Endoscopic Transsphenoidal Endonasal Approach for Large Pituitary Adenoma with Suprasellar Extension

Introduction: The transsphenoidal route is a direct and rapid extracerebral approach to the sellar region, and therefore it is the most widely used technique for the processes involving this area. Since its introduction in 1907, it has undergone tremendous developments.The endoscope is the latest innovation in the field of optical instrumentation; it allows the “surgeon's eye” to penetrate the depth and width of the access route.

Methods: During 4 years between December 2003 until December 2007, we operated 61 patients with large pituitary adenoma, 13 of them with giant adenoma. There were 32 males and 29 females. Twelve had hormone-active tumors (8 GH, 2 prolactinoma, 2 ACTH), and 49 with hormone-inactive tumors. Most patients presented with visual disturbances.

Results: Total excision was achieved in 50 patients. From 12 patients with active adenoma, 9 were cured, 3 had residual activity. Three patients developed recurrence, two patients developed postoperative bleeding, and three patients had postoperative CSF rhinorrhea. Of the patients with visual disturbances, 85% showed improvement.

Conclusion: The minimum traumatization of the nasal cavity without nasal retractor, the optical advantages of the endoscopic visualization in anatomical orientation and tumor removal, and the early postoperative improvement of the patients without nasal packing are obvious advantages of the endoscopic binostril technique.