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Updated: Jan 14, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Endoscopic Endonasal Fluorescein-Guided Resection of Functioning Intrasellar Pituitary Adenomas
Mehmet Can Ezgu1, Murat Kutlay1, Abdulbaki Yuceer1
1Department of Neurosurgery, Gulhane Medical School, University of Health Sciences, Ankara , Turkey.
Background And Objectives:
Gross total resection of pituitary adenomas (PAs) remains challenging despite advancements in transsphenoidal surgery, primarily due to difficulty in distinguishing adenoma tissue from the normal pituitary gland. Fluorescence-guided surgery using sodium fluorescein (SF) has shown promise in addressing this issue. This study evaluates the feasibility, safety, and efficacy of SF-guided endoscopic endonasal approach (EEA) for PA resection and presents preliminary results.
Methods:
Twenty-six patients with functioning intrasellar PAs underwent SF-guided EEA. A 4-mm endoscope with yellow and blue filters was used to visualize the adenoma and pituitary gland. Intravenous SF (5 mg/kg, 10%) was administered, and fluorescence staining was observed. Fluorescence emission was quantified using color spectrophotometry. Extent of resection was assessed by dynamic contrast-enhanced MRI at 3 months and postoperative hormone levels.
Results:
The cohort included 15 growth hormone-secreting (57.7%), 5 adrenocorticotropic hormone-secreting (19.2%), 4 prolactin-secreting (15.4%), and 2 FSH-secreting (7.7%) adenomas. Quantification revealed significant differences in fluorescence emission among dura (564 ± 5.621 nm), adenoma (549.65 ± 8.299 nm), and pituitary gland (531.42 ± 5.886 nm) ( P < .001). Residual tumor was detected in 14 patients (53.8%) under blue filter evaluation. Gross total resection was achieved in 88.5% of patients and near-total resection in 11.5%. Early biochemical remission was achieved in 84.6% of cases, including 80% of growth hormone-secreting, 80% of adrenocorticotropic hormone-secreting, 100% of prolactin-secreting, and 100% of FSH-secreting adenomas. No SF-related complications or adverse events occurred.
Conclusion:
This study represents the first series of fully endoscopic SF-guided EEA for intrasellar PAs, demonstrating the technique's feasibility, safety, and efficacy. SF enhances intraoperative discrimination between adenoma and pituitary tissue, providing real-time guidance without prolonging surgery or causing adverse effects. These findings suggest SF is a valuable adjunct for improving PA resection outcomes.
