Abstract
BackgroundThe endoscopic endonasal transsphenoidal approach (EETA) is an established technique for the resection of a large variety of benign sellar and suprasellar lesions, mostly pituitary adenomas. It has clear advantages over the microscopic approach, like a superior close-up view of the relevant anatomy and the tumor-gland interface, an enlarged working angle, as well as an increased panoramic vision inside the surgical area. We have been performing the EETA for over a decade, and this study will focus on perioperative and postoperative outcomes and complications and their association with the learning curve.Material and MethodsAll patients in our tertiary referral center (n = 369) undergoing an EETA for a lesion of the sellar and suprasellar region between January 1st 2008 and December 31st 2018 were included, and data were retrospectively retrieved from the electronic patient records.ResultsMedian follow-up after surgery was 55 months. Pituitary adenomas (n = 322) were the most frequent pathology. Headache (43.4%) and loss of vision (29.3%) were the most common presenting symptoms. Median procedure duration was significantly longer during the initial 5 years (106 versus 79 minutes; p <0.0001), but incidence of peri- and postoperative CSF leaks in the early years was not significantly higher. Knosp grade >2 was associated with perioperative CSF leak (p =0.002), and perioperative CSF leak was associated with postoperative CSF leak (p <0.001). Almost all cases of meningitis were preceded by a postoperative CSF leak. In 22.4% of patients, tumor recurrence required additional therapy. Perioperative (iatrogenic) mortality was 0.8%. The overall hospital stay decreased over time from an average of 7 to 5 days, and the case load increased yearly (p =0.015).ConclusionThe EETA is an excellent technique with complication rates comparable to or even lower than those in large microsurgical series in the literature. EETA has a significant learning curve affecting the procedure duration. Throughout the first 10 years following the transition from the microscopic approach to the EETA in our cohort, the caseload increased and hospital stay was reduced, while no increase in peri- and postoperative complications was observed.
Highlights
Tumors with the highest incidence located in the sellar and suprasellar region are benign pituitary adenomas [1]. They are derived from differentiated hormone-expressing cells located in the anterior part of the pituitary gland and are classified based on their size in microadenomas (40 mm) or on their hormone-producing capacity
Gonadotropinomas do not lead to hypersecretory syndromes and are diagnosed to the nonfunctional adenomas [3]
Monocentric cohort study we describe our 10 year experience with the endoscopic endonasal transsphenoidal approach (EETA) and evaluate the perioperative and postoperative outcomes, with emphasis on extent of tumor resection, cerebrospinal fluid (CSF) leakage, cranial nerve damage, recurrence, and the effects of the learning curve
Summary
Tumors with the highest incidence located in the sellar and suprasellar region are benign pituitary adenomas [1]. Non-functional adenomas can originate from any differentiated hormone-expressing cell, but are generally diagnosed when symptoms occur due to the size of the tumor [4] This so called mass-effect can lead to headache, hypopituitarism and/ or visual field deficits. Pituitary apoplexy can occur which is characterized by sudden onset of severe headache and rapidly worsening visual field deficits or double vision caused by compression of nerves surrounding the gland This is often followed by acute symptoms caused by lack of secretion of essential hormones. The endoscopic endonasal transsphenoidal approach (EETA) is an established technique for the resection of a large variety of benign sellar and suprasellar lesions, mostly pituitary adenomas It has clear advantages over the microscopic approach, like a superior close-up view of the relevant anatomy and the tumor-gland interface, an enlarged working angle, as well as an increased panoramic vision inside the surgical area. We have been performing the EETA for over a decade, and this study will focus on perioperative and postoperative outcomes and complications and their association with the learning curve
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