Binostril Endoscopic Trans-Sphenoidal Approach for Pituitary Adenomas
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- Category: Vol. 85, June 2017
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Binostril Endoscopic Trans-Sphenoidal Approach for Pituitary Adenomas, HESHAM ABO RAHMA and AHMED AZAB
Abstract
Introduction: Pituitary adenomas are a common intracra-nial tumors, that account for 15% of all intra cranial neoplasm's, they arise from the sella turcica, and grows vertically toward the supra sellar cisterns. They either functioning tumors which secret hormones or non functioning tumors. Surgical treatment is considers a second option in treating such pathology in functioning adenomas after failure of medical treatment, however in non functioning adenomas they gain a large size leading to pressure symptoms, in such cases surgical inter-vention is considered as the first treatment option.
Material and Methods: Twenty six patients submitted to endonasal endoscopic removal of pituitary adenomas with a follow-up from 6 to 24 months, all patients were investigated pre-operatively by brain magnetic resonance imaging as well as computed tomography, also hormonal analysis for all pituitary hormones, full visual assessment. Patients with prolactin hypersecrection were subjected to surgery after failure of medical treatment, follow-up MRI brain and sella with contrast was done in all cases in the first post-operative day also 3 months for full evaluation.
Results: Ten women and sixteen men, age range 29-65 years. 24 patients were harboring macroadenoma while 2 patients had microadenomas in the pre-operative scans. Hor-monal assay revealed 15 non-secreting adenomas, 6 growth hormone hyper secretion, and 4 patients has hyperprolactine-mia, one case of ACTH secreating adenoma. Visual manifes-tations were the main presenting symptoms followed by headache. Three patients developed intraoperative Cerebrospi-nal Fluid (CSF) leaks that was treated by fat graft and tissue glue, five patients developed diabetes insepidus it was transient in four and remained persistent in one patient. While gross total excision was achieved in 21 patient.
Conclusion: The binosril endoscopic endonasal transsphe-noidal approach for pituitary tumors is effective with low surgical morbidity that it provides resection of pituitary tumors under excellent visualization and should be used on routine basis to resect lesions of the pituitary gland.