Learning curve of endoscopic pituitary surgery: Experience of a neurosurgery/ENT collaboration

Lofrese, Giorgio; Vigo, Vera; Rigante, Mario; Grieco, Domenico Luca; Maresca, Maddalena; Anile, Carmelo; Mangiola, Annunziato; Bonis, Pasquale De

doi:10.1016/j.jocn.2017.09.011

Cited by 34 publications

(32 citation statements)

References 17 publications

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“…14,21,44 Moreover, the collaboration between neurosurgical and otolaryngology colleagues may provide additional benefits in terms of reduced complication profiles during the transition from NES to ES. 26 We also observed that private insurance and higher income were independent predictors of receiving ES. Other studies have observed socioeconomic determinants influencing pituitary surgical approaches.…”

Section: Discussionsupporting

confidence: 55%

Endoscopic versus nonendoscopic surgery for resection of pituitary adenomas: a national database study

Goshtasbi

Lehrich

Abouzari

et al. 2021

Journal of Neurosurgery

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OBJECTIVEFor symptomatic nonsecreting pituitary adenomas (PAs), resection remains a critical option for treatment. In this study, the authors used a large-population national database to compare endoscopic surgery (ES) to nonendoscopic surgery (NES) for the surgical management of PA.METHODSThe National Cancer Database was queried for all patients diagnosed with histologically confirmed PA who underwent resection between 2010 and 2016 in which the surgical approach was specified. Due to database limitations, microsurgery and craniotomy were both categorized as NES.RESULTSOf 30,488 identified patients, 16,373 (53.7%) underwent ES and 14,115 (46.3%) underwent NES. There was a significant increase in the use of ES over time (OR 1.16, p < 0.01). Furthermore, there was a significant temporal increase in ES approach for tumors ≥ 2 cm (OR 1.17, p < 0.01). Compared to NES, patients who underwent ES were younger (p = 0.01), were treated at academic centers (p < 0.01), lived a greater distance from their treatment site (p < 0.01), had smaller tumors (p < 0.01), had greater medical comorbidity burden (p = 0.04), had private insurance (p < 0.01), and had a higher household income (p < 0.01). After propensity score matching to control for age, tumor size, Charlson/Deyo score, and type of treatment center, patients who underwent ES had a shorter length of hospital stay (LOS) (3.9 ± 4.9 days vs 4.3 ± 5.4 days, p < 0.01), although rates of gross-total resection (GTR; p = 0.34), adjuvant radiotherapy (p = 0.41), and 90-day mortality (p = 0.45) were similar. On multivariate logistic regression, African American race (OR 0.85, p < 0.01) and tumor size ≥ 2 cm (OR 0.89, p = 0.01) were negative predictors of receiving ES, whereas diagnosis in more recent years (OR 1.16, p < 0.01), greater Charlson/Deyo score (OR 1.10, p = 0.01), receiving treatment at an academic institution (OR 1.67, p < 0.01) or at a treatment site ≥ 20 miles away (OR 1.17, p < 0.01), having private insurance (OR 1.09, p = 0.01), and having a higher household income (OR 1.11, p = 0.01) were predictive of receiving ES. Compared to the ES cohort, patients who started with ES and converted to NES (n = 293) had a higher ratio of nonwhite race (p < 0.01), uninsured insurance status (p < 0.01), longer LOS (p < 0.01), and higher rates of GTR (p = 0.04).CONCLUSIONSThere is an increasing trend toward ES for PA resection including its use for larger tumors. Although ES may result in shorter LOS compared to NES, rates of GTR, need for adjuvant therapy, and short-term mortality may be similar. Factors such as tumor size, insurance status, facility type, income, race, and existing comorbidities may predict receiving ES.

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Section: Discussionsupporting

confidence: 55%

Endoscopic versus nonendoscopic surgery for resection of pituitary adenomas: a national database study

Goshtasbi

Lehrich

Abouzari

et al. 2021

Journal of Neurosurgery

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“…The year 2000 was previously shown to be pivotal for outcomes with GKRS for arteriovenous malformations. 24 These findings contribute to the growing body of evidence that the greater experiences of a neurosurgeon and center (i.e., the treatment team) are associated with better treatment results across a spectrum of neurosurgical procedures, including transsphenoidal resection of pituitary adenomas, 4,16 excision of vestibular schwannomas, 2,18 intracranial aneurysm clipping 11 and coiling, 1 and scoliosis correction surgery, 8 among others. Similarly, studies from the radiation oncology literature also indicate that there are both institutional and individual learning curves for radiation therapy planning when treating locally advanced head and neck cancer 17 and primary lung cancer.…”

Section: Discussionmentioning

confidence: 84%

Outcomes of Cushing’s disease following Gamma Knife radiosurgery: effect of a center’s growing experience and era of treatment

Bunevičius¹,

Sheehan²,

Vance

et al. 2021

Journal of Neurosurgery

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OBJECTIVEStereotactic radiosurgery (SRS) is used for the management of residual or recurrent Cushing’s disease (CD). Increasing experience and technological advancements of Gamma Knife radiosurgery (GKRS) systems can impact the outcomes of CD patients. The authors evaluated the association of their center’s growing experience and the era in which GKRS was performed with treatment success and adverse events in patients with CD.METHODSThe authors studied consecutive patients with CD treated with GKRS at the University of Virginia since installation of the first Gamma Knife system in March 1989 through August 2019. They compared endocrine remission and complication rates between patients treated before 2000 (early cohort) and those who were treated in 2000 and later (contemporary cohort).RESULTSOne hundred thirty-four patients with CD underwent GKRS during the study period: 55 patients (41%) comprised the early cohort, and 79 patients (59%) comprised the contemporary cohort. The contemporary cohort, compared with the early cohort, had a significantly greater treatment volume, radiation prescription dose, maximal dose to the optic chiasm, and number of isocenters, and they more often had cavernous sinus involvement. Endocrine remission rates were higher in the contemporary cohort when compared with the early cohort (82% vs 66%, respectively; p = 0.01). In a Cox regression analysis adjusted for demographic, clinical, and SRS characteristics, the contemporary GKRS cohort had a higher probability of endocrine remission than the early cohort (HR 1.987, 95% CI 1.234–3.199; p = 0.005). The tumor control rate, incidence of cranial nerve neuropathy, and new anterior pituitary deficiency were similar between the two groups.CONCLUSIONSTechnological advancements over the years and growing center experience were important factors for improved endocrine remission rates in patients with CD. Technological aspects and results of contemporary Gamma Knife systems should be considered when counseling patients, planning treatment, and reporting treatment results. Studies exploring the learning curve for GKRS are warranted.

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“…For endoscopic pituitary surgery, the Southern Surgeons club noted that 90% of complications happened in the first 30 patients of the learning curve, with the initial risk being tenfold of that after 50 operations. (21) They were using 2D endoscopy and a number of explanations were given including: loss of depth perception (stereopsis), ergonomic difficulties of using an endoscope, and issues with training. (20,21) Regarding our cadaveric study, the mean dissection time for both sides of the cadavers using 2D endoscope was 19.67±1.53 minutes while in using 3D endoscope was 21.33±4.93 minutes which was not statistically significant (p > 0.05).…”

Section: Discussionmentioning

confidence: 99%

“…(21) They were using 2D endoscopy and a number of explanations were given including: loss of depth perception (stereopsis), ergonomic difficulties of using an endoscope, and issues with training. (20,21) Regarding our cadaveric study, the mean dissection time for both sides of the cadavers using 2D endoscope was 19.67±1.53 minutes while in using 3D endoscope was 21.33±4.93 minutes which was not statistically significant (p > 0.05). It is possible that if we had chosen a more complicated index longer operation to compare then we might increase the likelihood of repeating the same results as seen in the clinical study with 2D taking longer than 3D.…”

Section: Discussionmentioning

confidence: 99%

Use of Three-Dimensional Endoscopy in Endonasal and Anterior Skull Base Surgery

Kholief

Youseef

Ibrahim

et al. 2021

Preprint

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Objectives: The three dimensional (3D) endoscope is considered as a new surgical tool which used in different approaches in intranasal and anterior skull base surgical procedures. There are many advantages of the 3D endoscopy over the two dimensional (2D) one that have been demonstrated along clinical applications, surgical training and different experimental studies. Our study aimed to show the difference between using the 3D & 2D endoscopes during endonasal and anterior skull base surgery and its importance specially when used by novice users. Design: Our study is divided into two phases (clinical & cadaveric phases).In the clinical study we have done 52 endonasal & anterior skull base surgical procedures (26 study cases and 26 control cases).We recorded accuracy, duration and intraoperative complication for each case. The cadaveric study was performed on three cadavers, difference in accuracy and dissection time were recorded using 3D & 2D endoscopy for each side chosen by randomization. Results: In the clinical study, the cases done by 3D endoscope were significantly faster and more accurate with less intraoperative complications compared to cases done using 2D endoscope. In cadaveric dissection while using 3D endoscope there was better depth of perception regarding the anatomical landmarks compared to 2D endoscope. Conclusion: 3D endoscopy is an advanced instrument that allows better training for the coming generation of ENT surgeons. Both clinical and cadaveric studies offer a promising outcomes in both endonasal and anterior skull base surgery.

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Learning curve of endoscopic pituitary surgery: Experience of a neurosurgery/ENT collaboration

Cited by 34 publications

References 17 publications

Endoscopic versus nonendoscopic surgery for resection of pituitary adenomas: a national database study

Endoscopic versus nonendoscopic surgery for resection of pituitary adenomas: a national database study

Outcomes of Cushing’s disease following Gamma Knife radiosurgery: effect of a center’s growing experience and era of treatment

Use of Three-Dimensional Endoscopy in Endonasal and Anterior Skull Base Surgery

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