Endocrine Abstracts

Objective: With the progress of neuroendoscopic surgery in recent years, the application of endoscopy to transnasal surgery for pituitary tumors is increasing. At our institution, endonasal surgery using an endoscope alone (eTSS) has been performed in 825 patients with pituitary adenomas since November 2001. Among them, 156 patients (18.9%) had GH-secreting pituitary adenoma (GHoma), so the outcome and complications of eTSS-treated GHomas were investigated in the present study.

Materials and methods: Rigid endoscopes with an outer diameter of 4 and 2.7 mm (visual field angle: 0, 30, and 70 degrees) manufactured by Machida Endoscope Co., Ltd. were used. These endoscopes were mounted on a new floor stand manufactured by Mitaka Kohki Co., Ltd. A CT navigation system set for bone conditions was used in all patients.

Results: The range of supracellar tumor resection was increased by employing a rigid endoscope with a visual field angle of 70 degrees. Resection of tumors invading the cavernous sinus was evaluated in patients with GHomas classified according to Knosp for which clear criteria are available. As a result, the curing rate improved to 84.2% in grades 0, 1, and 2, while it was a low 16.7% in grades 3 and 4. Also, Capsulectomy could even be performed by endoscopy in patients with GHomas of enclosed type. As complications, epistaxis, transient visual dysfunction due to postoperative hematoma, and abducens nerve paralysis were noted in 1.4, 0.7, and 0.7% of the patients, respectively.

Conclusion: Tumors could be approached accurately by eTSS with a wide visual field, and the incidence of complications could be minimized. Since the suprasellar excision rate was increased owing to a wide visual field, eTSS can also improve the QOL of patients. However, further studies will be necessary to improve the resection rate of tumors with extensive invading into the cavernous sinus.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.