Fully endoscopic transnasal versus transseptal transphenoidal pituitary surgery

A long-term retrospective study was conducted of 300 patients who underwent fully endoscopic transnasal pituitary adenoma resection between November 1998 and October 2004. These patients' records and data from postoperative follow-up visits were used to ascertain their outcomes. The data were then compared with mean values calculated from several transseptal-transsphenoidal reports. Of a total of 300 pituitary adenomas, 139 (46%) were hormonally active, whereas 161 (54%) were nonfunctioning. The mean follow-up period was 38.2 months. The average length of hospital stay was 1.4 days. All patients had postoperative magnetic resonance imaging studies to assess residual or recurrent disease; all patients with hormonally active tumors had additional postoperative hormonal studies. Remission was defined as no hormonal or radiologic evidence of recurrence within the time frame of the follow-up period. Remission was demonstrated in 127 (95%) of 134 of enclosed adenomas and 144 (87%) of 166 of invasive adenomas. Comparison of fully endoscopic transnasal versus transseptal-transsphenoidal remission results revealed an improved outcome using the fully endoscopic transnasal technique: corticotropin-secreting (86% vs. 81%), prolactin-secreting (89% vs. 66%), and growth hormone-secreting (85% vs. 77%) adenomas. The remission rate for nonfunctioning adenomas was 149 (93%) of 161. Additionally, there was a marked reduction in complications related to this procedure. There have been few series to document the results of this procedure; the results of the current study conclude that the fully endoscopic transnasal technique is a safe and effective method for removal of pituitary adenomas, providing more complete tumor removal and reducing complications. This report presents the largest number of patients to date who have undergone fully endoscopic transnasal pituitary surgery and compares their outcomes with those published for the traditional transseptal-transsphenoidal method.