Comparison of endoscopic and microscopic removal of pituitary adenomas: single-surgeon experience and the learning curve

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The endoscopic endonasal approach for resection of pituitary lesions is an effective surgical option for tumors of the sella turcica. In this study the authors compared outcomes after either purely endoscopic resection or traditional microscope-aided resection. They also attempted to determine the learning curve associated with a surgical team converting to endoscopic techniques.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Retrospective data were collected on patients who were surgically treated for a pituitary lesion at the Hospital of the University of Pennsylvania between July 2003 and May 2008. Age, sex, race, presenting symptoms, length of hospital stay, surgical approach, duration of surgery, tumor pathological features, gross-total resection (GTR) of tumor, recurrence of the lesion, and intraoperative and postoperative complications were noted. All procedures were performed by the same senior neurosurgeon, who was initially unfamiliar with the endoscopic endonasal approach.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 25 patients underwent microscopic resection and 25 patients underwent endoscopic resection performed by a single skull base team consisting of the same senior neurosurgeon and otorhinolaryngologist (M.S.G. and B.W.O.). In the microscopically treated cohort, there were 8 intra- or postoperative complications, 6 intraoperative CSF leaks, 17 (77%) of 22 patients had GTR on postoperative imaging, 5 patients underwent ≥ 2 operations, and 10 (59%) of 17 patients reported total symptom resolution at follow-up. The endoscopically treated group had 7 intraor postoperative complications and 7 intraoperative CSF leaks. Of the patients who had pre- and postoperative imaging studies, 14 (66%) of 21 endoscopically treated patients had GTR; 4 patients had ≥ 2 operations, and 10 (66%) of 15 patients reported complete symptom resolution at follow-up. The first 9 patients who were treated endoscopically had a mean surgical time of 3.42 hours and a mean hospital stay of 4.67 days. The next 8 patients treated had a mean surgical time of 3.11 hours and a mean hospital stay of 3.13 days. The final 8 patients treated endoscopically had a mean surgical time of 2.22 hours and a mean hospital stay of 3.88 days. The difference in length of operation between the first 9 and the last 8 patients treated endoscopically was significantly different. There was a trend toward decreased CSF leaks and other complications from the first 2 groups compared with the third group.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In this subset of patients, the use of endoscopic endonasal resection results in a similar complication and symptom resolution rate compared with traditional techniques. The authors postulate that the learning curve for endoscopic resection can be ≤ 17 procedures.</jats:p></jats:sec>

Outcomes after a purely endoscopic transsphenoidal resection of growth hormone–secreting pituitary adenomas

“…Overall, the complication rates have typically been commensurate between endoscopic and microsurgical techniques. 22,53 In a study of two groups of 25 patients undergoing microscopic approaches and endoscopic approaches, O'Malley et al 53 described similar complication rates between the groups for both CSF leak and incidence of diabetes insipidus, with a trend toward less diabetes insipidus in the endoscopic group. Overall complications realized in this cohort of patients were 11.5% with no major complication requiring return to the operating room, permanent deficit, or treatment.…”

Full Endoscopic Transsphenoidal Surgery for Pituitary Adenoma-emphasized on Surgical Skill of Otolaryngologist

“…The comparison between microscopic approach and transnasal endoscopic approach had been discussed in a great number of literature [3][4][5][6][7][8][9][10]. We have no experiences in microscopic pituitary adenoma surgery; so we simply focus on the practical skill of transnasal endoscopic pituitary surgery.…”

“…In the pituitary surgery, the procedure by nasal endoscope has a lot of advantages that microscope can't afford [3][4][5][6][7][8][9][10][11][12][13][14][15]17], though it also has several disadvantages, however which will be overcomed along with the continuously developing of new instruments and new techniques.…”

“…Some of them [6][7][8] concluded that nasal endoscopic procedure overmatched microscopic surgery in terms of duration, remission rate, rate of total or subtotal excision, and the iatrogenic complications. Other articles [9,10] however, indicated that endoscopic pituitary surgery had no difference in outcome compared with microscopic approach. Actually, the outcome of endoscopic pituitary surgery is closely associated with the skill of playing nasal endoscopy; and the initial operation that has been performed inside nose.…”

“…Many articles which compared the outcome of nasal endoscopy with traditional microscopy transsphenoidal surgery had been published [6][7][8][9][10]. Some of them [6][7][8] concluded that nasal endoscopic procedure overmatched microscopic surgery in terms of duration, remission rate, rate of total or subtotal excision, and the iatrogenic complications.…”