2 The procedure

2.1 Indications

2.1.1 Endoscopic transsphenoidal pituitary adenoma resection is used to treat pituitary adenomas. Pituitary adenomas are benign slow-growing tumours that arise within the pituitary gland.

2.1.2 The symptoms of pituitary adenoma depend on the location, type and size of tumour and any hormone that it may secrete.

2.1.3 The treatment options for pituitary adenoma include surgery, pharmacological therapy, and radiotherapy.

2.2 Outline of the procedure

2.2.1 Under general anaesthetic, an endoscope is inserted into the nose and is directed towards the base of the tumour at the skull base. Surgical instruments are then inserted and the tumour is removed.

2.3 Efficacy

2.3.1 The evidence indicated that endoscopic transsphenoidal pituitary adenoma resection results in surgical outcomes, such as adequacy of removal and normalisation of hormone levels, comparable with those achieved using conventional surgery.

2.3.2 The operating time for endoscopic transsphenoidal resection was shorter compared with conventional surgery. For more details refer to the 'Sources of evidence' section.

2.3.3 The majority of the Specialist Advisors considered the procedure to be a variation of an existing procedure, and the likely efficacy of resection to be unchanged.

2.4 Safety

2.4.1 The evidence indicated that major morbidity (cerebrospinal fluid leak, meningitis, stroke, intracranial haemorrhage, or visual loss) occurred in between 1.4% (3/215) and 15% (3/20) of patients. Less serious complications (sinusitis and nasal septal perforations) occurred in less than 7% of patients. The complication rate associated with endoscopic transsphenoidal pituitary adenoma resection was lower than the rates associated with conventional surgery.

2.4.2 The most serious reported complication of the procedure was meningitis. This occurred in two patients in the two largest case series, which included 310 patients. For more details refer to the 'Sources of evidence' section.

2.4.3 The Specialist Advisors did not report any particular safety concerns, though bleeding, optic nerve damage, cerebrospinal fluid leakage, and carotid artery injury were noted as potential complications of endoscopic transsphenoidal pituitary adenoma resection.

2.5 Other comments

2.5.1 It was noted that there was a lack of long-term follow-up data on this procedure.

Andrew Dillon
Chief Executive
December 2003