Comparison of 2D HD and 3D Endoscopy during Endonasal Endoscopic Transsphenoidal Surgery (EETS) for Treatment of Perisellar Pathologies

Abstract

Objective: EETS for central skull base pathology treatment offers many advantages over microsurgical procedures. HD resolution improves the image detail accuracy but no stereoscopic vision is provided. The objective was to compare treatment results between a 2D HD and a 3D system after EETS with respect to residual tumor, periprocedural complications or new postoperative endocrinological deficit. Methods: Between December, 2008 and October, 2013; 134 patients (64 males, 47.8%) underwent EETS to treat (para)sellar pathologies (103 pituitary adenomas, 6 pituitary abscesses, 4 cysts, 3 meningiomas, 2 chordomas, and 16 other pathologies). In 65 patients the 2D HD system (Karl Storz, Germany) and in 69 the 3D system (VisionSense, New York, United States) was used. Prospective collected data were entered into a SPSS database. Results: Sex, age, pathology, and tumor volume did not statistically differ between groups. Three months MRI depicted residual tumor in 24% in the 2D and 26% in the 3D group. In 17 and 10 patient's residual tumor was difficult to differentiate in the 2D and 3D group, respectively. Overall 9 and 12 patients developed a new endocrine deficit in any of the hormone axis during the postoperative course in the 2D and 3D group. In the 2D seven (11%) and in the 3D eight (12%) patients had perioperative complications. Conclusions: In this series the rate of residual tumor, perioperative complications and new endocrine deficiency after EETS was similar using a 2D HD or a 3D system.