P18.04 Experience of Endoscopic Transsphenoidal Surgery for Pituitary Adenoma

Abstract

Trans sphenoidal approach has been widely applied in surgical treatment of pituitary adenoma. Based on the traditional microscopic surgery, end oscopic technique has been developed as a promising alternative in recent years. Our group have been applying end oscopic trans sphenoidal surgery for almost 10 years. Hereby we report our experience in this new surgical technique. From December 2006 to February 2016, 426 surgeries were performed, and 378 patients (non-functional: 192, PRL-secreting: 56, GH secreting: 88, ACTH-secreting: 24, TSH-secreting: 3, multiple-hormone secreting: 15) were surgically treated. Among the 378 patients, 42 were treated twice and 3 patients were treated three times following diagnosis of recurrence. The tumor's subtypes in recurrent cases were identical to those in previous surgery(s). In all the surgeries, a unilateral and purely end onasal approach was applied with a 30° rigid endoscope. The mucosa between the sphenoid sinus' opening and the base of septum nasi osseum was incised and pushed laterally and downward. Then the anterior wall of sphenoid sinus and the sellar floor were opened with a high-speed burr. In the cases with conchal type sphenoid sinus, X-ray imaging was used. After opening the sellar floor dura and exposing the tumor, the tumor was removed in a backward to lateral to consequence. Finally, hemo static gauze, gelatin sponge, artificial dura, and in some cases mucosa from the anterior wall of sphenoid sinus, were used for sellar floor reconstruction. According to MRI follow ups 3 months after the surgery, total resection was achieved in 328 surgeries (77.0%), subtotal resection in 86 surgeries (20.2%), and partial resection in 12 surgeries (2.8%). Cases with subtotal or partial resections were subsequently treated with radiotherapy or craniotomy. 184 (91.5%) of 201 cases with visual field deficit obtained visual remission after the surgery. Hormonal remission was achieved in 50 cases with PRL-secreting tumor (80.0%), 89 cases with GH-secreting tumor (88.1%), 19 cases with ACTH secreting tumor (70.4%), and 3 cases (100%) with TSH-secreting tumor. The most prevalent complications include diabetes insipidus (33.6%), CSF leackage (22.6%), meningitis (4.9%), and hypopituitarism (4.7%). In conclusion, the efficacy and safety of end oscopic trans sphenoidal approach observed in our practice is comparable to those of the same technique in literature, and this technique is superior to traditional microscopic approach reported in most references.