Comparative Efficacy of Transsphenoidal Endonasal Endoscopic and Microscopic Pituitary Surgery at Single Center of a Developing Country

Abstract

Objective This study was aimed to compare comparative efficacy of transsphenoidal endonasal endoscopic and microscopic pituitary surgery at single center of a developing country.

Methods This study included 198 patients in which 50 patients were studied prospectively and 148 patients were studied retrospectively, diagnosed with pituitary adenoma who presented to neurosurgery department at Sawai Man Singh hospital in Jaipur, India, and were operated via transsphenoidal route between 2013 and 2018. Patients' records were reviewed and relevant clinical and surgical data were collected. Patients were divided into two groups based on the surgical procedure performed, endoscopic endonasal transsphenoid approach (group 1) and microscopic transsphenoidal approach (group 2). Outcomes, in terms of efficacy and the resulting complications of each procedure were compared and analyzed.

Results A total of 198 patients with pituitary adenoma were operated during the study period. Among them, 119 (60.1%) patients were operated by endoscopic and 79 (39.9%) patients were operated by microscopic transsphenoidal approach. In endoscopic group, intraoperative cerebrospinal fluid (CSF) leak was present in 39 patients (32.77%) and 23 (29.11%) in microscopic group. Complete tumor removal was achieved in 69.75% in endoscopic and 48.13% in microscopic group (p = 0.004). Endocrine control was achieved in 78.94% (30 out of 38) in endoscopic and 68.18% (15 out of 22 patients) in microscopic group.

Conclusion The transsphenoidal approaches for resection of pituitary adenoma, both endoscopic and microscopic approach, are minimally invasive and effective for disease control. Both the approaches lead to similar endocrine control, visual symptoms, complications, and long-term outcome. Therefore, the selection of the final approach should be individualized, ultimately depending on the surgeons' comfort, experience, and familiarity with the particular technique.

Keywords

pituitary adenoma - endoscope - transsphenoidal surgery

Publication History

Received: 01 June 2019

Accepted: 17 November 2019

Article published online:
03 February 2020

• References

• 1 Ezzat S, Asa SL, Couldwell WT. et al. The prevalence of pituitary adenomas: a systematic review. Cancer 2004; 101 (03) 613-619
• 2 Gondim JA, Schops M, de Almeida JP. et al. Endoscopic endonasal transsphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center. Pituitary 2010; 13 (01) 68-77
• 3 Leclercq TA, Grisoli F. Avoidance of diabetes insipidus in transsphenoidal hypophysectomy. A modified technique of selective hypophysectomy. J Neurosurg 1983; 58 (05) 682-684
• 4 Schloffer H. Erfolgreiche Operation eines Hypophysentumors auf nasalem Wege. Wien Klin Wochenschr 1907; 20: 621-624
• 5 Cushing H. The Weir Mitchell lecture: surgical experiences with pituitary disorders. J Am Med Assoc 1914; 63 (18) 1515-1525
• 6 Hardy J. [Surgery of the pituitary gland, using the trans-sphenoidal approach. Comparative study of 2 technical methods]. Union Med Can 1967; 96 (06) 702-712
• 7 Guiot G, Rougerie J, Fourestier A. et al. [Intracranial endoscopic explorations]. Presse Med 1963; 71: 1225-1228
• 8 Jankowski R, Auque J, Simon C, Marchal JC, Hepner H, Wayoff M. Endoscopic pituitary tumor surgery. Laryngoscope 1992; 102 (02) 198-202
• 9 Giustina A, Chanson P, Bronstein MD. et al; Acromegaly Consensus Group. A consensus on criteria for cure of acromegaly. J Clin Endocrinol Metab 2010; 95 (07) 3141-3148
• 10 D'Haens J, Van Rompaey K, Stadnik T, Haentjens P, Poppe K, Velkeniers B. Fully endoscopic transsphenoidal surgery for functioning pituitary adenomas: a retrospective comparison with traditional transsphenoidal microsurgery in the same institution. Surg Neurol 2009; 72 (04) 336-340
• 11 Eltabl MA, Eladawy YM, Hanafy AM, Saleh EE, Elnoomany HA. Surgical outcome of endoscopic versus microscopic trans-sphenoidal approach for pituitary adenomas. Menoufia Med J 2015; 28 (01) 87
• 12 Ammirati M, Wei L, Ciric I. Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2013; 84 (08) 843-849
• 13 Farid M. Endoscopic versus microscopic approach for management of pituitary tumors. J Am Sci 2015; 11 (01) 1
• 14 Esposito F, Kelly DF. Closure methods. In: Laws ER, Lanzino G. eds. Transsphenoidal Surgery. Philadelphia, PA: Saunders Elsevier; 2010: 169-180
• 15 Ciric I, Ragin A, Baumgartner C, Pierce D. Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 1997; 40 (02) 225-236
• 16 Zhou Q, Yang Z, Wang X. et al. Risk factors and management of intraoperative cerebrospinal fluid leaks in endoscopic treatment of pituitary adenoma: analysis of 492 patients. World Neurosurg 2017; 101: 390-395
• 17 Prajapati HP, Jain SK, Sinha VD. Endoscopic versus microscopic pituitary adenoma surgery: An institutional experience. Asian J Neurosurg 2018; 13 (02) 217-221
• 18 Cheng RX, Tian HL, Gao WW, Li ZQ. A comparison between endoscopic trans-sphenoidal surgery and traditional trans-sphenoidal microsurgery for functioning pituitary adenomas. J Int Med Res 2011; 39 (05) 1985-1993