Deliberate Two-Staged Endoscopic Endonasal Transsphenoidal Surgery in Large Pituitary Adenomas

Lee, Dong Hwan; Jeon, Byung Chan

Abstract

OBJECTIVE
Two-staged endoscopic endonasal transsphenoidal approach(TSA) has not been reported for the satisfactory removal of large pituitary adenomas with suprasellar extension. This study is aimed to determine whether deliberate two-staged endoscopic endonasal TSA would be effective for the treatment of large pituitary adenomas with suprasellar extensions.
METHODS
Since 1998, we have started endonasal endoscopic TSA, so encountered 12 patients of large pituitary adenomas with suprasellar extension in which deliberate two-staged removal was carried out. The extent of tumor removal, improvement of eye symptoms and endocrine functions after staged operation were analyzed retrospectively.
RESULTS
Among the 12 patients with large pituitary adenomas, five had prolactinomas; four growth hormone secreting adenomas; three nonfunctioning tumors. The interval between the two surgical procedures ranged from three weeks to 14 weeks(mean 8.4 weeks). Of 12 patients treated by deliberate two-staged endonasal endoscopic TSA, 38.8%(7/18 eyes) recovered normal visual acuity; improvement was noted in another 55.6%(10/18 eyes). The visual fields were corrected in 88%(15/17 eyes). In these large tumors, 58.3%(7/12 patients) was removed totally, 25%(3/12 patients) subtotally, 16.7%(2/12 patients) partially. Endocrine outcome of 9 hypersecretory adenomas was relatively good. There were no significant complications.
CONCLUSION
The authors conclude that the patients who have large pituitary adenomas with suprasellar extension are good candidates for deliberate two-staged endoscopic endonasal transsphenoidal surgery, which maximize tumor removal and improvement of eye symptoms, minimize complication and morbidity.