A Comparative Outcome Analysis of Three-Dimensional (3D) and Two-Dimensional (2D) Endoscopic Transsphenoidal Surgery in the Treatment of Pituitary Adenomas in a Series of 115 Patients

Abstract

Introduction: Two-dimensional (2D) endoscopes are limited by poor depth perception, lack of stereoscopic vision, and image distortion. Recently, a new three-dimensional (3D) endoscopic system that provides improved stereoscopic vision has been developed. No data exist comparing the results and outcomes of 2D versus 3D endoscopy in treatment of a large cohort of pituitary adenoma patients. We compared the results of transnasal endoscopic pituitary surgery using the 2D and 3D endoscopy systems. Methods: A total of 115 patients underwent endoscopic transnasal transsphenoidal pituitary adenomectomy at Emory University Hospital. In all cases, pituitary tumor resection was performed by a single neurosurgeon (NO). The endoscopic transnasal approach and closure were performed by the otolaryngology service. The 3D endoscopic system was used for pituitary adenomectomy in 72 patients (63%), and the 2D system was used in 43 patients (37%) over a 2-year period. A retrospective analysis included preoperative, perioperative, and postoperative metrics. The statistical comparison was completed using the t test and the chi-square test. Results: The preoperative data for the two groups (3D vs. 2D) is presented: the average age 49.5 versus 45.9, tumor size (all tumors) 6.9 versus 5.8 cm3, and tumor size (macroadenomas) (94/115) 8.3 versus 7.1 cm3 with Knosp cavernous sinus invasion grade of 1.8 versus 1.4. The perioperative data (3D vs. 2D) includes: median operative time of 145 versus 168 minutes, EBL 200 versus 200 mL, LD placement 35/72 (49%) versus 21/43 (49%). The postoperative data (3D versus 2D) includes: hospital stay 5 days versus 5 days, endocrine complications 7/72 (10%) versus 5/43 (12%), CSF leak rate 5/72 (7%) versus 4/43 (9%), remission for functioning tumors was 20/30 (67%) versus 12/21 (57%), readmission rate was 15/72 (21%) versus 10/43 (23%), reoperation rate was 4/72 (6%) versus 8/43 (19%), and transsphenoidal CSF leak repair 0/72 (0%) versus 3/43 (7%). The reoperation rate and the CSF leak repair rate were statistically different (P < 0.03, chi-square). The other metrics were not statistically different. Conclusions: Three-dimensional endoscopy improves the depth of field and provides stereoscopic vision. This improvement resulted in a statistically significant decrease in overall reoperation and CSF leak repair rate in our series.