Endonasal Endoscopic Pituitary Adenoma Resection: Preservation of Neurohypophyseal Function

Abstract

Objectives In the past 10 years, endoscopic resection of pituitary adenomas has become an alternative to microsurgical resection with the additional advantage of increasing the patient's postoperative comfort. This analysis explored whether endoscopic resection can reduce the risk of postoperative neurohypophyseal dysfunction.

Design We rated and compared the need to administer desmopressin during the first four postoperative days and with the need after a follow-up of at least 3 months (chronic administration).

Setting Three groups of patients were compared: Patients in group 1 were operated on microscopically. Patients in group 2 were operated on endoscopically. Patients in group 3 were operated on endoscopically with intraoperative magnetic resonance imaging (iMRI).

Participants Group 1 was made up of 50 patients treated in 1999; group 2 comprised 50 patients operated on from 2006 to 2007; and Group 3 comprised 50 patients operated on in 2008.

Main Outcome Measures In group 1 the need to use desmopressin postoperatively occurred in eight patients; three needed chronic treatment. In group 2 the need for postoperative application of desmopressin occurred in four patients; none required chronic treatment. In group 3 desmopressin had to be administered postoperatively in five patients but only temporarily.

Results and Conclusions Endoscopic surgery is a safe and effective method for the resection of pituitary adenomas. The rate of chronic desmopressin application was reduced. In conjunction with iMRI and navigation, the endoscopic technique allows increased radicality together with fewer adverse effects.

Keywords

endoscopic endonasal resection - pituitary adenoma - diabetes insipidus - postoperative frequency of diabetes insipidus

• References

• 1 Rosegay H. Cushing's legacy to transsphenoidal surgery. J Neurosurg 1981; 54 (4) 448-454
• 2 Walker EA. A History of Neurological Surgery. Baltimore, MD: Williams and Wilkins; 1982
• 3 Hardy J. Transsphenoidal hypophysectomy. J Neurosurg 1971; 34 (4) 582-594
• 4 Fusek I, Černý E. Transsphenoidal operation of hypophyseal tumors. J Neurosurg Sci 1977; 21: 2-3 , 159–160
• 5 Fusek I, Černý E. Our experience of indications for transsphenoidal surgery on Turkish saddle tumours [in Czech]. Česka A Slovenska Neurol Neurochir 1978; 41/74 (2) 107-114
• 6 Fusek I. Surgical Treatment for Turkish Saddle Tumours Using the Transsphenoidal Approach [in Czech]. Prague, Czech Republic: Avicenum Czechoslovak Medical Press; 1986
• 7 Cappabianca P, Alfieri A, de Divitiis E. Endoscopic endonasal transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS). Minim Invasive Neurosurg 1998; 41 (2) 66-73
• 8 Cappabianca P, Alfiery A, de Divitiis E , et al. Atlas of Endoscopic Anatomy for Endonasal Intracranial Surgery. New York, NY: Springer-Verlag; 2001: 134
• 9 Cappabianca P, Alfieri A, Thermes S, Buonamassa S, de Divitiis E. Instruments for endoscopic endonasal transsphenoidal surgery. Neurosurgery 1999; 45 (2) 392-395 ; discussion 395–396
• 10 de Divitiis E, Cappabianca P. Endoscopic endonasal transsphenoidal surgery. In Pickard JD, , ed. Advances and Technical Standards in Neurosurgery. Vol 27. New York, NY: Springer Verlag; 2002: 137-177
• 11 de Divitiis E, Cappabianca P, Cavallo LM. Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions. Neurosurgery 2002; 51: 669-707
• 12 Das K, Spencer W, Nwagwu CI , et al. Approaches to the sellar and parasellar region: anatomic comparison of endonasal-transsphenoidal, sublabial-transsphenoidal, and transethmoidal approaches. Neurol Res 2001; 23 (1) 51-54
• 13 Derome PJ. The transbasal approach to tumors invading the skull base. In Schmidek HH, Sweet WH, , eds. Operative Neurosurgical Techniques: Indications, Methods and Results. Vol 1. New York, NY: Grune and Stratton; 1998: 619-633
• 14 Hashimoto N, Kikuchi H. Transsphenoidal approach to infrasellar tumors involving the cavernous sinus. J Neurosurg 1990; 73 (4) 513-517
• 15 Kitano M, Taneda M. Extended transsphenoidal approach with submucosal posterior ethmoidectomy for parasellar tumors. Technical note. J Neurosurg 2001; 94 (6) 999-1004
• 16 Lalwani AK, Kaplan MJ, Gutin PH. The transsphenoethmoid approach to the sphenoid sinus and clivus. Neurosurgery 1992; 31 (6) 1008-1014 ; discussion 1014
• 17 Munich SA, Fenstermaker RA, Fabiano AJ, Rigual NR. Cranial base repair with combined vascularized nasal septal flap and autologous tissue graft following expanded endonasal endoscopic neurosurgery. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (2) 101-108
• 18 Malik MU, Aberle JC, Flitsch J. CSF fistulas after transsphenoidal pituitary surgery—a solved problem?. J Neurol Surg A Cent Eur Neurosurg 2012; 73 (5) 275-280
• 19 Ray BS. Intracranial hypophysectomy. J Neurosurg 1968; 28 (2) 180-186
• 20 Ray BS, Patterson Jr RH. Surgical treatment of pituitary adenomas. J Neurosurg 1962; 19: 1-8
• 21 Yasargil MG. Microneurosurgery. Microsurgical Anatomy of the Basal Cisterns and Vessels of the Brain. Vol 1. Stuttgart, Germany: Thieme; 1984: 208-244
• 22 Yasargil MG. Complication in Aneurysm Surgery in Microneurosurgery. Vol 2. New York, NY: Thieme; 1984: 331-339
• 23 Cappabianca P, Briganti F, Cavallo LM, de Divitiis E. Pseudoaneurysm of the intracavernous carotid artery following endoscopic endonasal transsphenoidal surgery, treated by endovascular approach. Acta Neurochir (Wien) 2001; 143 (1) 95-96
• 24 Cappabianca P, Cavallo LM, Mariniello G, de Divitiis O, Romero AD, de Divitiis E. Easy sellar reconstruction in endoscopic endonasal transsphenoidal surgery with polyester-silicone dural substitute and fibrin glue: technical note. Neurosurgery 2001; 49 (2) 473-475 ; discussion 475–476
• 25 Netuka D, Masopust V, Belšán T, Kramář F, Beneš V. Initial experience of the use of intraoperative MR in pituitary adenoma resections. Česka A Slovenska Neurologie Neurochirurgie 2009; 105 (1) 45-50
• 26 Nimsky C, Ganslandt O, Von Keller B, Romstöck J, Fahlbusch R. Intraoperative high-field-strength MR imaging: implementation and experience in 200 patients. Radiology 2004; 233 (1) 67-78
• 27 Elias WJ, Chadduck JB, Alden TD, Laws Jr ER. Frameless stereotaxy for transsphenoidal surgery. Neurosurgery 1999; 45 (2) 271-275 ; discussion 275–277
• 28 Fahlbusch R, Keller BV, Ganslandt O, Kreutzer J, Nimsky C. Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging. Eur J Endocrinol 2005; 153 (2) 239-248
• 29 Nimsky C, von Keller B, Ganslandt O, Fahlbusch R. Intraoperative high-field magnetic resonance imaging in transsphenoidal surgery of hormonally inactive pituitary macroadenomas. Neurosurgery 2006; 59 (1) 105-114 ; discussion 105–114
• 30 Jones J, Ruge J. Intraoperative magnetic resonance imaging in pituitary macroadenoma surgery: an assessment of visual outcome. Neurosurg Focus 2007; 23 (5) E12
• 31 Schwartz TH, Stieg PE, Anand VK. Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging. Neurosurgery 2006; 58 (1, Suppl): ONS44 –ONS51; discussion ONS44–ONS51
• 32 Bohinski RJ, Warnick RE, Gaskill-Shipley MF , et al. Intraoperative magnetic resonance imaging to determine the extent of resection of pituitary macroadenomas during transsphenoidal microsurgery. Neurosurgery 2001; 49 (5) 1133-1143 ; discussion 1143–1144
• 33 Alfieri A, Jho HD. Endoscopic endonasal cavernous sinus surgery: an anatomic study. Neurosurgery 2001; 48 (4) 827-836 ; discussion 836–837
• 34 Masopust V, Netuka D, Beneš V. Endonasal endoscopic transsphenoidal resection of sellar lesions. Česka A Slovenska Neurol Neurochir 2008; 104 (6) 704-710