Endoscopic Transsphenoidal Surgery of Pituitary Adenomas

V.Yu. Cherebillo, V.R. Gofman, A.V. Polezhaev

(Faculty of Neurosurgery, Medicomilitary Academy, Saint Petersburg)

Use of endoscopic technique is conditioned by necessity to perform total selective removal of adenomas and to reduce a rate of intraoperative damage of cavernous sinuses, optic nerves and the saddle diaphragm. Specialists of the Clinic of Neurosurgery of the Medicomilitary Academy have gained a rather great experience in surgery of pituitary adenomas with a transnasosphenoidal endoscopic approach (1010 operations, performed during the last years).

Endoscopes with an angular view allow to widen indications for a transsphenoidal approach and to remove adenomas with different versions of growth, including giant tumors. The obtained experience has shown, that minimum-invasive interventions can be made in more than 95% of cases with pituitary adenomas. Thus, highly invasive giant tumors with numerous nodes are the only object of transcranial surgery.

The data of postoperative MRI examinations of the chiasm-sellar region and analysis of arrested visual and hormonal disorders make it possible to state, that transsphenoidal endoscopic surgery gives quite acceptable results (operation efficacy - 87.2% of cases, regression of visual and hormonal disorders – 89.35% and 82.9% of cases respectively, the mortality rate 0.37%).

Further improvement of surgical technique and high skills of a surgeon will permit to improve postoperative results, to ensure a “functional” character of an operation and to arrest both visual and hormonal disorders even in case of giant tumors.