Display options
Cite
Aiyer RG, Upreti G. Endoscopic Endo-nasal Trans-Sphenoidal Approach for Pituitary Adenomas: A Prospective Study. Indian J Otolaryngol Head Neck Surg. 2019;72(1):36-43doi: 10.1007/s12070-019-01725-8.
Aiyer, R. G., & Upreti, G. (2020). Endoscopic Endo-nasal Trans-Sphenoidal Approach for Pituitary Adenomas: A Prospective Study. Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 72(1), 36-43. https://doi.org/10.1007/s12070-019-01725-8
Aiyer, R G, and Upreti, Garima. "Endoscopic Endo-nasal Trans-Sphenoidal Approach for Pituitary Adenomas: A Prospective Study." Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India vol. 72,1 (2020): 36-43. doi: https://doi.org/10.1007/s12070-019-01725-8
Aiyer RG, Upreti G. Endoscopic Endo-nasal Trans-Sphenoidal Approach for Pituitary Adenomas: A Prospective Study. Indian J Otolaryngol Head Neck Surg. 2020 Mar;72(1):36-43. doi: 10.1007/s12070-019-01725-8. Epub 2019 Aug 19. PMID: 32158653; PMCID: PMC7040117.
Copy Download .nbib Format: NLM
Share it on

Indian J Otolaryngol Head Neck Surg. 2020 Mar;72(1):36-43. doi: 10.1007/s12070-019-01725-8. Epub 2019 Aug 19.

Endoscopic Endo-nasal Trans-Sphenoidal Approach for Pituitary Adenomas: A Prospective Study.

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India

R G Aiyer, Garima Upreti

Affiliations

  1. 1Department of ENT and Head Neck Surgery, Baroda Medical College and SSG Hospital, Vadodara, Gujarat India.
  2. Department of ENT and Head Neck Surgery, Government Medical College Silvassa, Shri Vinoba Bhave Civil Hospital, Silvassa, Dadra and Nagar Haveli India.

PMID: 32158653 PMCID: PMC7040117 DOI: 10.1007/s12070-019-01725-8

Abstract

The surgical approach for hypophysectomy has undergone sweeping revolution in the past three decades. With the advent of endoscopes, better instrumentation, better illumination and viewing cameras, endoscopic endo-nasal trans-sphenoidal approach to sella has now largely become the norm. The aim of this study is to present our experience, analysing the surgical outcomes of this approach in patients with pituitary adenoma, pertaining to entirety of tumor removal, alleviation of symptoms and rate of complications. This prospective  study was conducted at our tertiary health care  centre from June 2012 to June 2015. A total of 14 patients, meeting the inclusion criteria, underwent endoscopic trans-sphenoidal hypophysectomy for pituitary adenoma. Age of presentation ranged from 19 to 73 years (mean 43.6 years). 9 patients were female and 5 were male. The most common presenting symptom was headache, followed by visual disturbances. Amongst those with hormonal imbalance, most common were prolactinomas and growth hormone secreting adenomas. Preoperative MRI brain showed macroadenomas in all 14 patients. 7 (50%) patients had suprasellar extension, while 5 (36%) patients had intracavernous extension too. CT paranasal sinuses provided the roadmap for surgery by identifying anatomical variations. Alleviation of headache occurred in all cases. Normalization of altered hormonal profile was seen in all cases. 83.3% of our patients with visual field defects on perimetry showed improvement post-surgery. Recidivism was directly related to the size and extent of adenoma. Transient diabetes insipidus was seen in 4 (28%) cases. Persistent diabetes insipidus occurred in 1 (7%) patient. CSF leak was seen in 2 (14%) patients, 1 (7%) patient developed postoperative meningitis. Most common nasal complication was excessive crusting. There was no incidence of any vascular complications, focal neurological deficit or hypopituitarism in our study. The pure endoscopic approach is a safe, efficacious, and minimally invasive technique for the removal of pituitary adenomas. The results have been encouraging in our prospective study. However, the importance of learning curve in endoscopic skull base surgery and use of a multi-disciplinary collaboration cannot be overemphasized.

© Association of Otolaryngologists of India 2019.

Keywords: Endoscopic endo-nasal surgery; Endoscopic hypophysectomy; Endoscopic trans-sphenoidal approach; Pituitary adenoma

Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interest.

References

  1. J Korean Neurosurg Soc. 2015 Jan;57(1):23-31 - PubMed
  2. Surg Neurol. 2006 Apr;65(4):332-41, discussion 341-2 - PubMed
  3. Laryngoscope. 2012 Mar;122(3):511-8 - PubMed
  4. Adv Tech Stand Neurosurg. 2008;33:151-99 - PubMed
  5. Clin Neurosurg. 1976;23:401-16 - PubMed
  6. Otolaryngol Clin North Am. 2006 Jun;39(3):563-83, x - PubMed
  7. Otolaryngol Head Neck Surg. 2008 Apr;138(4):531-2 - PubMed
  8. Surg Neurol. 2004 Sep;62(3):227-33; discussion 233 - PubMed
  9. Am J Rhinol. 2005 Mar-Apr;19(2):185-9 - PubMed
  10. Neurosurg Focus. 2011 Apr;30(4):E14 - PubMed
  11. J Neurol Neurosurg Psychiatry. 2013 Aug;84(8):843-9 - PubMed
  12. J Neurosurg. 2009 Sep;111(3):545-54 - PubMed
  13. Am J Ophthalmol. 2000 Dec;130(6):813-20 - PubMed
  14. Skull Base. 2008 Jan;18(1):9-15 - PubMed
  15. Clin Otolaryngol. 2011 Jun;36(3):212-20 - PubMed
  16. Laryngoscope. 1992 Feb;102(2):198-202 - PubMed
  17. Laryngoscope. 2006 Oct;116(10):1882-6 - PubMed
  18. Neurosurg Focus. 2011 Apr;30(4):E10 - PubMed
  19. Laryngoscope. 2010 Jul;120(7):1292-7 - PubMed
  20. J Neurosurg. 2001 Dec;95(6):1083-96 - PubMed
  21. J Otolaryngol Head Neck Surg. 2010 Jun;39(3):309-14 - PubMed

Publication Types