Complications Related to the Endoscopic Endonasal Transsphenoidal Approach for Nonfunctioning Pituitary Macroadenomas in 300 Consecutive Patients

Park

et al. 2016

J Korean Neurosurg Soc

ObjectiveThe inter-rater reliability of the modified Knosp's classification was measured before the analysis. The clinical validity of the parasellar extension grading system was evaluated by investigating the extents of resection and complication rates among the grades in the endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenomas.MethodsFrom November 2008 to August 2015, of the 286 patients who underwent EETS by the senior author, 208 were pituitary adenoma cases (146 non-functioning pituitary adenomas, 10 adrenocorticotropic hormone-secreting adenomas, 31 growth hormone-secreting adenomas, 17 prolactin-secreting adenomas, and 4 thyroid-stimulating hormone-secreting adenomas; 23 microadenomas, 174 macroadenomas, and 11 giant adenomas). Two neurosurgeons and a neuroradiologist independently measured the degree of parasellar extension on the preoperative sellar MRI according to the modified Knosp's classification. Inter-rater reliability was statistically assessed by measuring the intraclass correlation coefficient. The extents of resection were evaluated by comparison of the pre- and post-operative MR images; the neurovascular complications were assessed by reviewing the patients' medical records. The extent of resection was measured in each parasellar extension grade; thereafter, their statistical differences were calculated.ResultsThe intraclass correlation coefficient value of reliability across the three raters amounted to 0.862. The gross total removal (GTR) rates achieved in each grade were 70.0, 69.8, 62.9, 21.4, 37.5, and 4.3% in Grades 0, 1, 2, 3A, 3B, and 4, respectively. A significant difference in the extent of resection was observed only between Grades 2 and 3A. In addition, significantly higher complication rates were observed in the groups above Grade 3A.ConclusionAlthough the modified Knosp's classification system appears to be complex, its inter-rater reliability proves to be excellent. Regarding the clinical validity of the parasellar extension grading system, Grades 3A, 3B, and 4 have a negative predictive value for the GTR rate, with higher complication rates.

Section: Discussionsupporting

confidence: 54%

Parasellar Extension Grades and Surgical Extent in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas : A Single Surgeon's Consecutive Series with the Aspects of Reliability and Clinical Validity

Park

et al. 2016

J Korean Neurosurg Soc

Neurol. Med. Chir.(Tokyo)

“…6,12,14,43–47) Despite a wider exposure and dissection and, thus, a higher risk of intraoperative CSF leakage in endoscopic approach, the postoperative leak rates are at least equivalent if not superior to lower than those in microscopic surgery in the recent literature. The results of endoscopic series reported in the literature indicate an amount of new adenohypophysial dysfunction between 2.1 and 14.6%.…”

Section: Complicationsmentioning

confidence: 99%

“…The results of endoscopic series reported in the literature indicate an amount of new adenohypophysial dysfunction between 2.1 and 14.6%. 6,12,14,15,43,47) The risk for permanent diabetes insipidus with endoscopic surgery accounted for between 0.7 and 8.5%. 6,14,22,43,47) Injury of the carotid artery is a rare but severe and potentially fatal complication and is reported with a rate of less than 1%.…”

Section: Complicationsmentioning

confidence: 99%

“…6,12,14,15,43,47) The risk for permanent diabetes insipidus with endoscopic surgery accounted for between 0.7 and 8.5%. 6,14,22,43,47) Injury of the carotid artery is a rare but severe and potentially fatal complication and is reported with a rate of less than 1%. 6,15,42,44–46) In general, the surgical complication rates of endoscopic procedure are either equivocal or slightly superior to those of microscopic procedure.…”

Section: Complicationsmentioning

confidence: 99%

“…Postoperative epistaxis due to bleeding of the sphenopalatine artery or from one of the septal branches may develop in 1–2% of cases. 12,14,47) Sinonasal QOL following endoscopic pituitary surgery reaches a nadir at 2 to 3 weeks and recovers by 6 weeks to 3 months postoperatively. 49–51) Sinonasal QOL and overall health status are well correlated in the postoperative period, suggesting the importance of sinonasal QOL on the patient experience.…”

Section: Complicationsmentioning

confidence: 99%

See 2 more Smart Citations

Recent Evolution of Endoscopic Endonasal Surgery for Treatment of Pituitary Adenomas

Nishioka

2017

For the treatment of pituitary tumors, microscopic transsphenoidal surgery has been considered the “gold standard” since the late 1960s. Over the last two decades, however, a worldwide shift towards endoscopic endonasal surgery is in progress for many reasons. These include a wide panoramic view, improved illumination, an ability to look around anatomical corners using angled tip and, in addition, application to the extended approaches for parasellar tumors. Both endoscopic and microscopic approaches appear equally effective for nonfunctioning adenomas without significant suprasellar or lateral extensions, whereas the endoscopic approach may improve outcomes associated with the extent of resection and postoperative complications for larger tumors. Despite many theoretical benefits in the endoscopic surgery, remission rates of functioning adenomas do not substantially differ between the approaches in experienced hands. The endoscopic approach is a valid alternative to the microscopic approach for adenomas. The benefits will be more appreciated in the extended surgery for parasellar tumors.

Int Forum Allergy Rhinol

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

151

279

Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.