Our experience with Endoscopic Transnasal Transsphenoid Resection of Pituitary Adenomas

Mahmoud, Mohamed Hassan; Eid, Mahmoud Hassan; Abd Elrahman, Mahmoud Ahmed Hassan; Soliman, Mahmoud Mohamed; Mohamed, Khaled El-Sayed; Abdelmonem, Ahmed M

doi:10.21608/pajn.2023.204631.1091

Our experience with Endoscopic Transnasal Transsphenoid Resection of Pituitary Adenomas

Document Type : Original Articles

Authors

¹ Neurosurgery Department, Suez Canal University, Egypt

² Department of Otolaryngology, Faculty of Medicine, Suez Canal University

³ Department of Otolaryngology Faculty of Medicine, Suez Canal University

⁴ Department of Neurosurgery, Faculty of Medicine, Suez Canal University, Ismailia – Egypt

⁵ Neurosurgery Department, Suez Canal University, Ismailia, Egypt

10.21608/pajn.2023.204631.1091

Abstract

Introduction:
The two most typical subtypes of pituitary adenomas are prolactinomas and non-functioning adenomas. Patients usually demonstrate infertility, diminished libido and galactorrhea, visual manifestations, or headache as signs of endocrine malfunction. Medical management is administered before surgical resection since prolactinomas are highly receptive to it. Since the advent of endoscopic equipment, the transsphenoidal technique has been the first surgical method of choice for treating pituitary adenomas.

Material and Methods:
56 patients that underwent endoscopic trans-nasal transsphenoidal resection for the pituitary macroadenomas and microadenomas in Suez Canal University Hospital from 01 January 2018 to 31 June 2022.

Results:
In 43 individuals (77%), growth complete resection was accomplished. Regarding clinical improvement, endocrinological improvement was seen in 23 out of 26 patients (88.5%), including 18 prolactinoma patients (32.1%), and visual improvement was seen in 14 out of 16 patients with visual field impairment (87.5%). Seven patients (13%) experienced postoperative diabetes insipidus, of whom three (5%) had the condition for an extended period of time. Despite using fibrin glue and a multilayer closure, the research team only had one patient (1.8%) with CSF fluid leaking. In this case, surgical exploration was performed, and a high flow CSF leak was discovered despite the initial operation's standard skull base reconstruction.

Conclusion:
Endonasal Endoscopic resection of pituitary macroadenomas and microadenomas is a safe technique in experienced hands. A sounding knowledge of the anatomy along with faithful study of patient’s imaging are our map and roadmap.

Keywords