Retrospective analysis of a concurrent series of microscopic versus endoscopic transsphenoidal surgeries for Knosp Grades 0–2 nonfunctioning pituitary macroadenomas at a single institution

Dallapiazza, Robert F.; Bond, A.E.; Grober, Yuval; Louis, Robert G.; Payne, Spencer C.; Oldfield, Edward H.; Jane, John A.

doi:10.3171/2014.6.jns131321

Cited by 82 publications

(48 citation statements)

References 22 publications

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“…The adoption of the fully endoscopic technique has occurred because of the belief that the improved visualization it offers leads to better gland preservation rates and better EOR; however, there are limited studies with high-quality objective outcomes data comparing fully endoscopic surgery to microscopebased techniques to justify this trend. As more centers have gained experience with fully endoscopic techniques, several meta-analyses and single-center experiences have been published 1,6,7,10,14,16,21,23 (Table 7). The primary limitations of previous series that we have tried to address in this study are the absence of formal volumetric EOR data, experimental cohorts containing several tumor types, lack of rigorous endocrine outcomes reporting, and the fact that most published comparisons of techniques represent cases performed by a single surgeon in different surgical epochs rather than concurrently performed cases.…”

Section: Discussionmentioning

confidence: 99%

“…This is the most commonly reported method in pituitary series. 6,16,21 Patients with questionable residual tumor on postoperative imaging were assigned to the STR outcome. Second, formal volumetric analysis using manual tumor tracing was performed using manual segmentation with region of interest analysis to measure tumor volume (in cm 3 ) on the basis of contrast enhancement, as previously described.…”

Section: Extent Of Resection Analysismentioning

confidence: 99%

“…The metaanalyses by Zhu et al 23 and Goudakos et al 10 also found a similar trend. However, Dallapiazza et al 6 found no difference between the endoscopic and microscopic techniques with respect to development of diabetes insipidus and hypocortisolism but did not report functional outcomes of other pituitary axes (thyroid, testosterone, growth hormone). Messerer et al concluded that the endoscope provided superior endocrinological results in an analysis of a retrospectively collected database, but dichotomized outcomes as "partial anterior pituitary deficits" or as "total anterior pituitary deficits" without reporting the number of patients with hormone replacement therapy for each pituitary axis.…”

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confidence: 99%

“…4,18 This transition from a microscopic to a fully endoscopic pituitary surgery technique has occurred despite limited objective comparative outcome data. 6,10,21,23 In 2011, our institution initiated a prospective endonasal quality-of-life (QOL) study to compare patients' QOL with respect to sinonasal symptoms after direct endonasal uninostril microscopic and fully endoscopic binostril TNTS approaches for sellar pathology. 12 To better understand the impact of surgical technique on outcomes, we retrospectively studied this cohort of patients to determine EOR using formal volumetric techniques, endocrine outcomes, and complications.…”

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confidence: 99%

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Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma

Zaidi

Awad

Bohl

et al. 2016

JNS

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abbreviatioNs CSF = cerebrospinal fluid; EOR = extent of tumor resection; GTR = gross-total resection; QOL = quality of life; STR = subtotal resection; TNTS = transnasal transsphenoidal. obJective The comparative efficacy of microscopic and fully endoscopic transsphenoidal surgery for pituitary adenomas has not been well studied despite the adoption of fully endoscopic surgery by many pituitary centers. The influence of surgeon experience has also not been examined in this setting. The authors therefore compared the extent of tumor resection (EOR) and the endocrine outcomes of 1 very experienced surgeon performing a microscopic transsphenoidal surgery technique with those of a less experienced surgeon using a fully endoscopic transsphenoidal surgery technique for resection of nonfunctioning pituitary adenomas in a concurrent series of patients. methods Post hoc analysis was conducted of a cohort of adult patients prospectively enrolled in a pituitary adenoma quality-of-life study between October 2011 and June 2014. Patients were followed up for 6 months after surgery. Patients were treated either by a less experienced surgeon (100 independent cases) who practices fully endoscopic surgery exclusively or by a very experienced surgeon (1800 independent cases) who practices microscopic surgery exclusively. Patient demographic characteristics, tumor characteristics, hypopituitarism, complications, and length of hospital stay were analyzed. Tumor volumes and EOR were determined by formal volumetric analysis involving manual segmentation of MR images performed before surgery and within 6 months after surgery. Logistic regression analysis was used to determine predictors of EOR. results Fifty-five patients underwent fully endoscopic transsphenoidal surgery, and 80 patients underwent fully microscopic transsphenoidal surgery. The baseline characteristics of the 2 treatment groups were well matched. EOR was similar between the endoscopic and microscopic groups, respectively, as estimated by gross-total resection rate (78.2% vs 81.3%, p = 0.67), percentage of tumor resected (99.2% vs 98.7%, p = 0.42), and volume of residual tumor (0.12 cm 3 vs 0.20 cm 3 , p = 0.41). Multivariate modeling suggested that preoperative tumor volume was the most important predictor of EOR (p = 0.001). No difference was found in the development of anterior gland dysfunction (p > 0.14), but there was a higher incidence of permanent posterior gland dysfunction in the microscopic group (p = 0.04). Combined rates of major complications and unplanned readmissions were lower in the endoscopic group (p = 0.02), but individual complications were not significantly different. coNclusioNs A less experienced surgeon using a fully endoscopic technique was able to achieve outcomes similar to those of a very experienced surgeon using a microscopic technique in a cohort of patients with nonfunctioning tumors smaller than 60 cm 3 . The study raises the provocative notion that certain advantages afforded by the fully endoscopic technique may impact the learning c...

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Section: Discussionmentioning

confidence: 99%

Section: Extent Of Resection Analysismentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma

Zaidi

Awad

Bohl

et al. 2016

JNS

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“…This form of selection bias takes into account individual training and experience, along with issues about the individual tumor, yet does not necessarily detract from the validity of observation. 6 The nature of this form of selection bias is becoming more recognized in surgical studies, and in fact it has been suggested that this bias is built into the design of RCTs.…”

Section: Potential Limitationsmentioning

confidence: 99%

Comparative analysis of outcomes following craniotomy and expanded endoscopic endonasal transsphenoidal resection of craniopharyngioma and related tumors: a single-institution study

Jeswani¹,

Nuño²,

Wu³

et al. 2016

JNS

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Surgeons have advocated for both approaches, and at present there is no consensus whether one approach is superior to the other. The authors therefore compared surgical outcomes between craniotomy and endoscopic endonasal transsphenoidal surgery (EETS) for suprasellar tumors treated at their institution. methods A retrospective review of patients undergoing resection of suprasellar lesions at Cedars-Sinai Medical Center between 2000 and 2013 was performed. Patients harboring suspected craniopharyngioma were selected for extensive review. Other pathologies or predominantly intrasellar masses were excluded. Cases were separated into 2 groups, based on the surgical approach taken. One group underwent EETS and the other cohort underwent craniotomy. Patient demographic data, presenting symptoms, and previous therapies were tabulated. Preoperative and postoperative tumor volume was calculated for each case based on MRI. Student t-test and the chi-square test were used to evaluate differences in patient demographics, tumor characteristics, and outcomes between the 2 cohorts. To assess for selection bias, 3 neurosurgeons who did not perform the surgeries reviewed the preoperative imaging studies and clinical data for each patient in blinded fashion and indicated his/her preferred approach. These data were subject to concordance analysis using Cohen's kappa test to determine if factors other than surgeon preference influenced the choice of surgical approach. results Complete data were available for 53 surgeries; 19 cases were treated via EETS, and 34 were treated via craniotomy. Patient demographic data, preoperative symptoms, and tumor characteristics were similar between the 2 cohorts, except that fewer operations for recurrent tumor were observed in the craniotomy cohort compared with EETS (17.6% vs 42.1%, p = 0.05). The extent of resection was similar between the 2 groups (85.6% EETS vs 90.7% craniotomy, p = 0.77). An increased rate of cranial nerve injury was noted in the craniotomy group (0% EETS vs 23.5% craniotomy, p = 0.04). Postoperative CSF leak rate was higher in the EETS group (26.3% EETS vs 0% craniotomy, p = 0.004). The progression-free survival curves (log-rank p = 0.99) and recurrence rates (21.1% EETS vs 23.5% craniotomy, p = 1.00) were similar between the 2 groups. Concordance analysis of cases reviewed by 3 neurosurgeons indicated that individual surgeon preference was the only factor that determined surgical approach (kappa coefficient -0.039, p = 0.762) coNclusioNs Surgical outcomes were similar for tumors resected via craniotomy or EETS, except that more CSF leaks occurred in the EETS cohort, whereas more neurological injuries occurred in the craniotomy cohort. Surgical approach appears to mostly reflect surgeon preference rather than specific tumor characteristics. These data support the view that EETS is a viable alternative to craniotomy, providing a similar extent of resection with less neurological injury.

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The Direct Endoscopic Endonasal Transsphenoidal Approach to the Pituitary Gland

Zada

Lucas

Laws

2016

Atlas of Sellar and Parasellar Lesions

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Retrospective analysis of a concurrent series of microscopic versus endoscopic transsphenoidal surgeries for Knosp Grades 0–2 nonfunctioning pituitary macroadenomas at a single institution

Cited by 82 publications

References 22 publications

Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma

Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma

Comparative analysis of outcomes following craniotomy and expanded endoscopic endonasal transsphenoidal resection of craniopharyngioma and related tumors: a single-institution study

The Direct Endoscopic Endonasal Transsphenoidal Approach to the Pituitary Gland

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