Endoscopic Transnasal Trans-Sphenoidal Approach for Pituitary Adenomas: A Comparison to the Microscopic Approach Cohort by Propensity Score Analysis

Abstract

BACKGROUND Despite some evidence for the adoption of endoscopic transnasal trans-sphenoidal surgery (ETSS) for pituitary adenomas, the advantages of this technique over the traditional approach have not been robustly confirmed. OBJECTIVE To compare ETSS with the microscopic sublabial trans-septal trans-sphenoidal surgery (MTSS) for pituitary adenomas. METHODS We retrospectively reviewed 2 cohorts of ETSS and MTSS performed at our institution from 1995 to 2017. Patient characteristics, surgical data, and outcomes were recorded prospectively. We performed a univariate and multivariable analysis to determine the best surgical approach. To improve the quality of the results, we matched the distribution of patient characteristics between groups by propensity score (PS) method. RESULTS A total of 187 procedures (90 MTSS, 97 ETSS) were reviewed. We found better results in the ETSS group in terms of gross total resection (P = .002) and hormone-excess secretion control (P = .014). There was also a lower incidence of cerebrospinal fluid leakage (P = .039), transitory diabetes insipidus (P = .028), and postoperative hypopituitarism (P = .045), as well as a shorter hospital length of stay (P < .001). After PS matching, we confirmed by multivariable logistic regression analysis an increased odds ratio of gross total resection for the ETSS (3.910; 95% CI 1.720-8.889; P = .001). CONCLUSION By PS method, our results suggest that the ETSS provides advantages over the traditional MTSS approach for tumor resection. Better control of secreting tumors and a lower rate of most complications also support the selection of the ETSS approach for the treatment of pituitary adenomas.

Challenges, Learning Curve, and Safety of Endoscopic Endonasal Surgery of Sellar-Suprasellar Lesions in a Community Hospital

“…2%. [22][23][24][25][26][28][29][30][31][32][33][35][36][37][38][39][40][41][42][43]50 The rate of recovery from hormonal deficits in our study is greater than that found by other researchers. Most of our patients (83.9%) showed stable or improved hormonal deficits.…”

“…Other studies have reported rates of vision improvement from as low as 23% to as high as 100%. [22][23][24][25][26][28][29][30][31][32][33][34][37][38][39][40][41][42][43]50 In our study, no patients had worsened vision after surgery. This is consistent with results found by other researchers who generally saw a very low rate of worsened visual deficits after surgery, on the order of 0%e3.…”

“…Many studies show a similar if not greater efficacy of EES compared with the gold standard microsurgical techniques. 26,42,44 This is the first study to look for the outcomes of patients undergoing endoscopic transnasal sellar, suprasellar, and anterior cranial fossa lesion excisions in a community hospital setting. It has also been demonstrated that the transition to EES is hindered by its learning curve, although the details of this learning curve and its clinical implications have not been studied in detail.…”

“…Most of our patients (83.9%) showed stable or improved hormonal deficits. Pablo et al 43 and Castano-Leon 42 found that hormonal deficits were stable or improved in 76.9% and 75.3% of patients, respectively. However, our rate of new deficits postoperatively seems to be in line with that of other researchers, at 16.1%.…”

“…Visual and postoperative outcomes in our study were consistent with the results shown in other studies. 24,33,40,42,43,50 Of patients experiencing visual issues at the time of diagnosis, 86.1% of patients had vision improvement and only 13.9% had no change in vision. No patients had a worsening vision.…”