Objective
To assess the advantages and disadvantages of an endoscopic transnasal approach to
pituitary surgery for a select group of clinically nonfunctioning macroadenomas and
to compare results of this approach with the sublabial transseptal approach at a single
institution.
Patients and Methods
We retrospectively reviewed the records of 26 patients with clinically nonfunctioning
pituitary macroadenomas approached endoscopically and 44 matched control patients
with the same tumors approacbed sublabially between January 1, 1995, and October 31,
1997.
Results
At baseline, the groups were not significantly different for age, sex distribution,
number of comorbid conditions, visual field defects, degree of anterior pituitary
insufficiency, or preoperative assessment of tumor volume or invasiveness. Mean (SD)
operative times were significantly reduced in the endoscopic group vs the sublabial
group: 2.7 (0.7) hours vs 3.4 (0.9) hours (P<.001). Postoperative assessment of surgical resection and postoperative alterations of anterior
pituitary function or visual fields were not significantly different between groups,
and complication rates were similar in both groups.
Conclusion
This endoscopic transnasal approach to pituitary resection results in significantly
shorter operative time without compromising the extent of tumor resection. The distinct
disadvantage of this approach is an off-center view of the sella and a diminished
working channel to the sella turcica. For these reasons, the endoscopic approach or
its variation is an alternative to the sublabial approach but should be considered
only by experienced pituitary neurosurgeons.
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Article info
Footnotes
Presented in part at the Fifth International Pituitary Congress, Naples, Fla, June 29,1998.
Identification
Copyright
© 1999 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
