Fully endoscopic transsphenoidal surgery for functioning pituitary adenomas

D’Haens, Jean; Rompaey, K. Van; Stadnik, Tadeus; Haentjens, Patrick; Poppe, Kris; Velkeniers, Brigitte

doi:10.1016/j.surneu.2009.04.012

Cited by 154 publications

(39 citation statements)

References 26 publications

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“…The efficacy of the endoscopic TSA for the management of pituitary tumors has been reported in the literature, with results and complication rates at least comparable with microsurgical series (Table 3)12,17,28). A meta-analysis of eleven published studies revealed no difference in endocrinological remission rate of functioning adenomas (60% versus 66%) and complete tumor removal rate (69% versus 71%) between microscopic and endoscopic TSA.…”

Section: Discussionmentioning

confidence: 75%

Feasibility of Endoscopic Endonasal Approach for Recurrent Pituitary Adenomas after Microscopic Trans-Sphenoidal Approach

Hwang

Kim

et al. 2013

J Korean Neurosurg Soc

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ObjectiveThe surgical approach for recurrent pituitary adenoma after trans-sphenoidal approach (TSA) is challenging. We report the outcomes of the endoscopic TSA for recurrent pituitary adenoma after microscopic TSA.MethodsFrom February 2010 to February 2013, endoscopic TSA was performed for removal of 30 recurrent pituitary adenomas after microscopic TSA. Twenty-seven (90%) patients had a clinically non-functioning pituitary adenoma. Twenty-four (80%) patients suffered from a visual disturbance related to tumor growth. The clinical features and surgical outcomes were retrospectively analyzed for the ophthalmological, endocrinological, and oncological aspects.ResultsThe mean tumor volume was 11.7 cm3, and gross total resection was achieved in 50% of patients. The volumetric analysis based on the postoperative MR showed that the mean extent of resection rates were 90%. Vision was improved in 19 (79%) of 24 patients with visual symptoms, and endocrinological cure was achieved in all of three functioning pituitary adenomas; however, the post-operative follow-up endocrinological examination revealed a new endocrinological deficit in one patient. Two patients required antibiotics management for post-operative meningitis.ConclusionThe endoscopic TSA can be an effective treatment option for recurrent pituitary adenoma after microscopic TSA with acceptable outcome.

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Section: Discussionmentioning

confidence: 75%

Feasibility of Endoscopic Endonasal Approach for Recurrent Pituitary Adenomas after Microscopic Trans-Sphenoidal Approach

Hwang

Kim

et al. 2013

J Korean Neurosurg Soc

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“…Meta-analyses comparing endoscopic and microscopic pituitary surgery have been inconclusive; several studies report improved short-term endocrine remission and fewer complications (except for CSF leaks), particularly for patients with functioning adenomas. 9,30 Rotenberg et al demonstrated that endoscopic surgery afforded fewer complications, shorter hospital stays and greater patient comfort. 25 There is a consistent lack of evidence, however, that endoscopic surgery leads to higher rates of GTR.…”

Section: Discussionmentioning

confidence: 99%

The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experience in the Advanced Multimodality Image Guided Operating suite

Zaidi¹,

Reyes²,

Barkhoudarian³

et al. 2016

FOC

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OBJECTIVE Endoscopic skull base surgery has become increasingly popular among the skull base surgery community, with improved illumination and angled visualization potentially improving tumor resection rates. Intraoperative MRI (iMRI) is used to detect residual disease during the course of the resection. This study is an investigation of the utility of 3-T iMRI in combination with transnasal endoscopy with regard to gross-total resection (GTR) of pituitary macroadenomas. METHODS The authors retrospectively reviewed all endoscopic transsphenoidal operations performed in the Advanced Multimodality Image Guided Operating (AMIGO) suite from November 2011 to December 2014. Inclusion criteria were patients harboring presumed pituitary macroadenomas with optic nerve or chiasmal compression and visual loss, operated on by a single surgeon. RESULTS Of the 27 patients who underwent transsphenoidal resection in the AMIGO suite, 20 patients met the inclusion criteria. The endoscope alone, without the use of iMRI, would have correctly predicted extent of resection in 13 (65%) of 20 cases. Gross-total resection was achieved in 12 patients (60%) prior to MRI. Intraoperative MRI helped convert 1 STR and 4 NTRs to GTRs, increasing the number of GTRs from 12 (60%) to 16 (80%). CONCLUSIONS Despite advances in visualization provided by the endoscope, the incidence of residual disease can potentially place the patient at risk for additional surgery. The authors found that iMRI can be useful in detecting unexpected residual tumor. The cost-effectiveness of this tool is yet to be determined.

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“…report that in 381 patients who received endoscopic endonasal surgery, complication rates were similar or less than the complication rates of microscopic pituitary surgery reported in the literature, and tumor removal was superior for endosellar lesions with endoscopic surgery [207]. Regarding endocrinologic outcomes, in one study comparing the two techniques in two series of patients operated upon by the same surgeon, the hypersecretion remission rate, or cure rate, for the endonasal approach was 63% compared with 50% with microsurgery, and the cure rate difference was most notable in grade II tumors (78% endoscopic vs 43% microsurgical) [208]. Similarly, Kabil and colleagues reported a 90% cure rate overall in their retrospective review of 300 patients who received endoscopic endonasal pituitary tumor resection compared with a microsurgical cure rate of 66–82% in the literature [209–214].…”

Section: Open Craniotomy Versus Microsurgical Versus Endoscopic Endonmentioning

confidence: 99%

“… † Major surgical complications only CS: Case series; E: Endoscopic approach; M Microsurgical approach. Data taken from [194,207,208,210,215–217,219]. …”

Section: Tablementioning

confidence: 99%

Pituitary adenomas: historical perspective, surgical management and future directions

et al. 2015

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Pituitary adenomas are among the most common central nervous system tumors. They represent a diverse group of neoplasms that may or may not secrete hormones based on their cell of origin. Epidemiologic studies have documented the incidence of pituitary adenomas within the general population to be as high as 16.7%. A growing body of work has helped to elucidate the pathogenesis of these tumors. Each subtype has been shown to demonstrate unique cellular changes potentially leading to tumorigenesis. Surgical advancements over several decades have included microsurgery and the employment of the endoscope for surgical resection. These advancements increase the likelihood of gross-total resection and have resulted in decreased patient morbidity.

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Fully endoscopic transsphenoidal surgery for functioning pituitary adenomas

Cited by 154 publications

References 26 publications

Feasibility of Endoscopic Endonasal Approach for Recurrent Pituitary Adenomas after Microscopic Trans-Sphenoidal Approach

Feasibility of Endoscopic Endonasal Approach for Recurrent Pituitary Adenomas after Microscopic Trans-Sphenoidal Approach

The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experience in the Advanced Multimodality Image Guided Operating suite

Pituitary adenomas: historical perspective, surgical management and future directions

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