Minimally invasive endoscope-assisted endonasal trans-sphenoidal microsurgery for pituitary tumors: Experience with 215 cases comparing with sublabial trans-sphenoidal approach

Recent advances in endoscopic surgery have developed an endonasal route suitable for pituitary surgery. The main goal of this article is to evaluate benefits of our endoscope-assisted endonasal trans-sphenoidal microsurgery for pituitary tumors in 215 consecutive cases. The pathological classifications of the 215 cases are as follows: 163 pituitary adenomas, 23 Rathke's cleft cysts, 17 craniopharyngiomas, and 12 others. The patients were surgically treated via the endonasal trans-sphenoidal approach using an operating microscope as the primary instrument for tumor resection. Endoscopes were used to complement the operating microscope in visualization. We compared the new approach to the sublabial trans-sphenoidal approach (197 cases) with respect to endocrinological outcomes and surgical complications. Our endonasal trans-sphenoidal approach was beneficial in eliminating the complications of lip numbness, which was often observed in patients undergoing sublabial surgery, and nasal septal perforation. In addition, endocrinological outcome comparable to those in the sublabial group was achieved in the endonasal group. We consider that the endoscope, which allows visualization of areas not seen with the operating microscope, should be used actively in conjunction with the operating microscope that provides three-dimensional visualization and is timesaving. Our surgical method for pituitary tumors provides good results with minimal invasion, by exploiting the advantages of a microscope and an endoscope.