Prospective comparison of sinonasal outcomes after microscopic sublabial or endoscopic endonasal transsphenoidal surgery for nonfunctioning pituitary adenomas

Pledger, Carrie L.; Elzoghby, Mohamed; Oldfield, Edward H.; Payne, Spencer C.; Jane, John A.

doi:10.3171/2015.6.jns142695

Cited by 39 publications

(55 citation statements)

References 32 publications

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“…Eventually, 19 studies were included in the final analysis, enrolling 389 patients underwent microscopic transsphenoidal resection and 3458 patients with endoscopic approach. Four of which directly compared endoscopic and microscopic approaches [7][8][9][10], while the other 15 articles are single-armed studies [11][12][13][14][15][16][17][18][19][20][21][22][23], reporting purely endoscopic or microscopic transsphenoidal surgery on NFPA [11][12][13][14][15][16][17][18][20][21][22][23]. The proportion of gender, the presence of pre-operatively hypopituitarism, visual deficiency and invasive tumours were significant different between the two groups ( Table 1).…”

Section: Resultsmentioning

confidence: 99%

Outcomes of endoscopic and microscopic transsphenoidal surgery on non‐functioning pituitary adenomas: a systematic review and meta‐analysis

Yao

et al. 2018

J Cellular Molecular Medi

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Both microscopic and endoscopic transsphenoidal surgery are effective approaches for nonfunctioning pituitary adenomas. The issue on the comparison of their efficacy and safety remains inconsistent. A thorough search of the literatures (PubMed, EMBASE, MEDLINE) were performed up to March 2017. Studies reporting outcomes of microscopic or endoscopic transsphenoidal surgery on nonfunctioning pituitary adenomas were included. A meta‐analysis was performed focusing on the early stage and long term outcomes. The final search yielded 19 eligible studies enrolling 3847 patients, 389 of them underwent microscopic approach and 3458 of them with endoscopic approach. As to the early stage outcomes, the rate of gross tumor resection was significantly higher in the endoscopic group than that in microscopic group (73% versus 60%, P < 0.001). Meanwhile, endoscopic approach showed priority over microscopy on postoperative hypopituitarism (63% versus 65%, P < 0.001) and CSF leakage (3% versus 7%, P < 0.001). For the long term outcomes, the rate of visual improvement was significant higher in the endoscopic group than that in microscopic group (77% versus 50%, P < 0.001). However, there was no significant difference between the groups regarding the rate of permanent diabetic insipidus and meningitis. The endoscopic approach may be associated with higher rate of gross tumor movement and lower risk of postoperatively complications for treating nonfunctioning pituitary adenoma, when compared with microscopic approach. However, the confidence was shorted due to limited high quality evidence (largely randomized and controlled studies).

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Section: Resultsmentioning

confidence: 99%

Outcomes of endoscopic and microscopic transsphenoidal surgery on non‐functioning pituitary adenomas: a systematic review and meta‐analysis

Yao

et al. 2018

J Cellular Molecular Medi

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“…Here, a further follow‐up would be necessary. In another comparative study of microscopical and bilateral endoscopical surgery, Pledger et al found no significant difference between the late postoperative SNOT‐20 scores . Similarly, to Hong et al, they applied bilateral endoscopic techniques that may have a greater impact on QOL than the unilateral approaches, suggested in this article.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic unilateral transethmoid‐paraseptal approach to the central skull base

Eördögh

Briner

Simmen

et al. 2017

Laryngoscope Investig Oto

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ObjectivesThe endoscopic technique in transnasal skull base surgery offers optimal visualization and free manipulation in the surgical field. However, it may cause approach‐related sinonasal injury, influencing patients' quality of life (QOL). To minimize rhinological morbidity without restrictions in surgical manipulation and tumor resection, we introduced the unilateral transethmoidal‐paraseptal approach. In this article, we analyzed the long‐term results and sinonasal outcome of this technique.Study DesignRetrospective analysis of medical records.MethodsForty‐two consecutive patients underwent surgery between June 2010 and March 2014 using the transethmoid‐paraseptal approach. Perioperative work‐up included neurological, radiological, endocrinological, ophthalmological, and rhinological analysis. Patients' preoperative, 1‐month and 1‐year postoperative QOL was measured using the Sino‐Nasal Outcome Test (SNOT‐22).ResultsAt all individuals, a unilateral transethmoid‐paraseptal approach was performed. Removal of the turbinates, posterior septal resection or a conversion to biportal surgery could be avoided in all cases. There were no intraoperative neurovascular complications. All patients had a notable improvement in any disease‐related symptoms, as well as by objective criteria. Complete tumor resection was aimed in 39 cases and achieved in 31 of them. The SNOT‐22 scores transiently worsened 1 month after surgery and non‐significantly improved after 1 year, compared with the preoperative status. A subgroup of 7 patients with preoperative sinonasal disease evidence showed continuous significant improvement (p < .05) of SNOT‐22 scores across time. The smell screening tests showed no significant difference across time.ConclusionThe described approach allows safe removal of various skull base lesions without deterioration in sinonasal QOL and smell function.Level of Evidence4.

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“…49) Many authors noted better sinonasal QOL after endoscopic approach than microscopic approach at least in short-term period after surgery. 49–54) However, Pledger et al 51) reported that although patients who underwent endoscopic surgery experienced significantly fewer nasal symptoms during the first 8 weeks, by 1 year after surgery, there were no significant differences between the endoscopic and microscopic groups.…”

Section: Complicationsmentioning

confidence: 99%

“…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. 49) Many authors noted better sinonasal QOL after endoscopic approach than microscopic approach at least in short-term period after surgery.…”

Section: Complicationsmentioning

confidence: 99%

Recent Evolution of Endoscopic Endonasal Surgery for Treatment of Pituitary Adenomas

Nishioka

2017

Neurol. Med. Chir.(Tokyo)

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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.

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Prospective comparison of sinonasal outcomes after microscopic sublabial or endoscopic endonasal transsphenoidal surgery for nonfunctioning pituitary adenomas

Cited by 39 publications

References 32 publications

Outcomes of endoscopic and microscopic transsphenoidal surgery on non‐functioning pituitary adenomas: a systematic review and meta‐analysis

Outcomes of endoscopic and microscopic transsphenoidal surgery on non‐functioning pituitary adenomas: a systematic review and meta‐analysis

Endoscopic unilateral transethmoid‐paraseptal approach to the central skull base

Recent Evolution of Endoscopic Endonasal Surgery for Treatment of Pituitary Adenomas

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