Medical Aspect of Endoscopic Endonasal Transsphenoidal Hypophysectomy in Skull Base Center of Basra

Abstract

Background: Endoscopic endonasal transsphenoidal (EETS) approach is a minimally invasive technique that has gained increased acceptability for the removal of sellar and para-sellar tumors. Objectives: To evaluate the EETH in the skull base center of Basra and compare our EETH procedures with others done in different centers. Patients and Methods: A prospective observational study was carried out in Basra skull base center at Al-Sader Teaching Hospital between August 2017 and July 2019, and it included 50 patients (29 female and 21 male) with a female to male ratio of 1.38:1. We included all patients with a pituitary tumor fit for surgery, and there were no exclusion criteria. The standard technique involved a unilateral, endoscopic, and endonasal approach to the sella turcica via an anterior sphenoidotomy, with enlargement of the natural sphenoid ostium using powered instrumentation and 0° and 30° rigid endoscopes for visualization. This was performed as a joint procedure by a consultant otolaryngologist and a consultant neurosurgeon. Results: The most common presenting symptom for pituitary tumor was headache, which is present in 80% (40 patients) of patients, followed by visual disturbance in 56% (28 patients). The MRI study of the brain and sellar region shows that 46 patients (90%) were diagnosed as having pituitary adenomas. Eighty-four patients present had a tumor larger than 1cm in size. Sixty eight percent (34 patients) had an abnormal hormonal study before the operation, whereas 32% (16 patients) had a normal hormonal analysis. Histopathological examination of the tumors showed pituitary adenoma in 90% (45 patients), followed by craniopharyngiomas in 6% (three patients) and 2% (one patient) was Rathke's cyst and 2% (one patient) was pituitary carcinoma. Postoperative follow-up result indicated headache improvement in 82% (34 patients), improvement in menstrual disturbance in 67% (13 patients), and vision improvement in 46% (13 patients). Seventy-four percent showed hormonal normalization after EETH, which is statistically significant (P < 0.05). Conclusion: This study show that endoscopic, endonasal, transsphenoidal hypophysectomy is a minimally invasive, effective, and safe procedure to remove pituitary tumors.