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  • Endoscopic Endonasal Transsphenoidal Approach to Pituitary Adenomas: the Experience of the Toronto Western Hospital

    Final Number:
    1414

    Authors:
    Ali S. Haider BS; Farshad Nassiri MD; Suganth Suppiah MD; Karolyn Hei Lun Au MD; Mark Wilson BSc, MRCA, FRCN (SN), FIMC, FRGS; John de Almeida; Allan Vescan MD; Fred Gentili MD; Gelareh Zadeh MD, PhD, FRCS(C)

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Endoscopic transsphenoidal approaches are increasingly utilized for skull base lesions, however, there are few reports of large series on this topic. Our objective is to report the results of a consecutive series of patients who exclusively underwent an endoscopic endonasal approach for pituitary adenoma resection at our institution over a 7-year period.

    Methods: We reviewed 433 consecutive patients from 2008 to 2014 with pituitary adenomas who underwent endoscopic endonasal transsphenoidal resection of their lesions by two surgeons at a single institution.

    Results: The most common subtypes were gonadotroph (45.8%) and ACTH-secreting (14.4%) adenomas. FGFR and p27 were expressed in the majority (88.5%) of tumors. There were 213 males (49.2%). The average age of the cohort was 50.6 (range 13-86). Patients most frequently presented with endocrinopathy (36.4%) and visual deficits (35.2%). Gross-total resection was achieved in 78% of cases. Endocrinopathy improved in 87.9% of the affected patients. Complications included CSF leak (12.8%) and death (0.2%).

    Conclusions: The endoscopic endonasal transsphenoidal approach for pituitary adenoma resection is safe and effective as shown in our large series with low complication rates. This study adds to the growing body of literature which will help to establish minimally accepted complication rates with this favorable approach.

    Patient Care: Our study uses a large cohort to investigate the safety and effectiveness of endoscopic endonasal transsphenoidal surgery for pituitary adenomas performed by experienced operators. The results from our series adds to the growing body of evidence showing the safety of the endoscopic approach and will help set the minimally accepted complication rates for this increasingly accepted approach.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of the endoscopic endonasal transsphenoidal approach for pituitary adenomas. 2) Discuss, in small groups, the favorable rate of tumor resection to complications using this approach. 3) Identify the importance of this approach in pituitary surgery and what can be considered as important complications or risk factors for future complication avoidance when considering this approach in pituitary adenoma surgery.

    References:

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