Clinical outcomes of endoscopic versus microscopic trans-sphenoidal surgery for large pituitary adenoma

Akbari, Hamideh; Malek, Mojtaba; Ghorbani, Mohammad; Hashemi, Seyed Mahmoud Ramak; Khamseh, Mohammad E.; Mehrjardi, Ali Zare; Emami, Zahra; Valojerdi, Ameneh Ebrahim

doi:10.1080/02688697.2018.1429569

Cited by 29 publications

(17 citation statements)

References 32 publications

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“…These results compare favorably with the published literature, where the rate of postoperative CSF leaks ranges from 1% to 6% 26 and other serious complications are rare, with no evidence of increase in complication rate compared to series without use of iMRI. 9,26,27 Overall, our findings support the general advantages of the endoscopic over the microscopic approach and augmented results with iMRI. iMRI inevitably adds to the operative time, estimated to be approximately 45-60 minutes, although evolving workflows have reduced time requirements, and iMRI often eliminates the need for postoperative MRI prior to discharge.…”

Section: Discussionsupporting

confidence: 76%

“…7 In secretory tumors, particularly with adrenocorticotropic hormone (ACTH), even small residual tumors can be associated with high rates of morbidity. 8 Although reported resection rates are generally higher in patients treated endoscopically compared with microscopically, 5,9 concern has been raised regarding the potential increased risk of endocrine deficits and CSF leaks.…”

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confidence: 99%

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Radiographic and clinical outcomes using intraoperative magnetic resonance imaging for transsphenoidal resection of pituitary adenomas

Juthani

Reiner

Patel³

et al. 2021

Journal of Neurosurgery

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OBJECTIVEThe utility and safety of intraoperative MRI (iMRI) for resection of pituitary adenomas is not clearly established in the context of advances in endoscopic approaches. The goal in this study was to evaluate the safety and efficacy of iMRI for pituitary adenoma resection, with endoscopic transsphenoidal (ETS) versus microscopic transsphenoidal (MTS) approaches.METHODSRadiographic and clinical outcomes of all pituitary adenomas resected using iMRI between 2008 and 2017 at a single institution were retrospectively evaluated.RESULTSOf 212 tumors treated, 131 (62%) underwent further resection based on iMRI findings, resulting in a significant increase in gross-total resection on postoperative MRI compared with iMRI (p = 0.0001) in both ETS and MTS groups. iMRI increased rates of gross-total resection for cavernous sinus invasion Knosp grades 1 and 2, but not in Knosp ≥ 3 across treatment groups (p < 0.0001). The extent of resection on postoperative MRI was significantly correlated with increased progression-free survival (p < 0.0001). Initial hormone remission off medical therapy was achieved in 64%, with a significantly higher rate of remission in tumors resected via the ETS approach (81%) compared with the MTS approach (55%) (p = 0.02). The rate of persistent new hormone deficit was low at 8%, including a 2.8% rate of permanent diabetes insipidus, and 45% of patients had improvement in preoperative hormone deficit following surgery. Serious postoperative complications including CSF leaks requiring reoperation were rare at 1%, with no postoperative infections.CONCLUSIONSThese results suggest that iMRI is a safe and effective method of increasing the extent of resection for pituitary adenomas while preserving hormone function. When paired with the endoscope, iMRI may offer the ability to tailor more aggressive removal of tumors while optimizing pituitary function, resulting in high rates of secretory hormone remission. Secretory tumors and adenomas with Knosp grade < 3 cavernous sinus invasion may benefit most from the use of iMRI.

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Section: Discussionsupporting

confidence: 76%

mentioning

confidence: 99%

Radiographic and clinical outcomes using intraoperative magnetic resonance imaging for transsphenoidal resection of pituitary adenomas

Juthani

Reiner

Patel³

et al. 2021

Journal of Neurosurgery

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“…Treatments such as radiotherapy or stereotactic radiosurgery may be offered to those patients who don't benefit from surgery. 2 Transsphenoidal surgery for pituitary adenomas has a very low incidence of complications and even lower mortality. Transient diabetes insipidus due to CSF leak and post-op hematoma is a complication that is apprehended.…”

Section: Introductionmentioning

confidence: 99%

“…However, in increased tumor size, the success rate can be lower in both approaches owing to lateral extension and invasion of the cavernous sinus. 2,5 Pituitary adenomas were most effectively addressed and the treatment was most rewarding when it is detected early followed by rendering prompt and relevant treatment. In another study, it has been concluded that endoscopic transsphenoidal surgery is an effective and safe modality for pituitary adenoma's treatment and can be employed as a first-choice therapy.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcome and Complication of Endoscopic Endonasal Transsphenoidal Surgery (ETSS) for Pituitary Adenoma: A Retrospective Study at Prime Teaching Hospital Peshawar

2021

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Objectives: The study aimed to ascertain the clinical outcome and complications of endoscopic endonasal transsphenoidal surgery (ETSS) for pituitary adenomas. Material & Methods: A retrospective study conducted at the Department of Neurosurgery Prime Teaching Hospital Peshawar, Pakistan. Pituitary adenoma was diagnosed in 89 patients on MRI Brain with contrast and post-surgical biopsy. Post-surgical outcomes and complications were documented. Results: Out of 89 patients, 54% were male, and 46% female patients. The mean age was 42 ± 5 years. Headache was reported in 92% as a most common presentation, followed by decreased visual acuity in 62 %, amenorrhea in 22%, and acromegaly in 29% of patients. Overall, the symptoms related to surgical improvement were observed in 72% of patients. A good surgical outcome was observed in 80% of patients with microadenomas, as compared to the patients with macroadenomas. The most common complication was the transient diabetes insipidus followed by Cerebrospinal fluid (CSF) leak and post-operative hematoma. Conclusion: Endoscopic endonasal transsphenoidal surgery (ETSS) is a safe, less invasive, cosmetically effective technological advancement for pituitary adenomas.

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“…Except for lactating pituitary adenomas, surgical resection is the first choice of treatment, and most pituitary adenomas can be removed by transsphenoidal surgery. At present, resection of pituitary adenomas by transsphenoidal approach under microscopy and neuroendoscopy is a clinically mature minimally invasive surgery[5].…”

Section: Introductionmentioning

confidence: 99%

Neuroendoscopic and microscopic transsphenoidal approach for resection of nonfunctional pituitary adenomas

Ding

Zhang

Wang

2019

WJCC

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BACKGROUND Nonfunctional pituitary adenoma is a common type of pituitary adenoma, which can lead to headache, visual field disturbance, and cranial nerve damage due to increased tumor volume. Neuroendoscopic and microscopic transsphenoidal approaches have been widely used in the resection of nonfunctional pituitary adenomas. However, the clinical efficacy in neuroendoscopic and microscopic surgery is still controversial. AIM To explore the clinical efficacy of neuroendoscopic and microscopic transsphenoidal approach for resection of nonfunctional pituitary adenomas. METHODS We retrospectively analyzed 251 patients with nonfunctional pituitary adenomas; 138 underwent neuroendoscopic surgery via transsphenoidal approach, and 113 underwent microscopic surgery via transsphenoidal approach between July 2010 and September 2015. All patients were followed up for > 6 mo. Gender, age, course of disease, tumor diameter, tumor location, and percentage of patients with headache, visual impairment, sexual dysfunction, and menstrual disorders were contrasted between the two groups to compare the difference of preoperative data. Cure rate, symptom improvement rate, recurrence rate, the postoperative hospital stay, operating time, intraoperative blood loss, and the incidence of postoperative complications were compared in order to evaluate the advantages and disadvantages of neuroendoscopic and microscopic surgery. RESULTS There was no significant difference in cure rate, symptom improvement rate, and recurrence rate between neuroendoscopy group and microscopy group (82.6% vs 85.8%, P > 0.05; 90.6% vs 93.8%, P > 0.05; 5.1% vs 9.7%, P > 0.05). In the neuroendoscopy group, the postoperative hospital stay was 8.4 ± 0.6 d; operating time was 167.2 ± 9.6 min; intraoperative blood loss was 83.4 ± 9.3 mL, and the rates of diabetes insipidus and electrolyte imbalance were 4.3% and 8.0%, respectively. The corresponding results in the microscopic group were 11.2 ± 0.6 d, 199.7 ± 9.3 min, 138.8 ± 13.6 mL, and 32.7% and 20.4%, respectively. There were significant differences in postoperative hospital stay, operating time, intraoperative blood loss, and the rates of diabetes insipidus and electrolyte imbalance between the two groups ( P < 0.05). CONCLUSION Neuroendoscopic and microscopic transsphenoidal approaches have similar clinical efficacy for the resection of nonfunctional pituitary adenomas. Neuroendoscopic surgery reduces operating time, intraoperative bleeding, postoperative recovery, and complications.

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Clinical outcomes of endoscopic versus microscopic trans-sphenoidal surgery for large pituitary adenoma

Abstract: ETS is superior to MTS in treatment of large pituitary adenomas with comparable post-operative complications.

Cited by 29 publications

References 32 publications

Radiographic and clinical outcomes using intraoperative magnetic resonance imaging for transsphenoidal resection of pituitary adenomas

Radiographic and clinical outcomes using intraoperative magnetic resonance imaging for transsphenoidal resection of pituitary adenomas

Clinical Outcome and Complication of Endoscopic Endonasal Transsphenoidal Surgery (ETSS) for Pituitary Adenoma: A Retrospective Study at Prime Teaching Hospital Peshawar

Neuroendoscopic and microscopic transsphenoidal approach for resection of nonfunctional pituitary adenomas

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