Abstract
Background Surgery is, next to medical and radiation therapy, the mainstay
therapy for pituitary adenomas. While scientific consensus regarding the key
aspects of pituitary surgery exists among neurosurgeons, procedures are not
standardized and might vary significantly between hospitals and surgeons.
Objective To provide an overview of how neurosurgical departments in
Germany manage pituitary surgery.
Methods Responses from the European Pituitary Adenoma Surgery Survey were
analyzed. The survey contained 60 questions regarding demographics, training,
surgical and endocrinological aspects, and patient management.
Results Sixty neurosurgical centers from Germany responded to the survey.
Among the centers, 35.3% (n=18) exclusively use the microscopic
and 31.1% (n=14) the endoscopic technique; all other centers
(n=28) use both approaches. Of responding centers, 20%
(n=12) perform less than 10 transsphenoidal pituitary surgeries per
year, and 1.7% (n=1), more than 100 operations. The number of
transcranial pituitary operations is significantly smaller, with 53.3%
of centers performing only 0–2 per year, 35% performing
3–5, and only one center (1.7%) performing more than 15
transcranial operations per year. In 8 centers (13.3%), surgeries are
always performed together with an ENT surgeon; in 29 centers (48.4%) ENT
surgeons are never involved. In most centers (n=54, 90%)
intraoperative MRI is not available. Image guidance (with preoperative CT
and/or MRI data) is used by 91.7% of respondents (n=55).
Forty-two centers (72.4%) routinely prescribe hydrocortisone after
pituitary surgery, and 75% (n=45) have pituitary board meetings
with endocrinologists, radiologists, and radiosurgeons. Fifty-two
(86.7%) respondents perform the first follow-up scan by MRI 3–4
months after surgery.
Conclusions The data showed differences as well as similarities between
centers and could help to discuss the standardization of methods and the
formation of networks and certification to improve patient care.
Key words
pituitary adenoma - pituitary surgery - survey
