonasal approach (EEA) has become the gold standard for the surgical treatment of pituitary adenomas due to the wide-angle view and exposure it provides. In this study, the authors seek to evaluate the EEA's real contributions to the prognosis and survival of pituitary adenoma patients.

Methods: A retrospective analysis was conducted of all endoscopic pituitary surgeries for adenomas completed between 2015 and 2018 at a single tertiary referral institution. 129 patients met the inclusion criteria. Patient complications, resection, and remission rates were assessed.

Results: Out of 129 patients, 63 (49%) had nonfunctional adenomas and 73 (51%) had functional adenomas, including 39 with growth hormone-secreting tumors and 27 with adrenocorticotropic hormone-secreting tumors. Amongst the 39 patients with growth hormone-secreting adenomas, 5 had microadenomas and 34 had macroadenomas. Radiographically, 46% of the cases were Knosp Grades 3 and 4. A cure (IGF-1 <100) was obtained in 100% of the microadenomas and 67.6% of the macroadenomas, with a global cure rate of 72%. Amongst the 27 patients with adrenocorticotropic hormone-producing adenomas, 21 had microadenomas and 6 had macroadenomas. Radiographically, 14% of the cases were Knosp Grades 3 and 4. A cure (salivary and free urine cortisol) was obtained in 81.8% of the microadenomas and 80% of the macroadenomas, with a global cure rate of 81.4%. Out of the 63 cases with nonfunctional macroadenomas, 45 were under 25 mm and 9 were over 40 mm. Radiographically, 63.4% of the cases were Knosp Grades 3 and 4. Gross total resection was achieved in 64.5% of the cases. 40 (63.5%) of the patients presented prior campimetric deficit. Total improvement was obtained in 26, partial improvement in 12, and stability in 2. The mean follow-up was 20 months for patients with functional adenomas and 15 months for those with nonfunctional adenomas. One patient developed a postoperative CSF leak, 2 patients presented epistaxis, and no postsurgical visual disorder or cranial nerve palsies were detected.

Conclusions: Endoscopic endonasal surgery in experienced hands can provide a better prognosis for patients diagnosed with pituitary adenomas. Aggressive cavernous sinus surgery can provide a cure rate even higher than those published to date.

No conflict of interest has been declared by the author(s).