title: [Endoscopic endonasal surgery for sellar region pathology. An analysis of our first 200 patients. What we have learned].
abstract: Pituitary and sellar region tumours account for 10-15% of intracranial benign tumours, with pituitary adenoma being the most common one. In this article, a review is presented on 9 years of experience in surgical treatment using an endoscopic approach of sellar region lesions. The main features of our surgical technique will be explained, as well as the results in clinical and hormonal terms.
  
  
  
  A retrospective analysis was conducted on 200 patients operated on due to sellar lesions by the same neurosurgeon (J.E.) using an endoscopic endonasal transsphenoidal approach between February 2006 and February 2015. The cases excluded were, those requiring extended approaches of the skull base, as well as craniopharyngiomas, inflammatory, metastatic, or malignant lesions.
  
  
  
  Of the 200 patients treated (59.5% women, mean age of 51.7 years, range: 18-82 years old), there were: 7 Rathke cysts and 193 adenomas (26 micro-adenomas and 165 macro-adenomas). All of them sub-classified according to the degree of invasion of the cavernous sinus (Knosp 0, 1, and 2: 129 cases and Knosp 3 and 4: 71 cases). Total resection was achieved in 143 patients (71.5%), subtotal resection in 39 (19.5%), and partial resection in 18 (9%). In the group of higher occupancy of the cavernous sinus (Knosp 3 and 4) complete resection was achieved in 55.5% (40 of 71 patients). Hormonal remission was achieved in 34 patients with acromegaly (85%), 23 patients with prolactinomas (76%), and 30 patients with Cushing's disease (86%).
  
  
  
  The results obtained in our series, due to the centralisation of pathology and experience, are comparable to those achieved in pituitary surgery reference centres. Early surgical exploration of cerebrospinal fluid leaks reduces the risk of post-surgical meningitis.
authors.affiliation: Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España. Electronic address: alberto_1704@yahoo.com.
authors.forename: Luis
authors.initials: L
authors.lastname: Reyes
authors.affiliation: Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
authors.forename: Sergio
authors.initials: S
authors.lastname: García
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: Halperín
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 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 Anestesiología y Reanimación, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
authors.forename: Ricard
authors.initials: R
authors.lastname: Valero
authors.affiliation: Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
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; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acromegalia; Acromegaly; Adenoma de hipófisis; Cerebrospinal fluid leak; Cirugía transesfenoidal; Cushing's disease; Enfermedad de Cushing; Fístula de líquido cefalorraquídeo; Knosp; Pituitary adenoma; Transsphenoidal surgery