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

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.