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Endoscopic trans-sphenoidal approach for pituitary surgery: Retrospective and prospective study of 70 patients

Author: 
Nikunj R. Godhani, Harshil C. Shah, Jaimin K. Shah, Ankur B. Pachani and Vikash Singh
Subject Area: 
Health Sciences
Abstract: 

Background: Endoscopic trans sphenoidal approach is increasingly used in the treatment of pituitary adenoma. It is considered approach of choice in pituitary tumor surgery. There are varying opinions about results of endoscopic approach in pituitary surgery. We therefore Retrospectively & prospectively studied the outcome of endoscopic Approach in Pituitary surgery. Aim: To investigate the outcome of endoscopic Trans sphenoidal approach in patients with pituitary adenoma surgery. Methods and Materials: A prospective study of 70 patients undergoing endoscopic Trans sphenoidal excision in our institution from July 2013 to December 2015 was carried out. Diagnosis of pituitary adenoma was done by preoperative computed tomographic scan and magnetic resonace imaging, visual field charting, hormone profile. The results of Pituitary surgery were determined by assessing clinical signs of visual acuity, post op Hormone profile, Visual field charting as well as by MRI / CT scans. Results such as extent of excision, rate of relapse in functioning adenoma, visual improvement, incidence of DI were compared with other studies done in past. Results: Most common age group to be affected by pituitary tumors falls between 41-50 years of age.It is more common in Female 52% compared to Male 48%. Most common clinical symptoms in our series are Headaches followed by Visual disturbance. These symptoms of mass effect are much common than endocrinologic dysfunction of acromegaly and galactorrhea amenorrhea syndrome. Optic nerve involvement is other common clinical finding presenting in form of decreased vision or loss of vision, field defect or fundus changes. Commonest field defect is bitemporal hemianopia. Approximately half of the patients exhibited normal preoperative pituitary function in form of baseline hormone profile. Among 70 patients 37 were NFPA, 18 were GH adenoma, 2 were ACTH adenoma, 11 were prolactinoma and 2 patients with apoplexy. MRI is the diagnostic investigation of choice in pituitary tumors to define extent, invasion and relationship to major vessels and nerves. Total/near total removal was done in 63 patients and subtotal removal done in 7 patients. Adjuvant therapies were given in 8 patients. Two patients were given radiotherapy and 3 were given pharmacotherapy. The post operative complications were CSF leak 6%, Diabetes insipidus 21%. 59 patients had improvement in their symptoms including relief from headache, improvement in vision and endocrinal dysfunction. Post operatively visual functions improved in 35 patients and it remained stationary in 34 patients. Only one patient complained of worsening of his visual function and it was improved in follow up period. Conclusion: The Pituitary constitutes a unique class of intracranial neoplasia. widespread use of MRI is now accepted as imaging procedure of choice in the evaluation of these tumors. Trans-Sphenoidal surgery is the primary treatment of choice for this class of tumors. Which can achieve superior extent of resection with acceptable rate of complication. Though long term follow up is needed for better understanding of the result.

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