Fully Endoscopic Endonasal vs. Transseptal Transsphenoidal Pituitary Surgery

Kabil, Mohamed S; Eby, Joseph B.; Shahinian, Hrayr K.

doi:10.1055/s-2005-915635

Cited by 150 publications

(119 citation statements)

References 23 publications

(30 reference statements)

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“…The remission rate of hypersecretion was significantly better in the endoscopic group (63 vs 50%). Kabil et al reported on 300 pts undergoing endoscopic resection with a similar cure rate of 87% in GH secreting adenomas, 86% in Cushing's disease and 80% in prolactinomas (Kabil et al, 2005). We have also noted a high cure rate in our endoscopic series of patients treated for Cushing's disease (figure 8a&b).…”

Section: Endoscopic Endonasal Surgery: Advantagessupporting

confidence: 60%

“…O'Malley et al reported on 50 pts, half of them undergoing microscopic approaches and half undergoing endoscopic approaches, and showed comparable complication rates between the two groups for both CSF leak and incidence of diabetes insipidis with a trend toward less diabetes incipidus (DI) in the endoscopic group (O'Malley et al, 2008) . Kabil et al demonstrated a 2% CSF leak in a series of over 650 patients undergoing endoscopic resection (Kabil et al, 2005). Minor complications include septal perforation, trauma to external nose and sinusitis.…”

Section: Complications and Disadvantagesmentioning

confidence: 99%

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Endoscopy in Intracranial Pathology

Najjar¹,

Turkmani²

2011

Advances in Endoscopic Surgery

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Section: Endoscopic Endonasal Surgery: Advantagessupporting

confidence: 60%

Section: Complications and Disadvantagesmentioning

confidence: 99%

Endoscopy in Intracranial Pathology

Najjar¹,

Turkmani²

2011

Advances in Endoscopic Surgery

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“…In these series, cure rates range from 57% to 100%. 7,10,13,21,22,27,31,33,34,44,57,66 We are aware of only one early study that focused specifically on outcomes after endoscopic resection in the setting of acromegaly. 44 In this early study the authors reviewed the cases of 5 patients with mostly microadenomas and reported a cure rate of 100% using a liberal cure benchmark.…”

Section: Discussionmentioning

confidence: 99%

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

Campbell¹,

Kenning

Andrews³

et al. 2010

FOC

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Object Using strict biochemical remission criteria, the authors assessed surgical outcomes after endoscopic transsphenoidal resection of growth hormone (GH)–secreting pituitary adenomas and identified preoperative factors that significantly influence the rate of remission. Methods A retrospective review of a prospectively maintained database was performed. The authors reviewed cases in which an endoscopic resection of GH-secreting pituitary adenomas was performed. The cohort consisted of 26 patients who had been followed for 3–60 months (mean 24.5 months). The thresholds of an age-appropriate, normalized insulin-like growth factor–I concentration, a nadir GH level after oral glucose load of less than 1.0 μg/l, and a random GH value of less than 2.5 μg/l were required to establish biochemical cure postoperatively. Results Overall, in 57.7% of patients undergoing a purely endoscopic transsphenoidal pituitary adenectomy for acromegaly, an endocrinological cure was achieved. The mean clinical follow-up duration was 24.5 months. In patients with microadenomas (4 cases) the cure rate was 75%, whereas in patients harboring macroadenomas (22 cases) the cure rate was 54.5%. Cavernous sinus invasion (Knosp Grades 3 and 4) was associated with a significantly lower remission rate (p = 0.0068). Hardy Grade 3 and 4 tumors were also less likely to achieve biochemical cure (p = 0.013). The overall complication rate was 11.5% including 2 incidents of transient diabetes insipidus and 1 postoperative CSF leak, which were treated nonoperatively. Conclusions A purely endoscopic transsphenoidal approach to GH-secreting pituitary adenomas leads to similar outcome for noninvasive macroadenomas compared with traditional microsurgical techniques. Furthermore, this approach may often provide maximal visualization of the tumor, the pituitary gland, and the surrounding neurovascular structures.

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“…The application of endoscopes in transsphenoidal surgery in the 1990s changed this situation, because the lenses provided a wider field of view. 11,15,36,39,60 This wider view enables the surgeon to inspect the medial wall of the CS directly and therefore to pass a more reliable judgment regarding parasellar invasiveness.…”

mentioning

confidence: 99%

“…52,62 Overt parasellar invasion into cavernous sinus (CS) structures is found intraoperatively in 6%-10% 1,20 of cases and is the most important reason for incomplete resection and the decrease in cure rates from 78%-92% (in cases without parasellar invasion) to 20%-52%. 16,20,21,24,36,39,62,64 Because of the close relationship of the internal carotid arteries (ICAs), histological specimens of the medial wall are not routinely available, 54,65,77 so surgical observations 59 and/or radiological signs of invasion 14 are still the most important methods of detection.…”

mentioning

confidence: 99%

Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification

Micko¹,

Wöhrer

Wolfsberger³

et al. 2015

JNS

399

281

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abbreviatioNs CS = cavernous sinus; ER = endocrinological remission; GTR = gross-total resection; ICA = internal carotid artery. submitted May 22, 2014. accepted December 2, 2014. iNclude wheN citiNg Published online February 6, 2015; DOI: 10.3171/2014.12.JNS141083. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect An important prognostic factor for the surgical outcome and recurrence of a pituitary adenoma is its invasiveness into parasellar tissue, particularly into the space of the cavernous sinus (CS). The aims of this study were to reevaluate the existing parasellar classifications using an endoscopic technique and to evaluate the clinical and radiological outcomes associated with each grade. methods The authors investigated 137 pituitary macroadenomas classified radiologically at least on one side as Grade 1 or higher (parasellar extension) and correlated the surgical findings using an endoscopic technique, with special reference to the invasiveness of the tumor into the CS. In each case, postoperative MRI was performed to evaluate the gross-total resection (GTR) rate and the rate of endocrinological remission (ER) in functioning adenomas. results The authors found a 16% rate of CS invasion during surgery for these macroadenomas. Adenomas radiologically classified as Grade 1 were found to be invasive in 1.5%, and the GTR/ER rate was 83%/88%. For Grade 2 adenomas, the rate of invasion was 9.9%, and the GTR/ER rate was 71%/60%. For Grade 3 adenomas, the rate of invasion was 37.9%, and the GTR/ER rate was 75%/33%. When the superior compartment of the CS (Grade 3A) was involved, the authors found a rate of invasion that was lower (p < 0.001) than that when the inferior compartment was involved (Grade 3B). The rate of invasion in Grade 3A adenomas was 26.5% with a GTR/ER rate of 85%/67%, whereas for Grade 3B adenomas, the rate of surgically observed invasion was 70.6% with a GTR/ER rate of 64%/0%. All of the Grade 4 adenomas were invasive, and the GTR/ER rate was 0%. A comparison of microscopic and endoscopic techniques revealed no difference in adenomas with Grade 1 or 4 parasellar extension. In Grade 2 adenomas, however, the CS was found by the endoscopic technique to be invaded in 9.9% and by microscopic evaluation to be invaded in 88% (p < 0.001); in Grade 3 adenomas, the difference was 37.9% versus 86%, respectively (p = 0.002). Grade 4 adenomas had a statistically significant lower rate of GTR than those of all the other grades. In case of ER only, Grade 1 adenomas had a statistically significant higher rate of remission than did Grade 3B and Grade 4 adenomas. coNclusioNs The proposed classification proved that with increasing grades, the likelihood of surgically observed invasion rises and the chance of GTR and ER decreases. The direct endoscopic view confirmed the low rate of invasion of Grade 1 adenomas but showed significantly lower rates of invasion in Grade 2 and 3 adenomas than those previousl...

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Fully Endoscopic Endonasal vs. Transseptal Transsphenoidal Pituitary Surgery

Cited by 150 publications

References 23 publications

Endoscopy in Intracranial Pathology

Endoscopy in Intracranial Pathology

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

Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification

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