Outcome of Purely Endoscopic Surgery for Pituitary Adenoma: A Systematic Review of the Literature

Introduction: Even though endoscopic management of pituitary adenomas has evolved in just more than a decade, it is increasingly becoming accepted as a preferred surgical option. We attempted to do a systematic review of the medical literature addressing the outcomes of pituitary adenomas, treated by a purely endonasal endoscopic approach.

Materials and Methods: Using MEDLINE Pubmed database from 1990 to 2007, we included studies with primary pituitary adenomas and we excluded studies with heterogeneous pathologies or with recurrent tumors, prior surgery, or radiation.

Results: A total of 16 studies (Class II, 2; Class III, 1; and Class IV, 13) with 974 patients (nonfunctioning, 444; macroadenomas, 709) were included. Four hundred eighty patients had functioning adenomas (GH, 31%; PRL, 37.5%; ACTH, 28.5%; TSH, 1.5%; mixed, 1.5%). Morbidities were reported 173 times (16.3%)(transient DI, 42; permanent DI, 31; meningitis, 6; vascular injury, 12; CSF leakage, 34; visual loss, 13; sinusitis, 5; and cosmetics, 17). Eleven teams used it in one nostril and four procedures were binostril. Mortality was reported in five patients. Forty-eight developed new endocrinolgical deficits. Preoperatory visual deficit improved for 88% and stayed stable for 10.7%. Six hundred thirty-five patients (65.2%) had either complete excision of tumor or remission following the surgery. The hospital stay ranged from 0.8 to 7 days (mean, 3.37 days) and the follow-up ranged from 4 to 81 months (mean, 19.2 months). No recurrence was reported during the follow-up.

Conclusion: Literature addressing the outcome of endoscopic surgery predominantly belongs to Class IV evidence. The available literature suggests the outcomes are comparable to that of the conventional microscopic approach with fewer sinonasal complications and shorter hospital stays.