Endoscopic transsphenoidal surgery for resection of pituitary macroadenoma: A retrospective study.

Jiun-Lin Yan,Pin-Yuan Chen,Chen-Nen Chang,Giannicola Iannella

doi:10.1371/journal.pone.0255599

Jiun-Lin Yan, Pin-Yuan Chen + Show 2 more

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https://doi.org/10.1371/journal.pone.0255599

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Abstract

BackgroundThe endoscopic transsphenoidal approach is an efficient minimally invasive procedure for removal of pituitary tumors that can be accomplished through a one-hand or two-hand approach. The one-hand procedure through one nostril is more intuitive for surgeons, but maneuvering the instruments can be restrictive. The two-hand procedure using a one-and-half nostril approach provides more precise manipulation. This study aimed to compare the surgical outcomes of one-hand/mono-nostril and two-hand/one-and-half nostril surgeries for resection of large pituitary tumors by a single neurosurgeon.Materials and methodsThe surgical data of 78 consecutive cases with pituitary macroadenoma (diameter >1 cm) were reviewed retrospectively. Altogether, 30 cases received one-hand/mono-nostril surgery, while 48 cases received two-hand/one-and-half nostril surgery. Postoperative outcomes of the two operations were compared.ResultsThe operative time, hospital stay, residual rate of pituitary macroadenoma, visual field, surgical complications, and re-operative rates were slightly improved in the two-hand/one-and-half nostril surgery group compared with that in the one-hand/mono-nostril surgery group (all p>0.05). However, postoperative hypopituitarism was less frequent (1/48; 2.0%) with the two-hand/one-and-half nostril approach than with the mono-nostril approach (p = 0.004). Similar surgical outcomes were found in all patients with either small or large pituitary tumors, except that the difference in postoperative improvement in visual field change reached statistical significance (p = 0.044).ConclusionA single-surgeon endoscopic endonasal transsphenoidal surgery with two-hand/one-and-half nostril approach is an effective and safe procedure for removal of large pituitary tumors.

Highlights

In the past 20 years, neurosurgeons have used the endoscope to perform transsphenoidal surgery for pituitary tumors resection [1,2,3,4,5]
The operative time, hospital stay, residual rate of pituitary macroadenoma, visual field, surgical complications, and re-operative rates were slightly improved in the two-hand/one-andhalf nostril surgery group compared with that in the one-hand/mono-nostril surgery group
Similar surgical outcomes were found in all patients with either small or large pituitary tumors, except that the difference in postoperative improvement in visual field change reached statistical significance (p = 0.044)

Summary

Introduction

In the past 20 years, neurosurgeons have used the endoscope to perform transsphenoidal surgery for pituitary tumors resection [1,2,3,4,5]. An otorhinolaryngology (ENT) surgeon makes the initial sphenoid exposure, and a neurosurgeon removes the bony structures of the skull base and the lesion while the ENT surgeon operates the endoscope. Manpower-saving approach is a single-surgeon operation, with a mechanical or pneumatic endoscope holder [21]. This approach does not vary from the two-surgeon method as long as the surgeon has equivalent ability to visualize structures from a variety of angles and to remove tumor. This study aimed to compare the surgical outcomes of one-hand/mono-nostril and two-hand/one-and-half nostril surgeries for resection of large pituitary tumors by a single neurosurgeon

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