A study assessing the outcome of endoscopic endonasal transsphenoidal excision of pituitary adenoma at a tertiary care institutions- An Initial experience of 30 cases

Background: Endoscopic Endonasal Transphenoidal Pituitary Surgery (EETS), has been proved to be a preferred alternative to conventional surgery because of its salient features like wider, more panoramic field of visualization, improved illumination and mobility of instruments, and an ability to look around anatomical corners using angled lens and minimal invasiveness.The current study was done to analyse the effectiveness and morbidity in the patients operated in our centre by Endoscopic Endonasal Transphenoidal Pituitary Surgery (EETS) done by single team in single centre in15 months. Aims and Objective: To describe a case series of patients with pituitary adenomas with endoscopic endonasaltranssphenoidal approach, the technique performed and complications in our centre. Materials and Methods: The technique performed in a series of 30 consecutive patients, and description of their complications and the protocol followed to treat these complications. Results: The tumor removal was gross total in 18 (60.0%) patients, subtotal in 8 (30.7%), and partial in 4 (7.7%) patient. Two patients with growth hormone-secreting adenomas had normalization of hormonal status. Four patients developed temporary diabetes insipidus. Four patients developed post-operative CSF rhinorrhea and were managed conservatively.Two patient had recurrence of tumor.one patient had meningitis and one patient expired in perioperative periods. Conclusions: Our experience suggests that the Endoscopic transsphenoidal approach offers a potentially viable and cost economic treatment option in pituitary tumors which are difficult to remove by the standard microscopic approaches. In past one and half year we have witnessed encouraging results without much of the anticipated complications.

Tumor to Cerebellar Peduncle T2-Weighted Imaging Intensity Ratio Fails to Predict Pituitary Adenoma Consistency

Object The consistency of pituitary macroadenomas affects the complexity of surgical resection. On T2-weighted (T2W) imaging, the intensity ratio of the tumor to the cerebellar peduncle (tumor to cerebellar peduncle T2-weighted imaging intensity [TCTI] ratio) correlates with meningioma consistency. We aimed to determine the correlation of this radiographic finding with pituitary macroadenoma consistency and to determine whether it can be used for preoperative planning. Methods We performed a retrospective evaluation of 196 patients with macroadenomas who underwent endoscopic transsphenoidal resection from January 2012 to June 2017. Macroadenoma consistency was determined by one senior neurosurgeon at the time of surgery. Axial and coronal T2W magnetic resonance imaging images were evaluated retrospectively, and adenoma size, Knosp grade, suprasellar extension and TCTI were calculated. Results The mean TCTI ratio was 1.70 (95% confidence interval [CI]: 1.65–1.75). Intraoperatively, 140 (71.4%) adenomas were classified as soft and 48 (24.5%) as fibrous. Gross total resection was achieved in 66.7% of fibrous adenomas and in 86.4% of soft adenomas (p = 0.007). The mean ratio was 1.68 (95% CI: 1.62–1.74) for soft tumors and 1.76 (95%CI: 1.67–1.84) for fibrous tumors. There was no difference in the mean TCTI ratio between groups. Lactotroph and somatotroph adenomas had a lower mean TCTI ratio compared with other functioning and nonfunctioning adenomas with a mean TCTI of 1.52 compared with 1.77. Conclusions In this retrospective cohort study, we found that the TCTI ratio does not correlate with tumor consistency. We also noted that the TCTI ratio is increased in prolactin and growth hormone-secreting adenomas.