Abstract
INTRODUCTION
Endoscopic transnasal surgery (ETS), commonly used for treatment of pituitary adenomas, is effective for other neoplastic and unusual lesions in the parasellar region and anterior skull base. We evaluated our experience treating oncologic and inflammatory lesions with this approach.
METHODS
We retrospectively analyzed 808 ETS performed between 2008 and 2017 at our institution by one surgeon (ERL). Patients with final pathological diagnoses other than adenoma or cyst were selected. Presentation and operative outcomes were reviewed.
RESULTS
Seventy-three of 808 (9.0%) cases met inclusion criteria. Pathological diagnoses included metastastic cancers (n=7, 9.6%), craniopharyngioma (n=30, 41.1%), meningioma (n=7, 9.6%), chordoma/chondrosarcoma (n=5, 6.8%), germ cell tumors (n=1, 1.4%), dermoid/epidermoid tumors (n=2, 2.7%), lymphoma (n=1, 1.4%), other tumors of the sellar region (n=8, 11.0%), lymphocytic hypophysitis (n=7, 9.6%), granulomatous lesions (n=2, 2.7%), sarcoidosis (n=1, 1.4%), Wegner’s Granulomatosis (n=1, 1.4%) and fibrous dysplasia (n=1, 1.4%). Common presenting symptoms were visual loss (67.1%), headaches (52.1%), and hypopituitarism (34.2%). Complications included postoperative CSF leak (11.0%), infection/meningitis (8.2%), visual loss (4.1%), carotid injury (4.1%), and postoperative hydrocephalus (1.4%). There were no peri-operative mortalities. Of the 61 patients with documented clinical follow up for visual symptoms, 68.9% (n=42) had improvement. Likewise 58 patients had documented follow up for headache with improvement in 62.1% (n=36). With regards to endocrinologic function, 12.3% and 17.8% experienced new transient and permanent diabetes insipidus, respectively. Postoperatively, patients required hormone replacement for thyroid (60.3%), testosterone/estradiol (16.4%), cortisol (60.3%), and vasopressin (41.1%). Finally, 12.3% (n=9) of patients received radiation therapy post-operatively.
CONCLUSIONS
ETS offers a potentially less invasive approach to neoplastic and inflammatory diseases of the parasellar region and the anterior skull base compared to conventional craniotomy, with acceptable morbidity and mortality. This technique can be effective for resection of lesions, to halt progression of neurological deficits, or to obtain tissue diagnosis for adjunctive therapy.