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Preliminary Comparison of the Endoscopic Transnasal vs the Sublabial Transseptal Approach for Clinically Nonfunctioning Pituitary Macroadenomas


      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.


      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.


      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.
      ACTH (adrenocorticotropic hormone), CSF (cerebrospinal fluid), DI (diabetes insipidus), FSH (follicle-stimulating hormone), LH (luteinizing hormone)
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        • Horsley V
        On the technique of operations on the central nervous system.
        BMJ. 1906; 2: 411-423
        • Welbourn RB
        The evolution of transsphenoidal pituitary microsurgery.
        Surgery. 1986; 100: 1185-1190
        • Rosegay H
        Cushing's legacy to transsphenoidal surgery.
        J Neurosurg. 1981; 54: 448-454
        • Hardy J
        Microneurosurgery of the hypophysis; a subnasal transsphenoidal approach with television magnification and televised radiofluoroscopic control.
        in: Rand RW Microneurosurgery. CV Mosby Co, St. Louis, Mo1969: 87-103
        • Hirsch O
        Pituitary tumors: a borderland between cranial and transsphenoidal surgery.
        N Engl J Med. 1956; 254: 937-939
        • Hirsch O
        Symptoms and treatment of pituitary tumors.
        Arch Otolaryngol. 1952; 55: 268-306
        • Bateman GH
        Trans-sphenoidal hypophysectomy: a review of 70 cases treated in the past two years.
        Trans Am Acad Ophtkalmol Otolaryngol. 1962; 66: 103-110
        • Sethi DS
        • Pillay PK
        Endoscopie management of lesions of the sella turcica.
        J Laryngot Otol. 1995; 109: 956-962
        • Rodziewicz GS
        • Kelley RT
        • Kellman RM
        • Smith MV
        Transnasal endoscopie surgery of the pituitary gland; technical note.
        Neuro-surgery. 1996; 39: 189-192
        • Heilman CB
        • Shucart WA
        • Rebeiz EE
        Endoscopie sphenoidotomy approach to the sella.
        Neurosurgery. 1997; 41: 602-607
        • Jho HD
        • Carrau RL
        • Ko Y
        • Daly MA
        Endoscopie pituitary surgery: an early experience.
        Surg Neural. 1997; 47: 213-222
        • Jho HD
        • Carrau RL
        Endoscopy assisted transsphenoidal surgery for pituitary adenoma: technical note.
        Acta Neurochir (Wien). 1996; 138: 1416-1425
        • Carrau RL
        • Jho HD
        • Ko Y
        Transnasal-transsphenoidal endoscopie surgery of the pituitary gland.
        Laryngoscope. 1996; 106: 914-918
        • Jho HD
        • Carrau RL
        Endoscopie endonasal transsphenoidal surgery: experience with 50 patients.
        J Neurosurg. 1997; 87: 44-51
        • Gamea A
        • Fathi M
        • el-Guindy A
        The use of the rigid endoscope in trans-sphcnoidal pituitary surgery.
        J Laryngol Otol. 1994; 108: 19-22
        • Yaniv E
        • Rappaport ZH
        Endoscopie transseptal transsphenoidal surgery for pituitary tumors.
        Neurosurgery. 1997; 40: 944-946
        • Kern EB
        • Laws ER
        • Randall RV
        • Westwood WB
        A transseptal, transsphenoidal approach to the pituitary: an old approach-a new technique in the management of pituitary tumors and related disorders.
        Trans Am Acad Ophthalmol Otolaryngol. 1977; 84: 997-1110
        • Charlson ME
        • Pompei P
        • Ales KL
        • MacKenzie CR
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Wilson CB
        A decade of pituitary microsurgery: the Herbert Olivecrona lecture.
        J Neurosurg. 1984; 61: 814-833
        • Committee on Medical Rating of Physical Impairment
        Guides to the evaluation of permanent impairment: the visual system.
        JAMA. 1958; 168: 475-488
        • Esterman B
        Grid for scoring visual fields, I: tangent screen.
        Arch Ophthalmol. 1967; 77: 780-786
        • Odaka T
        • Fujisawa K
        • Akazawa K
        • et al.
        A visual field quantification system for the Goldmann Peri meter.
        J Med Syst. 1992; 16: 161-169
        • Brennan MD
        • Miner KM
        • Rizza RA
        Profiles of the Endocrine Clinic: the Mayo Clinic.
        J Clin Endocrinol Metab. 1998; 83: 3427-3434
        • Hald JK
        • Nakstad PH
        • Kollevold T
        • Bakke SJ
        • Skalpe IO
        MR imaging of pituitary macroadenomas before and after transsphenoidal surgery.
        Act Radiol. 1992; 33: 396-399
        • Steiner E
        • Knosp E
        • Herold CJ
        • et al.
        Pituitary adenomas: findings of postoperative MR imaging.
        Radiology. 1992; 185: 521-527
        • Dina TS
        • Fcaster SH
        • Laws Jr, ER
        • Davis DO
        MR of the pituitary gland postsurgery: serial MR studies following transsphenoidal resection.
        AJNR Am J Neuromdiol. 1993; 14: 763-769
        • Tominaga A
        • Uozumi T
        • Arita K
        • Kurisu K
        • Yano T
        • Hirohata T
        Anterior pituitary function in patients with nonfunctioning pituitary adenoma: results of longitudinal follow-up.
        Endocr J. 1995; 42: 421-427
        • Powell M
        Recovery of vision following transsphenoidal surgery for pituitary adenomas.
        Br J Neurosurg. 1995; 9: 367-373
        • Nicola GC
        • Tonnarclli G
        • Griner AC
        • Zancaner F
        • Picozzi P
        • Roccucci P
        Surgery for recurrence of pituitary adenomas.
        in: Faglia G Beck-Peccoz P Ambrosi B Travaglini P Spada A Pituitary Adenomas: New Trends in Basic and Clinical Research. Elsevier Science Publishers BV, Amsterdam, the Netherlands1991: 329-336 (International Congress Series, Excerpta Medica, No. 961.)
        • Ciric I
        • Ragin A
        • Baumgartner C
        • Pierce D
        Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience.
        Neurosurgery. 1997; 40: 225-236