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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
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Giant Pituitary Adenoma - Special Considerations
Oliver Y Tang1, Wayne D Hsueh2, Jean Anderson Eloy3
1Department of Neurosurgery, Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA.
Otolaryngologic Clinics of North America
|April 2, 2022
Summary
Giant pituitary adenomas require surgical decompression. The endoscopic endonasal transsphenoidal approach offers lower mortality and better visual recovery compared to microsurgical transsphenoidal and transcranial methods for these large tumors.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Giant pituitary adenomas (GPAs) represent 5-15% of pituitary tumors.
- GPAs are associated with increased risks of extrasellar invasion, incomplete resection, surgical complications, and recurrence.
- Surgical decompression is generally indicated for GPAs, except possibly for giant prolactinomas.
Purpose of the Study:
- To compare the efficacy and safety of different surgical approaches for giant pituitary adenomas.
- To evaluate outcomes including gross total resection, recurrence rates, perioperative mortality, and visual function restoration.
- To determine the indications for microsurgical transsphenoidal (MT), endoscopic endonasal transsphenoidal (EET), and transcranial (TC) approaches.
Main Methods:
- A review of case series spanning three decades.
- Analysis of data from 699 patients undergoing MT, 1060 patients undergoing EET, and 513 patients undergoing TC surgery.
- Comparison of surgical outcomes across the different modalities.
Main Results:
- Gross total resection and recurrence rates were similar across MT, EET, and TC approaches.
- The EET approach demonstrated lower perioperative mortality rates.
- The EET approach showed superior restoration of visual function compared to MT and TC.
- Each surgical modality has distinct indications for GPA management.
Conclusions:
- While resection and recurrence rates are comparable, the endoscopic endonasal transsphenoidal approach is associated with better outcomes for giant pituitary adenomas.
- The choice of surgical approach should be tailored to individual patient and tumor characteristics.
- Combined endoscopic endonasal transsphenoidal and transcranial approaches are being investigated for further tumor debulking.
