Endoscopic endonasal approach for pituitary adenomas: a series of 555 patients

To report the results of a consecutive series of patients who underwent an endoscopic endonasal approach (EEA) for resection of a pituitary adenoma and compare them to previous series of microscopic and endoscopic approaches. A retrospective review of clinical and radiographic outcomes of a consecutive series of patients operated at our center between 2002 and 2011 was performed. 555 patients underwent an EEA for removal of a pituitary adenoma. The mean follow up was 3.1 years (range 3 months to 9.5 years); 36 were lost to follow up. Ninety-one (17.5 %) harbored recurrent adenomas. An expanded approach to reach the supra-, para- and infra-sellar spaces was employed in 290 patients (55.9 %). Reconstruction with a nasal septal flap was used in 238 cases (65.6 %). The rate of gross total resection was 65.3 % in the 359 patients with non-functioning adenomas. The remission rates with EEA alone were 82.5 % in the 57 ACTH-secreting adenomas, 65.3 % in the 49 GH-secreting adenomas and 54.7 % in the 53 prolactinomas. Of the 237 patients presenting with visual loss, 190 (80.2 %) improved or normalized, 41 (17.3 %) remained unchanged and 4 (1.7 %) experienced transient visual deterioration due to postoperative apoplexy. In addition, no patient without preexisting visual loss suffered new visual decline. The overall post-operative CSF leak rate was 5 % and this decreased to 2.9 % after the introduction of reconstruction with the naso-septal flap. Two patients (0.3 %) had an ICA injury. The EEA is a safe and effective way to surgically approach pituitary adenomas, particularly in recurrent tumors, those with supra-sellar extension or cavernous sinus invasion. The remission and complication rates are comparable or favorable compared with those reported in previous series of microscopic and endoscopic approaches.