Neuronavigation-guided pure endoscopic endonasal transsphenoidal approach for pituitary adenomas

Objective To analyze the efficacy of neuronavigation-guided pure endoscopic endonasal transsphenoidal approach for the surgical removal of pituitary adenomas.Methods We retrospectively analyzed the clinical data of 91 patients who received pure endoscopic endonasal transsphenoidal surgery for pituitary adenomas between April 2010 and December 2011.There were 40 males and 51 females,75 primary tumors and 16 residual or recurrent tumors.Patients aged from 12 to 75 years (mean 48.7 years).In 11 cases,the tumor diameter were less than 1cm,63 cases were 1-4cm,and 17 cases were more than 4 cm.57 cases were Knosp 0-2,19 cases Knosp 3,and 15 cases Knosp 4.There were 54 nonfunctional adenomas and 37 functional adenomas.Neuronavigation was used in all patients.Neuro-ophthalmological,neuroimaging and endocrinological follow-up was performed between 3 and 21 months (mean 10.2 months) postoperatively.Results The tumor was gross totally removed in 74 cases (81％,74/91),subtotal removed in 13 cases,and partially removed in 4 cases.For Knosp 0-2 adenomas,the gross total removal was achieved in 54 cases (95％,54/57),Knosp 3 in 17 cases (90％,17/19),and Knosp 4 in 3 cases (20％,3/15).Postoperative visual acuity improved in 32 cases (87％,32/37),and endocrine remission was observed in 21 cases (57％,21/37).The postoperative complications included electrolyte disturbances in 4 cases,CSF leakage in 3 cases,hypothyroidism in 3 cases,and diabetes insipidus in 2 cases.Temporary visual impairment,hypoadrenocorticism,meningitis,sphenoid sinus inflammation,and sella turcica bleeding were found in 1 case respectively.Conclusions The pure endoscopic endonasal transsphenoidal approach for the surgical removal of pituitary adenoma is safe and effective.The safety and effectiveness can be further increased through the combination with neuronavigation. Key words: Pituitary adenoma;  Neuroendoscopy;  Pure endoscopic endonasal transsphenoidal approach ;  Neuronavigation