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  • Traditional Transsphenoidal Microsurgery Versus Endoscopic Surgery for Resection of Pituitary Adenomas

    Final Number:

    Barbara Massa micon MD; Antonio Melcarne; Mario Cacciacarne; Carola Juneman; Michele Naddeo MD; Giuliano Faccani

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Traditional surgical approach to pituitary area is trans-sfenoidal microscope surgery; recently endoscopic technique gained a great success in pituitary surgery, due to wide visualization of anatomic structures and minimal invasiveness; however, current use of neuronavigation systems improved trans-sfenoidal microscope pituitary surgery, reducing the extension of the surgical approach, not wider than endoscopic.

    Methods: We performed microscope surgery for pituitary adenomas since 1992; since 2004 we employed neuronavigation for microsurgery; in present poster we will describe our series of surgical treatment on pituitary adenomas, since 2004 treated with transsfenoidal microscope surgery, neuronavigation assisted. We will compare our results with the endoscopic trans-sfenoidal surgical treatments described in literature, as retrieved using Medline.

    Results: Comparing gross tumor resection, recurrence, visual field improvement, hormone resolution, blood loss, operative time, hospital duration of stay, no significant differences in outcome were observed; complication rates (hormone deterioration, vision deterioration, nasal complication, death) appear to be similar in both approaches; the extension of the approach required for the "two nostrils, four hands" technique, required for endoscopic procedure, is wider than necessary for the microscope and neuronavigation tecnique and surgical reconstruction, in the case of microscopic surgery can be less time consuming; concerning post-operative cerebrospinal leak, an higher incidence was observed in endoscopic series. These results are strictly linked to the learning curve, that improves the surgical tecnique: microscope procedure have been performed in our Neurosurgical Department since 1992

    Conclusions: The microscopical trans-sfenoidal approach with the help of the neuronavigation support can be minimally invasive,. The endoscope permits a better visualization beyond the ability of the microscope but not necessary a better outcome. In our opinion, endoscope technique may offer some benefits as a supplement to microscopic surgery, as in assisted neurosurgery.

    Patient Care: Minimally invasive surgery is mandatory for a better confort for the patient and a better outcome

    Learning Objectives: By the conclusion of this session, partecipants should be able 1)to discuss about the advantage/disadvantageof endoscopic and microscopic approaches to the pituitary area, 2) to describe the importance of minimally invasive surgery, also with microscope tecnique


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