Abstract
Endoscopic pituitary surgery has shown promising results. This study reports the experiences of experienced microscopic pituitary surgeons changing to the endoscopic technique, and the beneficial effects on the postoperative outcomes. 45 transsphenoidal endoscopic-assisted surgeries performed in 2016–2017 were compared with 195 microscope-assisted surgeries performed in 2007–2017 for pituitary adenoma. Tumour size, hormonal status and vision were assessed preoperatively and 3–5 months postoperatively. Cases were identified through electronic patient records. GTR was achieved in 39% of the endoscopic operations vs. 22% of microscopic operations, p = 0.018. Mean duration of surgery was 86 min (77–95) with the endoscopic technique vs. 106 min (101–111) with the microscopic technique, p < 0.001. New hypothalamus–pituitary–adrenal axis deficiencies were observed after 3% of endoscopic vs. 34% microscopic operations, p = 0.001, and overall fewer postoperative pituitary deficiencies were observed in the endoscope-assisted group. Complications within 30 days of surgery occurred in 17% of endoscopic operations vs. 27% of microscopic operations (p > 0.05). Normalization of visual impairment occurred in 37% of the cases with preoperative visual impairment in the endoscopic group vs. 35% of those in the microscopic group (p > 0.05). The endoscopic technique performed better as a surgical procedure for pituitary adenomas. We found no statistically significant differences in complication rate or visual improvement between the two techniques.
Highlights
Endoscopic pituitary surgery has shown promising results
Pituitary adenomas (PAs) account for 10–25% of all intracranial tumours1,2. They arise from the pituitary in the sella turcica and are classified as either clinically non-functioning pituitary adenomas (NFPAs) or clinically functioning adenomas such as prolactinomas (PRL), adrenocorticotropic hormone (ACTH)-secreting, growth hormone (GH)-secreting or thyroid-stimulating hormone (TSH)-secreting adenomas3
Gross total resection was achieved in 39% (17/45) of operations using the endoscopic technique compared to 22% (42/195) of operations using the microscopic technique, p = 0.018
Summary
Endoscopic pituitary surgery has shown promising results. This study reports the experiences of experienced microscopic pituitary surgeons changing to the endoscopic technique, and the beneficial effects on the postoperative outcomes. 45 transsphenoidal endoscopic-assisted surgeries performed in 2016–2017 were compared with 195 microscope-assisted surgeries performed in 2007–2017 for pituitary adenoma. The aims are to remove all tumour tissue (i.e. gross total resection), relieve pressure and minimize the risk of relapse Both immediate and long-term complications can arise from surgery close to the anterior pituitary cells and stalk, the optic chiasma and adjacent cranial nerves in the cavernous s inus. Jankowski et al. demonstrated in 1992 a simpler and faster approach to the sella using an endoscopic transsphenoidal approach that improved the surgeon’s ability to identify high-risk structures and to resect PAs with a supra- and parasellar extension. This endoscopic technique has since been standardized and adopted worldwide as an alternative to the microscopic a pproach. Previous studies have investigated the introduction of the endoscopic procedure into
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call