Pure Endoscopic Endonasal Surgery for Pituitary Adenomas: Technique and Early Results in Banha Neurosurgery Department

Abstract
Background: Surgery for pituitary adenomas passed though several stages of refinement during the past decades. During the past 20 years a major shift has been made by neurosurgeons towards endoscopic pituitary surgery. This has been aided by the great development in technologies of rod lens and high resolution video cameras. The panoramic view offered by the endoscope made the surgery more safe and radical in removing the tumor. Now it is widely accepted in most neurosurgical institutes that the endoscopic endonasal surgery should be the gold standard in pituitary surgery.
Aim of Study: In this study we report our early results, challenges we faced and the problems we solved in applying the technique of pure endoscopic endonasal surgery for pituitary adenomas in Banha Neurosurgery Department.
Study Design: This is a retrospective study case series of 35 patients with pituitary adenomas. All patients were treated surgically using the pure endoscopic endonasal technique. Patients had been followed after surgery for a period of time ranged from 4 to 36 months during the years from February 2012 to March 2015.
Patients and Methods: Thirty five patients were included; twenty with nonfunctioning pituitary adenomas, (nine with suprasellar extension only and 11 with parasellar extension) and fifteen with functioning adenomas including 3 ACTH secreting, 8 GH secreting and 4 prolactinomas. Patients were endocrinologically, ophthalmologically and radiologically evaluated using CT paranasal sinus and MRI pituitary scans. Pre and post-operative scans as well as levels of pituitary hormones have been compared and evaluated for the degree of tumor resection, visual improvement and endocrinological cure.
Results: Gross total resection of the tumor has been achieved in 23 patients (65.7%) while 12 patients (34.3%) had incomplete resection. Among 15 patients with pre operative visual deficits, 13 patients (86,6%) showed variable degrees of visual improvement and 2 only (13.3%) did not improve. Endocrinological cure was 75% in GH secreting adenomas, 75% in prolactinomas and 66.7% in ACTH secreting adenomas.
The most common complications were transient post-operative DI and inrtaoperative CSF laek. No reported deaths, major vascular injury or worsening of vision.
Conclusion: The pure endoscopic endonasal technique, although challenging, it is less traumatic, and associated with good outcome.