Results of neuro-endoscopic pituitary surgery in 26 patients with pituitary adenoma

Document Type : Original


1 Assistant professor of neurosurgery

2 Department of neurosurgery, Sina hospital, Tehran University of Medical Sciences, Iran

3 Associate Professor of Ear, Throat and Nose

4 Professor of neurosurgery - Tehran University of Medical Sciences


Introduction: Endoscopic surgery of pituitary adenoma is a rapidly developing surgical procedure in the field of neurosurgery, with known limitations and advantages. The aim of this study was to evaluate the results of this technique for treatment of a group of patients with pituitary adenoma.
Materials and Methods: In the present study, 26 patients with the diagnosis of pituitary adenoma, who were considered for endoscopic operation between 2002-2005 in Sina and Amir Alam hospitals, were included. The following data were registered: age, sex, symptoms of disease, findings of neurological exam, adenoma type (functional versus non-functional), treatment outcome and complications of the procedure and duration of hospital stay.
Results: Twenty six patients (14 male and 11 female) included in the study. Most of them were in the 3-6 decades of life. They included 11 non-functional adenoma, 9 GH-producing adenomas, 3 ACTH secreting adenomas and 3 cases with prolactinomas. Seven patients had complications of the operation (reversible in 6 patients and fatal in 1) and 6 of them had recurrence of the tumor during the 2-year follow up.
Conclusion: Endoscopic surgery is an invaluable method for treatment of pituitary adenoma, and factors such as decreased complications and duration of hospital stay further adds to its popularity.


  1. 1- Kurok A, Kayama T. Endoscopic approach the pituitary lesion: Contemporary method and review of the literature. Biomed Phormacother 2002; 56: 158-64.

    2- Griffith HB, Veerapen RA. Direct transnasal approach to the sphenoid sinus. Technical  note. Neurosurgery 1987; 66: 140-2.

    3- Cooke RS, Jones RA. Experience with the direct transnasal transsphenoidal approach to the pituitary fassa. Br J Neurosurgery 1994; 3: 193-6.

    4- Carrau RL, Jho HD. Transnasal – transsphenoidal endoscopic surgery of the pituitary gland. Laryngoscope 1996; 106: 914-8.

    5- Jho HD, Carrau RL. [Endoscopy assisted transsphenoidal surgery for pituitary adenoma. Technical note]. Acta Neurochirurgia 1996; 138: 1416-25. (Japanese)

    6- Thapar K, Kovacs K, Scheithauer BW, Lioyd RY. Diagnosis and management of pituitary tumors. 1st ed. Otava NJ: Humana; 2000: 57-71.

    7- Fries G, Pernec ZK. Intracranial endoscopy. Ady Tech Stand Neurosurg 1999; 25: 21-60.

    8- Teramoto A. Contemporary transsphenoidal surgery for pituitary adenomas with emphasis on complications. Biomed Pharmacother 2002; 56: 154-7.

    9- Laws ER, Jane JA. Neurosurgical approach to treating pituitary adenomas. Growth Horm IGF Res 2005; 15: 36-41.

    10- de Divitiis, Capabianca P. Microscopic and endoscopic transsphenoidal surgery. Neurosurgery 2002; 51(6):1527-9.

    11- Pituitary tumors information page. National institute of neurological disorder. [cited  2005 Nov 8]. Available from: http: //www.ninds.nib.Gov/disorders / pituitary- tumors / pituitary

    12- Charalampaki P, Reish R, Ayad A, Conrad J. Endoscopic endonasal pituitary surgery: Surgical and outcome analysis of 50 cases. J Clin Neuroscience 2007; 14: 410-5.

    13- Sethi DS, Pillay PK. Endoscopic management of lesions of the sella turcica. J laryngol Otol 1995; 109(10): 956-62.

    14- Neal JG, Patel SJ, Kulbersh JS, Osguthrope JD, Schlossler RJ. Comparision of techniques for transsphenoidal pituitary surgery. Am J Rhinol 2007; 21(2): 203-6.

    15- Kawamata T, Iseki H, Ishizaki R, Hori T. Minimally invasive endoscope-assisted endonasal trans-sphenoidal microsurgery for pituitary tumors: Experience with 215 cases comparing with sublabial trans-sphenoidal approach.  Neurol Res 2002; 24(3): 259-65.

    16- Cappabianca P, Cavallo LM, de Diviitis E. Endoscopic endonasal surgery .Neurosurgery 2004; 55(4): 933-40.

    17- Zervas NT. Survey. In: Black PM, Zervas NT, Ridgeway EC, Martin J. (editors). Secretory tumors of the pituitary gland. 1st ed. New York: Raven; 1984: 377-85.

    18- Laws ER. Trans-sphenoidal approach to pituitary tumors. In: Schmidek HH, Swee WH. (editors). Operative neurosurgical techniques. 1st ed. Philadelphia: WB Saunders; 1995: 283-92.

    19- Laws ER. Trans-sphenoidal surgery in brain surgery: Complication avoidance and management. 1st ed. New York: Churchill Livingstone; 1993: 357-62.

    20- Laws ER. Vascular complication of trans-sphenoidal surgery. Pituitary 1999; 2: 163-70.

    21- Cho DY, Liau WR. Comparision of endonasal endoscopic surgery and sublabial microsurgery for prolactinomas. Surg Neurol 2002; 58: 371-6.

    22- Ogawa T, Matsumoto K, Nakashima T, Okano M. Hypophysis surgery with or without endoscopy. Auris Nasus Larynx 2001; 28: 143-9.

    1. Kovacs K, Horvath E. Tumors of the pituitary Gland. Atlas of tumor pathology. 2nd ed. Washingtone. DC: Armed forces institute of pathology; 1986: 261-9.

    24- Rudnik A, Kos-Kudla B, Larysz D, Zawadzki T, Bazzowski P. Endoscopic trans-sphenoidal treatment of hormonally active pituitary adenomas. Neuro Endocrinol 2007; 28(4): 438-44.