gms | German Medical Science

Introduction: Endoscopic endonasal hypophysectomy constitutes a challenge and an opportunity for the Otolaryngologist who is more familiar with the anatomy of the nose and the adjacent structures in comparison with the neurosurgeons.

Methods: Last 15 years, 246 hypophysectomies have been performed in cooperation with neurosurgical department of our hospital. These patients presented mainly to the neurosurgery department. As otolaryngologistes, we performed the first step of procedure (opening of the sphenoid sinus, opening of the prominence of sella, and reaching the dura of the pituitary adenomas). The second step is continued with the presence and cooperation of the neurosurgeon. For the first 182 hypophysectomies a sublabial approach was performed with the use of a microscope. Subsequently, 22 hypophysectomies were performed with a combined approach (sublabial microscope-endoscope assisted). Lastly, the most recent 42 hypophysectomies, endonasal endoscopic 4-hands technique was applied.

Results: With all 3 techniques success rate did not significantly differ. Complication rate (hemorrhage, cerebrospinal fluid leak) was significantly lower in the endoscopic technique. Hospital stay was also significantly lower in endoscopic technique.

Conclusions: The advantages of endoscopic approach are: less traumatic, faster, panoramic view, angle-view with the use of different endoscopes, and possibility to explore the sella for residual tumor at the end of operation. Its disadvantages are the lack of three-dimenshion view and the need of an assistant to hold the endoscope.