A study on sublabial transsphenoidal treatment of pituitary tumor under microscope with aid of endoscope

Abstract

Background: A pituitary tumor is a tumor with a high incidence among brain tumors. Microscopic traditional STT approach with aid of endoscope has a high therapeutic effect and few complications.

Methods: The authors reviewed 146 patients who underwent STT resection of sellar masses between January 1, 2006, and December 31, 2013. From this group, 40 patients who underwent microscopic STT surgery with aid of endoscope were included in the study. In this series, there were many nonfunctional and Growth Hormone(GH) secreting adenoma. In the study group, tumor size ranged from 60 to 79 mm in 3 cases. Pathophysiological studies, tumor sizes, clinical outcomes, extent of resection, visual function and complication were estimated.

Results: In our study, gross-total resection(GTR) was achieved in 33 patients (82.5%), subtotal in 3 (7.5%), and partial in 4 (10%). Visual acuity were improved in 82.1%, while 17.9% were unchanged. Visual fields were improved in 81.2%. No deaths occurred in this cohort of patients.

Conclusions: Pituitary adenoma surgery under microscope with aid of endoscope is an effective treatment method, which results in high (> 90%) rates of resection. It is not associated with high rates of major complications and is safe when performed by experienced surgeons.

Keywords: Complication; Endoscopic; Pituitary surgery; STT approach; Sellar.

Fig. 1

Coronal and sagittal MRI images of a patient who underwent a STT approach a. MRI image before surgery, showing a large pituitary adenoma extending suprasellar area and compressing the optic chiasm upward, b. MRI image 6 month later STT surgery showing fat grafts in the sella turcica and sphenoid sinus. The diaphragm sellae has descended into the sellar cavity and revealed complete disappearance of the tumor in the sellar and suprasellar region

Fig. 2

Removal of the tumor and pathological studies. a: Insertion of Hardy speculum to the sphenoidal bone. b: Confirm of ostium of sphenoidal sinus and removal of sphenoidal bone. c: Confirm of sellar floor. d: Removal of sphenoidal floor and exposure of sellar dura. e: The sellar dura was opened with a cruciate incision. f: Image after tumor removal. g, h: Pathological studies: multifunctional adenoma;PRL(+), GH(+), TSH(++)(g: hematoxylin and eosin staining, original magnification, *200. h: hematoxylin and eosin staining, original magnification, *400)