title: Endoscopic endonasal surgery for pituitary tumors. Results in a series of 121 patients operated at the same center and by the same neurosurgeon.
abstract: BACKGROUND
  Pituitary adenomas account for approximately 15% of intracranial benign tumors. The neurosurgical results achieved since the endoscopic endonasal transsphenoidal (EET) approach was introduced in our center in 2005 are reported here.
  
  
  METHODS
  A retrospective analysis of 121 patients with sellar lesions (58% females, age 55.7 ± 16 years, range 18-82) who underwent EET surgery from February 2005 to January 2012 and were followed up for a mean time of 4.58 years (range 1.08-8.58).
  
  
  RESULTS
  Six Rathke cleft cysts (3 intra-suprasellar, 1 intrasellar, 2 suprasellar); 114 pituitary adenomas (16 microadenomas, 98 macroadenomas), and 1 case of normal MRI were included. Baseline findings included hormonal changes in 59 patients (48,7%) and visual field changes in 38 patients (31%); in 7 patients (5.8%), clinical presentation was pituitary apoplexy. Complete resection was achieved in 77 patients (63.6%), subtotal resection in 29 (23.9%), and partial resection in 15 (12.3%). In patients with Grade 3 and 4 cavernous sinus invasion, resection was subtotal in 30% (12/39) and complete in 46% (18/39). Hormonal remission was achieved in 16 patients with Cushing disease (84%), 18 patients with prolactinoma (78.2%), and 18 patients with acromegaly (85,7%). There were 12 cases (9%) of cerebrospinal fluid leak, 4 cases of diabetes insipidus, and 3 cases with transient SIADH/hyponatremia. Seven patients developed panhypopituitarism. Postoperative mortality rate was 2.4%. One hundred and three patients (85.3%) were discharged from the hospital less than 48 hours after surgery.
  
  
  CONCLUSIONS
  Our results are similar to those reported by renowned pituitary units. Results achieved using an endoscopic approach in pituitary neurosurgery are better than those of microneurosurgery for cavernous sinus invasion.
authors.affiliation: Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
authors.forename: Jorge
authors.initials: J
authors.lastname: Torales
authors.affiliation: Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
authors.forename: Irene
authors.initials: I
authors.lastname: Halperin
authors.affiliation: Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
authors.forename: Felicia
authors.initials: F
authors.lastname: Hanzu
authors.affiliation: Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
authors.forename: Mireia
authors.initials: M
authors.lastname: Mora
authors.affiliation: Servicio de Otorrinolaringología, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
authors.forename: Isam
authors.initials: I
authors.lastname: Alobid
authors.affiliation: Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
authors.forename: Mateo
authors.initials: M
authors.lastname: De Notaris
authors.affiliation: Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
authors.forename: Enrique
authors.initials: E
authors.lastname: Ferrer
authors.affiliation: Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España. Electronic address: jensenat@clinic.ub.es.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Enseñat
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D009666:Nose; D010911:Pituitary Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acromegalia; Acromegaly; Adenoma hipofisario; Cerebrospinal fluid leak; Cirugía transesfenoidal; Clasificación de Knosp; Cushing's disease; Enfermedad de Cushing; Fístula de líquido cefalorraquideo; Knosp's classification; Pituitary adenoma; Prolactinomas; Transsphenoidal surgery