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Surgical Outcome in 65 Patients of Pituitary Adenoma: Our Institutional Experience

Amresh S. Bhaganagare, Associate Professor, Department of Neursurgery, Banglore medical college and research institute (BMCRI) and Pradhan mantra swasthasurakshayogana – super speicaility hospital (PMSSYSSH), Bangalore, Karnatka 560001, India. , Amresh S. Bhaganagare* , Vikas Naik** , Balaji S. Pai*** , Nagesh S.A.**** , Prakash Rathod***** , Nanditakujur******

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International Journal of Neurology and Neurosurgery 9(2):p 75-82, Jul-Dec 2017. | DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.9217.1

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Abstract

We retrospectively analyzed 65 patients of pituitary macroadenomas operated in superspeciality hospital of Bangalore medical college and research institute from June 2010 to June 2016. Management of pituitary adenomas represents a significant challenge for neurosurgeons, which is further amplified by the degree of local tumor infiltration into adjacent structures such as the cavernous sinus. The goal of the treatment of pituitary tumors are improvement of the visual, endocrinological and neurological symptoms with least morbidity and acceptable cosmetic results. The aim of our study was focused on surgical outcome of four approaches that we used, that is primary transcranial (PTC), sublabial transphenoidal (SLTS), endoscopic transphenoidal (ETS) and endoscope assisted transphenoidal (EATS). Results: forty patients were men and 25 were women. The youngest was 10 years of age and eldest was 66 year, with mean and median age of 38 and 41years respectively. Fiftyfive patients had nonfunctioning pituitary adenomas (NFAs) and 10 had hormonally active pituitary adenomas (PAs). The presenting symptoms were, visual obscuration (90.7%), headache (89%) and 7 patients had acromegaly due to growth harmone producing pituitary adenoma. Thirteen patients were operated by PTC, 30 patients by SLTS, 7 patients by ETS and 15 EATS. Gross total resection (GTR) was achieved in 70%, 42.8%, 73.8% and 46.6% patients in PTC, ETS, EATS and SLTS groups respectively. Visual improvement was seen in 70%, 42.8%, 73.8% and 46.6% of the patients in PTC, ETS, EATS and SLTS group respectively. Conclusions: since the goal of the treatment of pituitary adenomas are improvement of the visual, endocrinological and neurological symptoms with the lowest morbidity and acceptable cosmetic results. We suggest endoscope assisted transnasal transphenoidal approach as it combines the advantages of the stereoscopic view obtainable with a microscope and the endoscopic magnified panoramic view with best cosmetic results.

Keywords: Pituitary Adenomas; Giant Pituitary Adenomas; Transphenoidal; Endoscopic. 

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DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.9217.1

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