Comparative Analysis of the Early and Late Endoscopic Endonasal Surgical Experience in the Treatment of Pituitary Adenoma

Objective: To compare the results of endoscopic endonasal pituitary surgery between January 2010 and May 2021.

Method: Patients were divided into two groups based on the period of surgery. The first group from January 2010 to December 2015, and the second group from January 2016 to May 2021. A retrospective analysis of the complexity level, the extent of resection, complications, and outcomes was performed.

Results: There were 287 patients in the first group and 371 patients in the second group. The gender ratio, as well as the patient's age in both groups, was similar.

Distributions by size in the first and second groups were: 35 (12.2%) and 31 (8.35%) microadenomas, 125 (43.55%) and 182 (49.05%) macroadenomas, 86 (29.9%) and 124 large (33.4%), and 41 (14.3%) and 34 (9.16%) giant tumors, respectively. According to the KNOSP-classification, adenomas in the first and second groups were following: KNOSP-0—138 (47%) and 187 (50.4%), KNOSP-1—65 (22.6%) and 78 (21%), KNOSP-2—44 (15.3%) and 52 (14%), KNOSP-3—19 (6.6%) and 32 (8.3%), KNOSP-4—20 (6.9%) and 20 (5.4%), respectively.

The level of complexity in the first group corresponds to: Level-II—276 (96%) cases, Level-III—3 (1%) cases, and Level-IV—8 (3%) cases. While in the second group, there were: Level-II—335 (90%) cases, Level-III—13 (3.5%) cases, Level-IV—20 (5.4%) cases, and Level-V—3 (0.8%) cases.

In the first group a gross total resection (GTR) was achieved in 152 (52.9%) cases, near total resection (NTR) in 65 (22.6%) cases, subtotal resection (STR) in 42 (14.6%) cases, and partial in 28 (9.7%) cases. In the second group, a GTR was achieved in 269 (72.5%) cases, NTR in 28 (7.5%) cases, STR in 52 (14%) cases, and partial in 22 (5.9%) cases.

A postoperative CSF-leak occurred in 5 (1.7%) patients in the first group and 11 (2.9%) patients in the second group. Meningitis was observed in 2 (0.7%) and 6 (1.6%) patients respectively. Oculomotor functions in the first group improved in 9 (36%) patients, no changes in 15 (60%), and 3 (1.04%) patients developed a new deficit. In the second group, 14 (56.5%) patients demonstrated an improvement in oculomotor functions, 7 (30%) patients remained unchanged, and 2 (0.5%) patients deteriorated, while one was transient. A total of 125 (71.8%) patients in the first group and 213 (88.3%) patients in the second demonstrated a chiasmal syndrome improvement.

A new endocrinological deficit was detected in 42 (14.6%) patients in the first group, and in 47 (12.6%) patients in the second group. However, it was transient in 5 (1.74%) patients in the first and in 11 (2.96%) patients in the second group.

A perioperative mortality rate was 1 and 0.8% in the first and second groups, respectively.

Conclusion: Based on obtained data in this study we found that the level of complexity as the extent of the tumors resections (GTR) increased in the second group up to 20%, and it was not associated with the growing number of complications. This could be explained by improved skills and grown experience over the years.

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Artikel online veröffentlicht:
15. Februar 2022