Endoscopic Approach Successfully Treats Pituitary Macroadenomas

A new study shows that minimally invasive endoscopic procedures hold promise for safely removing macroadenomas, large tumors situated in the pituitary gland.

Researchers at the University of Cincinnati Neuroscience Institute (UCNI; OH, USA) conducted a retrospective study and analyzed the surgical outcomes of 27 consecutive patients who had undergone endoscopic removal of pituitary macroadenomas--tumors that are larger than 10 millimeters--between 2005 and 2007. During surgery, unexpected residual tumors were searched for using intrasellar endoscopy, followed by a second examination via intraoperative magnetic resonance imaging (MRI).

The results showed that following the initial endoscopic tumor removal, intrasellar endoscopy revealed that 23 of the 27 patients (85%) had no unexpected residual tumor. Surgeons were able to perform safely additional surgery on three of the four patients who had unacceptable residual tumor tissue. Following completion of the endoscopic procedures, all patients were checked with intraoperative MRI, which revealed that tumor removal was successful in 26 of the patients (96%). The results, according to the researchers, show that maximum tumor removal can be successfully achieved with endoscopy and without intraoperative MRI. The findings were published in the April 2010 issue of the Journal of Neurosurgery.

"This signals the dawn of a new era in minimally invasive cranial surgery,” said lead author Philip Theodosopoulos, M.D., director of skull base surgery at UCNI. "We have moved from the realm of assessing whether it is feasible to studying its clinical effectiveness. In this way, it is slowly starting to change from a novelty to standard treatment, setting the bar for the quality of surgical outcomes higher than ever before.”

Although tumors of the pituitary gland, located near the base of the skull, are benign, pituitary macroadenomas can wreak havoc, causing acromegaly, Cushing disease, and hyperthyroidism, as well as visual problems, headaches, and dizziness. When removing pituitary macroadenomas, surgeons have employed three distinct routes to the tumor: via craniotomy, through an incision under the upper lip and then through the intranasal septum (which must be split apart), or via an endoscopic transsphenoidal approach, which follows natural anatomical corridors and causes less disruption of nasal tissues. Surgeons can ensure that the entire tumor has been removed using intraoperative MRI.

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University of Cincinnati Neuroscience Institute