Endoscopic trans-sphenoid approach to pituitary tumors Kasr El-Eini Cairo University hospitals experience

ABSTRACT

Over the last decades pituitary surgery has been one of the models of the minimally invasive surgeries. Horsley performed the first reported pituitary operation in 1889 through a trans-cranial approach. Schloffer was the first to introduce the trans-sphenoid approach in 1907. Gushing popularized the sublabial trans-septal approach in 1910 and with the introduction of the operating microscope and intra-operative fluoroscopy in the 1950s and 1960s, the trans-septal approach became the gold standard for pituitary surgery. In the 1980s and 1990s, the nasal endoscope became the standard of care in surgery of the nose and PNS. Trans-sphenoidal hypophysectomy is becoming progressively less invasive. Recent endoscopic techniques avoid nasal or intraoral incisions, use of nasal specula and nasal packing for some operators. To present the endoscopic trans-sphenoidal approach for surgical treatment of pituitary adenomas and to evaluate its results and complications. From 1996 to 2006 in the Departments of Otorhinohryngology and Neurosurgery in Cairo University Hospital, 310 patients with pituitary adenomas were operated using the trans-sphenoidal endoscopic approach, among which 197 patients had giant adenomas with supra or para sellar extensions. Complete tumor removal was accomplished in 284 patients [91.6%]. Mortality rate was 3 patients [0.97%]. Morbidity rate was 68 patients [21.9%] in the form of transient diabetes insipidus in 64 patients [20.6%], intraoperative CSF leak in 2 patients [0.6%], bilateral visual loss in 1 patient [0.3%] and tension pneumocephalus in 1 patient [0.3%]. The endoscopic trans-sphenoid approach is the management of choice for pituitary adenomas including invasive type. The surgery can be done with minimal morbidity and more radically than classic transsphenoidal surgery. Invasion of the cavernous sinus is no longer a taboo and could he attempted in 68.2% of the cases with a parasellar extension