Endoscopic Endonasal Fluorescein-Guided Resection of Functioning Intrasellar Pituitary Adenomas.

BACKGROUND AND

OBJECTIVES

Gross total resection of pituitary adenomas (PAs) remains challenging despite advancements in transsphenoidal surgery, primarily due to difficulty in distinguishing adenoma tissue from the normal pituitary gland. Fluorescence-guided surgery using sodium fluorescein (SF) has shown promise in addressing this issue. This study evaluates the feasibility, safety, and efficacy of SF-guided endoscopic endonasal approach (EEA) for PA resection and presents preliminary results.

METHODS

Twenty-six patients with functioning intrasellar PAs underwent SF-guided EEA. A 4-mm endoscope with yellow and blue filters was used to visualize the adenoma and pituitary gland. Intravenous SF (5 mg/kg, 10%) was administered, and fluorescence staining was observed. Fluorescence emission was quantified using color spectrophotometry. Extent of resection was assessed by dynamic contrast-enhanced MRI at 3 months and postoperative hormone levels.

RESULTS

The cohort included 15 growth hormone-secreting (57.7%), 5 adrenocorticotropic hormone-secreting (19.2%), 4 prolactin-secreting (15.4%), and 2 FSH-secreting (7.7%) adenomas. Quantification revealed significant differences in fluorescence emission among dura (564 ± 5.621 nm), adenoma (549.65 ± 8.299 nm), and pituitary gland (531.42 ± 5.886 nm) ( P < .001). Residual tumor was detected in 14 patients (53.8%) under blue filter evaluation. Gross total resection was achieved in 88.5% of patients and near-total resection in 11.5%. Early biochemical remission was achieved in 84.6% of cases, including 80% of growth hormone-secreting, 80% of adrenocorticotropic hormone-secreting, 100% of prolactin-secreting, and 100% of FSH-secreting adenomas. No SF-related complications or adverse events occurred.

CONCLUSION

This study represents the first series of fully endoscopic SF-guided EEA for intrasellar PAs, demonstrating the technique's feasibility, safety, and efficacy. SF enhances intraoperative discrimination between adenoma and pituitary tissue, providing real-time guidance without prolonging surgery or causing adverse effects. These findings suggest SF is a valuable adjunct for improving PA resection outcomes.