OBJECTIVE: To evaluate the effect of surgical technique and clinical curative effect for a unilateral endonasal-transsphenoidal approach in the removal of pituitary adenomas (PAs) by an endoscope-assisted technique with sellar floor reconstruction. METHODS: Between April 2001 and March 2009, 426 consecutive patients underwent extended neuroendoscopic unilateral endonasal transsphenoidal surgery. The series consisted of 54 (12.7%) as I type of Pas and 105 (24.6%) II type, 181(42.5%) III type and 86 (20.2%) IV type according to Hardy's classification criteria of pituitary adenoma. RESULTS: Tumor removal, as assessed by intraoperative findings and postoperative magnetic resonance imaging or CT scans, revealed complete tumor removal in 370 cases (86.9%) and subtotal tumor removal in 32 cases (7.5%) were achieved. Partial removal was carried out in the remaining 24 cases (5.6%) with fibrous tumor. Three patients (0.7%) had postoperative death in this group. Twenty-four patients (5.6%) had a postoperative cerebrospinal fluid leak that required repair operations. Six patients (1.4%) experienced a sphenoid mucositis and meningitis and they were cured by medical therapy. CONCLUSION: The slightly soft texture of PAs with or without a limited suprasellar extension and without involvement of vascular structures, may be resected through such an extended neuroendoscopic transsphenoidal approach. Intraoperative angled endoscope is a useful adjunct for safe removals.
OBJECTIVE: To evaluate the effect of surgical technique and clinical curative effect for a unilateral endonasal-transsphenoidal approach in the removal of pituitary adenomas (PAs) by an endoscope-assisted technique with sellar floor reconstruction. METHODS: Between April 2001 and March 2009, 426 consecutive patients underwent extended neuroendoscopic unilateral endonasal transsphenoidal surgery. The series consisted of 54 (12.7%) as I type of Pas and 105 (24.6%) II type, 181(42.5%) III type and 86 (20.2%) IV type according to Hardy's classification criteria of pituitary adenoma. RESULTS:Tumor removal, as assessed by intraoperative findings and postoperative magnetic resonance imaging or CT scans, revealed complete tumor removal in 370 cases (86.9%) and subtotal tumor removal in 32 cases (7.5%) were achieved. Partial removal was carried out in the remaining 24 cases (5.6%) with fibrous tumor. Three patients (0.7%) had postoperative death in this group. Twenty-four patients (5.6%) had a postoperative cerebrospinal fluid leak that required repair operations. Six patients (1.4%) experienced a sphenoid mucositis and meningitis and they were cured by medical therapy. CONCLUSION: The slightly soft texture of PAs with or without a limited suprasellar extension and without involvement of vascular structures, may be resected through such an extended neuroendoscopic transsphenoidal approach. Intraoperative angled endoscope is a useful adjunct for safe removals.