Technical note Preservation of hormonal function by identifying pituitary gland at endoscopic surgery Stefan Linsler a,⇑ , Renate Hero-Gross b , Bettina Friesenhahn-Ochs c , Salman Sharif d , Frank Lammert c , Joachim Oertel a a Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland, Germany b Gesundheitszentrum am Markplatz, Praxis für Endokrinologie, Homburg, Deutschland, Germany c Klinik für Innere Medizin II, Gastroenterologie, Hepatologie, Endokrinologie, Diabetologie und Ernährungsmedizin, Universitätsklinikum des Saarlandes, Homburg, Deutschland, Germany d Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan article info Article history: Received 4 April 2017 Accepted 19 June 2017 Available online xxxx Keywords: Pituitary surgery Endoscopy Hypopituitarism Hormonal dysfunction abstract Objective: The endonasal endoscopic approach has been established for perisellar tumor surgery with a higher resection rate and reduced complications. We analyzed the potential to identify the pituitary gland under endoscopic view, at surgery and see its relation to postoperative hormonal insufficiency in endonasal endoscopic procedures. Methods: Between January 2011 and January 2014, 70 cases of pituitary adenomas with preoperative intact pituitary function underwent endoscopic endonasal transsphenoidal procedures for intrasellar pathologies. Endocrinologists and neurosurgeons followed these patients prospectively. Special attention was paid to intraoperative identification of gland tissue, surgical complications, degree of resection and postoperative hormonal insufficiency. Results: The pituitary gland was identified in 57 out of 70 procedures (81.4%). Eleven percent (8 of 70 patients) had persistent pituitary insufficiency. Two of these 8 patients belonged to the group with pitu- itary gland identification (2 out of 57); thus, when the pituitary gland was identified during the procedure postoperative hormonal insufficiency was seen in 3.5% of cases. Failure of pituitary gland identification presented with hormonal insufficiency of 46.2%. In analysis with Fisher’s exact test, there was a high sig- nificant correlation between the identification of the pituitary gland intraoperatively and normal pitu- itary function postoperatively (p < 0.005). On follow up radical tumor resection was seen in 88% (62 of 70 patients). Conclusions: This study indicates that identification and preservation of pituitary gland tissue and func- tion is possible in endoscopic transsphenoidal surgery. This preservation of gland tissue is a positive pre- dictor of postoperative normal pituitary function. Ó 2017 Elsevier Ltd. All rights reserved. 1. Introduction The microsurgical transsphenoidal approach was investigated and established over almost a century of research [1]. It used to represent the ‘‘gold standard” for surgical treatment of sellar lesions for neurosurgical community [2–6]. However, further developments of endoscopic techniques and its applications in neurosurgery influenced also transnasal approaches [7–16]. Con- tinuous efforts to improve surgical techniques are still being made [17–24]. Many publications on endonasal endoscopic surgery stress the less invasive nature of this technique, [25–27] providing a wider field of view. Additionally, angled telescopes allow inspec- tion of retrocarotid, intracavernous and suprasellar space [28]. Endocrinologic results similar to those obtained by traditional transsphenoidal microscopic surgery were reported initially [23,29–32]. Recently, publications point to a better endocrinologic outcome for functioning adenomas when using endoscopy http://dx.doi.org/10.1016/j.jocn.2017.06.045 0967-5868/Ó 2017 Elsevier Ltd. All rights reserved. Abbreviations: CSF, cerebrospinal fluid; CT, computer tomography; MRI, mag- netic resonance imaging; AIDA, Advanced Image and Data Acquisition; GH, growth hormone; IGF-1, Insulin-like growth factor; ACTH, adrenocorticotropic hormone; LH, luteinizing hormone; FSH, follicle stimulating hormone; OGTT, oral glucose tolerance test. ⇑ Corresponding author at: Klinik für Neurochirurgie, Universität des Saarlandes, 66421 Homburg/Saar, Germany. E-mail address: stefan.linsler@uks.eu (S. Linsler). Journal of Clinical Neuroscience xxx (2017) xxx–xxx Contents lists available at ScienceDirect Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn Please cite this article in press as: Linsler S et al. Preservation of hormonal function by identifying pituitary gland at endoscopic surgery. J Clin Neurosci (2017), http://dx.doi.org/10.1016/j.jocn.2017.06.045