[Only used unilateral transnasal approach applied endoscopic sinus surgery for pituitary adenomas]

Endoscope-assisted transnasal approach (TNA) for pituitary adenoma is a new alternative for Hardy's surgery (TSS). We performed TNA using only an endoscope through unilateral nostril. In our approach to sphenoid sinus, we apply method of endoscopic sinus surgery (ESS-TNA). We enter the sphenoid sinus directly through the natural ostium and do not brake the nasal septum nor vomer bone. Since September 2004 we had operated on 12 patients by endoscopic TNA. Six were non-functioning adenomas, and 6 were functioning adenomas. We are first to open the ethomoid sinus to make the space for middle concha to be displaced laterally. Secondary, we widen the natural ostium of the sphenoid sinus, retracting the middle concha laterally. The results were compared with those in 10 cases by TSS operated in our institute. Adenoma removal more than 80% was achieved in 58% by endoscopic TNA whereas in 50% by TSS. We had no case with postsurgical infection. Transient DI occurred in 4 cases and 1 case showed permanent. CSF rhinorrhea was seen in the case having small empty sellae in front of adenoma. For this case, we packed the fat tissue at the floor of the sella with endoscope under local anesthesia to close the fistula. Three cases that had hemianopsia before surgery showed the recovery postoperatively. In 6 functional adenoma, postoperative endocrinological examinations showed normalization in 3 cases and improvements in 3 cases. Postsurgical hospitalization days were 11.4 by endoscopic TNA whereas 15.4 by TSS. Our method showed same or better results than TSS in the removal rate and complication rate whereas the postoperative duration of nasal packing and hospitalization days were shorter than TSS.