Endocrine Abstracts

Background: Endoscopic endonasal transsphenoidal hypophysectomy is an alternative to microscopic transsphenoidal hypophysectomy. The technique may provide a safer, quicker and more effective treatment.

Objectives: To assess preliminary results of this technique when introduced at a single centre with a single surgeon.

Methods: A retrospective analysis of 62 patients who underwent transsphenoidal surgery, 33 microscopic and 29 endoscopic.

Results: Microscopic group:

Nineteen women and 14 men, average age 50 (19–84). Of the adenomas resected, 15 were functioning (7 ACTH, 5 GH, 3 PRL) and 14 non-functioning. The average operation time was 83 min (45–180 min) and the length of stay 11.6d (3–46d). Nine patients had residual tumour demonstrated on postoperative MRI, but only one (3%) required reoperation. Average follow up was 31 months. A review of the postoperative analgesic requirements revealed that all patients required paracetamol and opiate analgesia except one patient who only required paracetamol. Complications: 2 patients had CSF leak requiring reoperation, and 7 had diabetes insipidus requiring DDAVP, 2 had meningitis.

Endoscopic group: Eleven women and 18 men aged 17–83 (average 55). There were 7 functioning tumours (4 GH, 2 PRL, 1 FSH) and 14 non-functioning. Average operation time was 89 min (35–180 min) and the average length of stay was 6.8d (3–28d). Four patients had residual tumour on MRI with one patient requiring reoperation. Average follow up was 13 months. Nine patients (31%) required only paracetamol, the rest required opiates as well. Complications: 1 case of CSF leak, 7 had diabetes insipidus requiring DDAVP. There was 1 case each of pneumocephalus, ophthalmoplegia and pituitary fossa haematoma.

Conclusions: Endoscopic transsphenoidal hypophysectomy is at least as effective and as safe as microscopic endonasal hypophysectomy. It appears in this small review that length of stay and analgesic requirements are both reduced in the endoscopic group, with minimal differences in surgical complication rates.