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  • Retrospective analysis of microscopic versus endoscopic transsphenoidal surgery for nonfunctioning pituitary macroadenomas with Knosp Grade 0-2

    Final Number:

    Robert Dallapiazza MD, PhD; Aaron E. Bond MD, PhD; John Jane, Jr; Edward H. Oldfield MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: to compare surgical outcomes and postoperative complications in patients undergoing microscopic and endoscopic transsphenoidal surgery for nonfunctioning pituitary macroadenomas without cavernous sinus invasion.

    Methods: We retrospectively reviewed our patient database and analyzed patient records for outcomes and complications. We included patients who underwent microscopic or endoscopic surgery for nonfunctioning pituitary macroadenomas that had Knosp scores 0, 1, and 2. We excluded patients who had hormone secreting tumors, tumors with Knosp scores 3 and 4, and patients who were undergoing revision surgery. Statistical analyses were performed on tumor volume, intraoperative factors, and postoperative complications, and the results were used to compare the microscopic and endoscopic approaches.

    Results: From 2010 to 2013, 43 patients underwent microscopic transsphenoidal surgery and 56 underwent endoscopic transsphenoidal surgery for Knosp 0-2 nonfunctioning macroadenomas. We found no difference in intra-operative extent of surgical resection, endocrinological complications, or surgical complications including postoperative CSF leaks between the two groups. There were significantly more intraoperative CSF leaks in the endoscopic group. Operative blood loss and length of hospitalization were a significantly lower in patients undergoing endoscopic approaches. We had 2-month follow up imaging in 88% of patients, and 42% of patients had 1-year follow up imaging. At 2-months, there was no evidence of residual tumor in 77% and 87% of patients in the microscopic and endoscopic groups, respectively. At 1 year, 85% of patients had no evidence of residual tumor in the microscopic group (17/20) and 79% had no evidence of residual tumor in the endoscopic group (19/24).

    Conclusions: Our results are similar to previously published series comparing microscopic and endoscopic transsphenoidal surgery. In experienced hands, these two approaches have similar outcomes in regards to extent of resection and postoperative complications.

    Patient Care: This study provides useful information to surgeons who perform transsphenoidal surgery for pituitary tumors. It further defines the risks and benefits of two popular approaches for these tumors, thus allowing surgeons to chose an appropriate surgical method.

    Learning Objectives: By the conclusion of this session participants should be able to recognize the benefits and complications of microscopic and endoscopic transsphenoidal surgery for surgically resectable tumors.

    References: 1: 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. 2012 Dec 15. 2: Strychowsky J, Nayan S, Reddy K, Farrokhyar F, Sommer D. Purely endoscopic transsphenoidal surgery versus traditional microsurgery for resection of pituitary adenomas: systematic review. J Otolaryngol Head Neck Surg. 2011 Apr;40(2):175-85. Review. 3: Higgins TS, Courtemanche C, Karakla D, Strasnick B, Singh RV, Koen JL, Han JK. Analysis of transnasal endoscopic versus transseptal microscopic approach for excision of pituitary tumors. Am J Rhinol. 2008 Nov-Dec;22(6):649-52. 4: Frank G, Pasquini E, Farneti G, Mazzatenta D, Sciarretta V, Grasso V, Faustini, Fustini M. The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinology. 2006;83(3-4):240-8. 5: Koren I, Hadar T, Rappaport ZH, Yaniv E. Endoscopic transnasal transsphenoidal microsurgery versus the sublabial approach for the treatment of pituitary tumors: endonasal complications. Laryngoscope. 1999 Nov;109(11):1838-40.

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