Endoscopic versus Microscopic Transsphenoidal Hypophysectomy: Comparison of the Endocrine Outcome – An Institutional Experience
BACKGROUND: The transnasal transsphenoidal endoscopic approach to the sella turcica is an overwhelming alternative to the microscopic approach for the past few decades assuming into prominence as a new technique, reaching nearly gold standard for this pathology. The endoscopic approach to the pituitary has redefined accurate visualization of the sella. The panoramic view afforded by the endoscope is unparalleled as compared with the traditional conical view of the microscope.
AIMS: This study aims to compare both endoscopic and microscopic technologies, including advantages and disadvantages through the results of endocrine outcome.
SETTINGS AND DESIGN: Our retrospective/prospective study included 46 microscopically and 39 endoscopically treated patients during the period of 2010–2018. Tumors were classified according to the diameter and clinical outcomes were evaluated.
RESULTS: Our retrospective/prospective study included 46 microscopically and 39 endoscopically treated patients during the period of 2010–2018. Tumors were classified according to the diameter, hormone activity and clinical outcomes were evaluated. Comparison results revealed more efficacious and effective endocrine control and reestablishing the endocrine homeostasis utilizing the endoscopic technique, especially in secretory active macroadenomas. Further, the extension of the resection, which was better in endoscopic approach undouptedly contributed to better endocrine control of the disease. Complication rate, including endocrine, was lower following endoscopy compared with microsurgery.
CONCLUSION: This technique evidenced to have a statistically significant reduction in operative time and length of hospital stay, as well as more radical safe resection and complication control. There is also a trend toward improved endocrine outcomes and rate of return of visual defects. These two approaches are still comparable with eloquent advantages and disadvantages, formulated as balanced dialectics. In addition, the use of endoscopes, including multilocular polifilament 3D endoscope, facilitates extended approaches, reaching a delicate skull base lesions that are suprasellar, retrosellar, and parasellar, which permits visualization beyond the abilities of the microscope.
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Jane JA Jr., Catalino MP, Laws ER Jr. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, editors. Surgical Treatment of Pituitary Adenomas.. In: Endotext South Dartmouth, MA: MDText.com, Inc.; 2000.
Prajapati HP, Jain SK, Sinha VD. Endoscopic versus microscopic pituitary adenoma surgery: An institutional experience. Asian J Neurosurg. 2018;13(2):217-21. https://doi.org/10.4103/ajns. ajns_160_16 PMid:29682011
Kopczak A, Renner U, Karl Stalla G. Advances in understanding pituitary tumors. F1000Prime Rep. 2014;6:5. https://doi. org/10.12703/p6-5 PMid:24592317
Lin AL, Sum MW, DeAngelis LM. Is there a role for early chemotherapy in the management of pituitary adenomas? Neuro Oncol. 2016;18(10):1350-6. https://doi.org/10.1093/ neuonc/now059 PMid:27106409
Liu JK, Das K, Weiss MH, Laws ER Jr, Couldwell WT. The history and evolution of transsphenoidal surgery. J Neurosurg. 2001;95(6):1083-96. PMid:11765830
Schmidt RF, Choudhry OJ, Takkellapati R, Eloy JA, Couldwell WT, Liu JK. Hermann Schloffer and the origin of transsphenoidal pituitary surgery. Neurosurg Focus. 2012;33(2):E5. https://doi. org/10.3171/2012.5.focus12129 PMid:22853836
Cohen-Gadol AA, Liu JK, Laws ER Jr. Cushing’s first case of transsphenoidal surgery: The launch of the pituitary surgery era. J Neurosurg. 2005;103(3):570-4. https://doi.org/10.3171/ jns.2005.103.3.0570 PMid:16235694
Shou XF, Li SQ, Wang YF, Zhao Y, Jia PF, Zhou LF. Treatment of pituitary adenomas with a transsphenoidal approach. Neurosurgery. 2005;56(2):249-56. https://doi.org/10.1227/01. neu.0000147976.06937.1d PMid:15670373
Theodros D, Patel M, Ruzevick J, Lim M, Bettegowda C. Pituitary adenomas: Historical perspective, surgical management and future directions. CNS Oncol 2015;4(6):411-29. https://doi. org/10.2217/cns.15.21 PMid:26497533
Narayanan V, Narayanan P, Rajagopalan R, Karuppiah R, Rahman ZA, Wormald PJ, et al. Endoscopic skull base training using 3D printed models with pre-existing pathology. Eur Arch Otorhinolaryngol. 2015;272(3):753-7. https://doi.org/10.1007/ s00405-014-3300-3 PMid:25294050
Patel SK, Husain Q, Eloy JA, Couldwell WT, Liu JK. Norman Dott, Gerard Guiot, and Jules Hardy: Key players in the resurrection and preservation of transsphenoidal surgery. Neurosurg Focus 2012;33(2):E6. https://doi.org/10.3171/2012.6.focus12125 PMid:22853837
Reisch R, Stadie A, Kockro RA, Hopf N. The keyhole concept in neurosurgery. World Neurosurg. 2013;79(2 Suppl):S17.e9-13. https://doi.org/10.1016/j.wneu.2012.02.024 PMid:22381839
Song Y, Li H, Liu H, Li W, Zhang X, Guo L, et al. Endoscopic endonasal transsphenoidal approach for sellar tumors beyond the sellar turcica. Acta Otolaryngol. 2014;134(3):326-30. https:// doi.org/10.3109/00016489.2013.857785 PMid:24256041
Keyworth C, Hart J, Armitage CJ, Tully MP. What maximizes the effectiveness and implementation of technology-based interventions to support healthcare professional practice? A systematic literature review. BMC Med Inform Decis Mak. 2018;18(1):93. https://doi.org/10.1186/s12911-018-0661-3 PMid:30404638
Khan I, Shamim MS. Comparison between endoscopic and microscopic approaches for surgery of pituitary tumours. J Pak Med Assoc. 2017;67(11):1777-9. PMid:29171583
Yadav YR, Nishtha Y, Vijay P, Shailendra R, Yatin K. Endoscopic endonasal trans-sphenoid management of craniopharyngiomas. Asian J Neurosurg. 2015;10(1):10-6. https://doi.org/10.4103/1793-5482.151502 PMid:25767569
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