Volume 9, Issue 2 (March & April 2018 2018)                   BCN 2018, 9(2): 121-128 | Back to browse issues page

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Darwish H, El-Hadi U, Haddad G, Najjar M. Management of Pituitary Adenomas: Mononostril Endoscopic Transsphenoidal Surgery . BCN. 2018; 9 (2) :121-128
URL: http://bcn.iums.ac.ir/article-1-967-en.html
1- Department of Neurosurgery, School of Medicine, University of Virginia System, Charlottesville, USA.
2- Department of Otolaryngology- Head & Neck Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
3- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.

Introduction: The endoscopic transsphenoidal approach for pituitary adenomas and other sellar lesions is quickly becoming the procedure of choice in their surgical management. The most common approach is binostril three-hand technique which requires a large exposure and subjects both nasal cavities to potential trauma. To reduce nasal morbidity, we employ a mononostril two-hand technique with the help of the endoscope holder. In this research, we review our series to determine efficacy of this approach in the management of pituitary adenomas.
Methods: We performed a retrospective analysis of our initial series of 64 consecutive patients with pituitary adenomas operated by the same surgical team from 2008 till 2014 using a mononostril endoscopic approach. After categorizing the lesions into microadenomas, non-invasive macroadenomas, and invasive macroadenomas, we reviewed the radiological and biochemical outcomes of the surgeries after 3 months, 12 months, and 18 months. We also assessed recurrences and complications. Extent of resection was divided into gross total resection, near total resection (>90% resection), and partial resection for the remaining.
Results: Our results show resection rates comparable to most series in the literature, with a gross total resection of 87% in non-invasive macroadenomas, and surgical disease control in 75% of invasive nonfunctioning adenomas. The remission rate in Cushing’s disease was 81%, where it achieved up to 58% surgical remission in growth hormone secreting pituitary adenomas (including the invasive adenomas). The complication rate was very low.
Conclusion: We conclude that the mononostril endoscopic approach is well suited for most pituitary tumor operations and carries comparable remission and resection rates to most endoscopic series with minimal complications and nasal morbidity. 

Type of Study: Original | Subject: Clinical Neuroscience
Received: 2017/06/18 | Accepted: 2017/12/18 | Published: 2018/03/13

1. Biller, B. M. K., Grossman, A. B., Stewart, P. M., Melmed, S., Bertagna, X., Bertherat, J., et al. (2008). Treatment of Adrenocorticotropin-Dependent Cushing's Syndrome: A Consensus Statement. The Journal of Clinical Endocrinology & Metabolism, 93(7), 2454–2462. doi: 10.1210/jc.2007-2734 [DOI:10.1210/jc.2007-2734]
2. Bushe, K. A., & Halves, E. (1978). Modifizierte Technik bei transnasaler Operation der Hypophysengeschwülste. Acta Neurochirurgica, 41(1-3), 163–175. doi: 10.1007/bf01809147 [DOI:10.1007/BF01809147]
3. Cappabianca, P., Cavallo, L. M., Colao, A., Del Basso De Caro, M., Esposito, F., Cirillo, S., et al. (2002). Endoscopic Endonasal Transsphenoidal Approach: Outcome Analysis of 100 Consecutive Procedures. Min - Minimally Invasive Neurosurgery, 45(4), 193–200. doi: 10.1055/s-2002-36197 [DOI:10.1055/s-2002-36197]
4. Cappabianca, P., Cavallo, L. M., & de Divitiis, E. (2004). Endoscopic Endonasal Transsphenoidal Surgery. Neurosurgery, 55(4), 933–941. doi: 10.1227/01.neu.0000137330.02549.0d [DOI:10.1227/01.NEU.0000137330.02549.0D]
5. De Divitiis, E., Cappabianca, P., & Cavallo, L. M. (2002). Endoscopic Transsphenoidal Approach: Adaptability of the Procedure to Different Sellar Lesions. Neurosurgery, 51(3), 699–707. doi: 10.1097/00006123-200209000-00016 [DOI:10.1097/00006123-200209000-00016]
6. Dehdashti, A. R., Ganna, A., Karabatsou, K., & Gentili, F. (2008). Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery, 62(5), 1006–1017. doi: 10.1227/01.neu.0000325862.83961.12 [DOI:10.1227/01.neu.0000325862.83961.12]
7. Giustina, A., Chanson, P., Bronstein, M. D., Klibanski, A., Lamberts, S., Casanueva, F. F., et al. (2010). A Consensus on Criteria for Cure of Acromegaly. The Journal of Clinical Endocrinology & Metabolism, 95(7), 3141–3148. doi: 10.1210/jc.2009-2670 [DOI:10.1210/jc.2009-2670]
8. Hofstetter, C. P., Shin, B. J., Mubita, L., Huang, C., Anand, V. K., Boockvar, J. A., & Schwartz, T. H. (2011). Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas. Neurosurgical Focus, 30(4), E10. doi: 10.3171/2011.1.focus10317 [DOI:10.3171/2011.1.FOCUS10317]
9. Jgannathan, J., Laws, E. R., & Jane, J. J. (2012) Advantages of endoscope and transitioning from microscope to the endoscope for endonasal approaches. In Ed Kassam B., Endoscopic Approaches to Skull Base (pp. 7-21). Switzerland: Karger. [DOI:10.1159/000329124]
10. Jho, H. D., & Carrau, R. L. (1996). Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. Neurosurgical Focus, 87(1), 44-51. doi: 10.3171/foc.1996.1.1.4 [DOI:10.3171/foc.1996.1.1.4]
11. Koren, I., Hadar, T., Rappaport, Z. H., & Yaniv, E. (1999). Endoscopic Transnasal Transsphenoidal Microsurgery Versus the Sublabial Approach for the Treatment of Pituitary Tumors: Endonasal Complications. The Laryngoscope, 109(11), 1838–1840. doi: 10.1097/00005537-199911000-00022 [DOI:10.1097/00005537-199911000-00022]
12. Mamelak, A. N., Carmichael, J., Bonert, V. H., Cooper, O., & Melmed, S. (2012). Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases. Pituitary, 16(3), 393–401. doi: 10.1007/s11102-012-0437-1 [DOI:10.1007/s11102-012-0437-1]
13. Mortini, P., Losa, M., Barzaghi, R., Boari, N., & Giovanelli, M. (2005). Results of Transsphenoidal Surgery in a Large Series of Patients with Pituitary Adenoma. Neurosurgery, 56(6), 1222–1233. doi: 10.1227/01.neu.0000159647.64275.9d [DOI:10.1227/01.NEU.0000159647.64275.9D]
14. Nakagawa, T., Takashima, T., Tomiyama, K., & Asada, M. (2001). Approaches to Sella Turcica in Endoscopic Pituitary Surgery. Nippon Jibiinkoka Gakkai Kaiho, 104(1), 1–8. doi: 10.3950/jibiinkoka.104.1 [DOI:10.3950/jibiinkoka.104.1]
15. Neal, J. G., Patel, S. J., Kulbersh, J. S., Osguthorpe, J. D., & Schlosser, R. J. (2007). Comparison of techniques for transsphenoidal pituitary surgery. American Journal of Rhinology, 21(2), 203–206. doi: 10.2500/ajr.2007.21.2981 [DOI:10.2500/ajr.2007.21.2981]
16. Tabaee, A., Anand, V. K., Barrón, Y., Hiltzik, D. H., Brown, S. M., Kacker, A., et al. (2009). Endoscopic pituitary surgery: a systematic review and meta-analysis. Journal of Neurosurgery, 111(3), 545–554. doi: 10.3171/2007.12.17635 [DOI:10.3171/2007.12.17635]
17. Yaniv, E., & Rappaport, Z. H. (1997). Endoscopic Transseptal Transsphenoidal Surgery for Pituitary Tumors. Neurosurgery, 40(5), 944–946. doi: 10.1097/00006123-199705000-00012 [DOI:10.1097/00006123-199705000-00012]
18. Yano, S., Kawano, T., Kudo, M., Makino, K., Nakamura, H., Kai, Y. et al. (2009). Endoscopic Endonasal Transsphenoidal Approach Through the Bilateral Nostrils for Pituitary Adenomas. Neurologia Medico-Chirurgica, 49(1), 1–7. doi: 10.2176/nmc.49.1 [DOI:10.2176/nmc.49.1]

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