Endoscopic Approach for Pituitary Tumours - Outcome and Complications - An Institutional Experience

Abstract

Vishwanath Kamatagi1 , Sanjeev Attry2 , Vijay Kumar Gupta3 , Ekata Gupta4 , Ajay S. Carvalho5

BACKGROUND The endoscopic transsphenoidal approach and endonasal microscopic approach are both acknowledged and effective surgical techniques for patients of pituitary tumours. In this observational study, we describe the outcome and complications of the endoscopic approach (transsphenoidal endonasal endoscopic approach) for pituitary tumours. METHODS This study was carried out from July 2014 to March 2019 in the Department of Neurosurgery of a tertiary care hospital attached to a medical college in India. We enrolled 30 patients for our study. Assessment of outcome and complications was carried out for all patients over a period of five years. RESULTS Out of the 30 patients, 20 patients (66.7 %) presented with headache, 16 patients (53 %) with visual disturbance, 14 (46.7 %) with hypocortisolaemia, 12 (40 %) with hypothyroidism, 9 (30 %) with acromegaly and 4 (13.3 %) with infertility. Intraoperative cerebrospinal fluid (CSF) leakage was the most frequently noted complication (40 %). 1 patient died due to carotid artery rupture. Complete tumour resection was confirmed in 86.7 % patients. For functioning PAs, 94.7 % patients achieved biochemical remission. CONCLUSIONS Major advancement is seen in endoscope-based trans-sphenoidal pituitary surgery in the management of pituitary macro adenoma. Both the patient and the treating surgeons are benefited by it and microscope-based surgery should be replaced because endonasal endoscopic approach provides better magnification, improved visualisation leading to better gland preservation rates and better extent of resection and has very few postoperative nasal complications.

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