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Treatment outcome of endoscopic endonasal transsphenoidal approach for the pituitary adenomas: A retrospective, single-institutional 20-year experience
J Korean Skull Base Soc 2024;19(2):109-119
Published online October 31, 2024
© 2024 Korean Skull Base Society.

Dong-Won Shin1, Gi-Taek Yee1, Woo-Kyung Kim1, Joo Hyun Jung2

1Department of Neurosurgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
2Department of Otorhinolaryngology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
Correspondence to: Gi-Taek Yee
E-mail gtyee1@gmail.com
ORCID https://orcid.org/0000-0002-8706-7253
Received August 9, 2024; Revised August 25, 2024; Accepted August 26, 2024.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Pituitary adenomas (PAs) are the second most common benign intracranial tumors. The endoscopic endonasal transsphenoidal approach (EETSA) has been a treatment choice for such tumors. This study provides a 20-year experience of EETSA in a single institution as well as a subgroup analysis of the visual outcome after incomplete resection.
Materials and Methods: Electronic medical records of 120 patients, who underwent EETSA at our institution between January 2003 and August 2022, were retrospectively analyzed. The ophthalmologic outcome was analyzed with the surgical outcome as well as clinical factors. An analysis was conducted on surgical morbidities, including cerebrospinal fluid leakage, meningitis, and diabetes insipidus, categorizing, and assessing their incidence over distinct decades.
Results: Patients were followed for a median period of 41.3 months, with a median tumor size observed at 2.5 cm. Nonfunctioning PAs are 91 patients, and visual field defect was identified in 58 patients (48.3%). Gross total resection (GTR) was achieved in 53 patients (44.2%). Smaller tumor size and younger age were associated with GTR, whereas cavernous sinus (CS) invasion, suprasellar extension, and optic nerve compression were related to non-GTR. Forty-six patients were available for postoperative ophthalmologic evaluation. Thirty-six patients (78.3%) improved, 7 patients (15.2%) were stable, and 3 patients (6.5%) worsened.
Conclusions: The long-term outcomes following EETSA are favorable, with relatively low morbidity rates. Tumor size, age, suprasellar extension, and CS invasion were related to GTR. In subgroup analysis, the suprasellar residual tumor is not related to visual outcomes or tumor recurrence rate.
Keywords : Pituitary neoplasms, Endoscopy, Transnasal endoscopic surgery

October 2024, 19 (2)
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