The Endoscopic versus the Traditional Approach in Pituitary Surgery

Abstract

The transsphenoidal route is the most widely used technique for pituitary adenoma surgery due to its rapidity, good tolerance, effectiveness and low complication rate. These are the parameters we utilized in comparing endoscopic with microscopic transsphenoidal surgery. We reviewed the medical records of 418 patients affected by pituitary adenomas who underwent endoscopic transsphenoidal surgery between May 1998 and December 2004, and in this paper, we present the results of 381 patients who fulfilled the follow-up criteria after a minimum period of 15 months. Our experience confirms the previous data on the rapidity and satisfactory tolerance of the endoscopic procedure. We also confirm the low complication rate, specifying that complications characteristic of the approaching phase were certainly reduced; instead, complications characteristic of tumor removal still remained similar to those reported in the microsurgical literature. The results were comparable with those of the best microsurgical series regarding endosellar lesions, but tumor removal was notably superior when dealing with tumors having an extrasellar extension. The improvement may be explained by the excellent vision of the deep surgical fields due to the endoscope and by the extreme flexibility of the surgical trajectory, mainly due to the absence of the divaricator, giving access to the ramifications of the tumor, otherwise difficult to reach.

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

“…21,22,27,31 The authors of series dedicated to outcomes after the microsurgical treatment of GH-secreting adenomas have described biochemical cure rates after microscopic procedures ranging from 42% to 67%, using the most recent criteria. 3,29,36,40,42,52,63 To assess biochemical cure rates after a purely endoscopic resection, the results typically must be separated from endoscopic series reporting data on all adenomas ( Table 5).…”

THERAPY OF ENDOCRINE DISEASE: Surgery in microprolactinomas: effectiveness and risks based on contemporary literature

“…Series reporting the outcomes of endoscopic transsphenoidal surgery in microprolactinomas are rather limited ( Table 2). The postoperative remission rates range between 81 and 100%, and in all but one of the studies, there is no available information on previous DA administration (19,28,29,30,31,32,33,34,35). Given that the main advantages of the endoscopic approach involve invasive adenomas, it would be anticipated that the remission rates should not differ between microscopic and endoscopic techniques in microprolactinomas.…”

“…The reported peri-and postoperative complications in endoscopic series include mortality 0% (19,29,30,31,33,34,35,37), visual deterioration 0% (32,34,37), and other neurosurgical complications 0% (37). The outcomes of pituitary function are given in Table 3; new pituitary hormone deficits range between 0 and 6% (19,29,30,37).…”

Real Time Parallel Intraoperative Integration of Endoscopic, Microscopic, and Navigation Images: A Proof of Concept Based on Laboratory Dissections

“…[18][19][20][21][22][23][24][25][26] The main advantage of the microscope is the ability to provide stereoscopic images associated with high degree of maneuverability (by allowing the use of both hands). On the other hand, the endoscope provides a close-up view of the lesion, with capability of looking around the corners and, when angulated lenses are used, of providing a panoramic view of the surrounding area.…”

“…Until now, endoscopic and microscopic techniques have been, by and large, regarded as mutually exclusive, sometimes competitive, techniques. [19][20][21][22][23][24]26 Even when one wanted to combine the microscope and the endoscope in the same setting, there has been a lack of tools to make this combination smooth and effective, 20 mainly due to the fact that when using the endoscope in a microsurgical environment the surgeon has to switch from the microscope ocular view to the endoscope monitor view or vice versa.…”