Transsphenoidal Endoscopic Surgery of Pituitary Adenomas

Cherebillo V., Gofman V., Polezhaev À.

Medicomilitary Academy, Saint Petersburg, Russia

 

A transsphenoidal approach was used in 914 cases. According to hormonal activity, all adenomas were divided into the following groups: prolactinomas (18.1%), somatotropinomas (25.3%), corticotropinomas (9.2%), gonadotropinomas (0.9%), thyrotropinomas (0.2%) and inactive pituitary adenomas (45.3%). The tumors were characterized by suprasellar (48%), parasellar (11%), retrosellar (3%), antesellar (2%) and infrasellar (27%) growth. A total growth was watched in 11% of cases. Edosellar adenomas and microadenomas were diagnosed in 3% and 7% of cases respectively. Large (more than 40 mm) and giant (more than 50 mm) pituitary adenomas were revealed in 245 patients (26.8%). An approach to the Turkish saddle was performed according to Hirsh. Tumors were removed with curettes, microforceps and hypophyseal spoons under endoscopic control. In case of necessity an ultrasonic disintegrator was used. When the main bulk of tumor was removed, an endocope with an angular view of 0° was replaced by one with an angular view of 30°, which allowed to see and to remove its lateral parasellar and suprasellar (when rotated) segments. If necessary, an endoscope with an angular view of 70° was used. Peculiarities of its design made it possible to ensure lateral and backward views, “to peep” behind bony prominences and to remove ante- and retrosellar segments of adenoma. Direct visual control of tumor segments, grasped by curettes, microforceps or an ultrasonic disintegrator, permitted to avoid damage of the pituitary gland tissue and traction of adjacent neurovascular structures. Operation efficacy was estimated on the basis of MR examination of the chiasm-sella region and arrest of hormonal changes in blood. Removal was radical, subtotal and partial in 92.2%, 6.7% and 1.1% of cases respectively. The relapse rate was 9.2%. Regression of visual and hormonal disorders was present in 92% and 88% of patients respectively. Endoscopic surgery resulted in considerable decrease of intra- and postoperative complications.