[Minimally invasive surgical techniques in the treatment of pituitary and peripituitary tumors: experience with the paraseptal approach].

INTRODUCTION

The direct endonasal, paraseptal approach, performed with the aid of an operating microscope, for removal of pituitary and peripituitary tumors has the potential advantage over the traditional sublabial, transseptal routes of minimizing postoperative rhinological complications, yet maintaining a high degree of efficacy and safety. Combination of this approach with the endoscope or neuronavigation may improve the effectiveness of the operation.

METHODS AND RESULTS

Between June, 2000 and June, 2003 two hundred and seventeen patients underwent 221 paraseptal operations for tumor removal at the National Institute of Neurosurgery, Budapest. To asses the effectiveness of this procedure, duration of the operation, tumor remission rates and surgical complications as well as postoperative complaints of patients were reviewed. Surgical remission rates for pituitary adenomas were as follows: 94% for microadenomas, 67% for macroadenomas and 29% for giant adenomas. There were five surgical complications and no operative deaths. Ten out of 12 patients, who had undergone transseptal surgery previously, preferred the endonasal approach in terms of pain and ease of recovery.

CONCLUSIONS

The direct paraseptal route for pituitary and pericellar tumor removal has an efficacy and complication rates comparable to those of the transseptal and sublabial routes. Patients generally recovered rapidly from this minimally invasive procedure and had no or minimal sinonasal complaints. For patients requiring a repeated operation, the paraseptal route appears to be less painful and easier to recover from, than the transseptal route.