gms | German Medical Science

Objective: Although endoscopic surgical procedures have many advantages over microsurgical procedures the lack of stereoscopic vision is a major disadvantage. To overcome this problem 3 D endoscopic systems have been introduced recently and are used in endonasal endoscopic transsphenoidal surgery (EETS). The objective of this study was to compare treatment results after EETS between a three dimensional endoscopic system and a 2D high definition (HD) system with respect to residual tumor, periprocedural complications or new postoperative endocrinological deficits.

Method: Between December 2008 and March 2013 112 patients (65 males, 58%) underwent EETS to treat (para)sellar pathologies (86 adenomas, 5 pituitary abcesses, 3 chordoma, 3 meningioma, and other pathologies n=15). In 65 patients the 2D HD System from Storz (Karl Storz, Germany) and in 47 the 3D VSii system (VisionSense^®, USA) was used. Prospective collected data were entered into a SPSS database including pre- and postoperative neuroradiological, endocrinological and ophthalmological status.

Results: Sex, age, pathology and tumour volume did not statistically differ between both groups. In the 2D group 6 patients (9.2%) had perioperative complications (3 hematoma, 2 CSF fistula, [1 patient developed meningitis], 1 pulmonary embolus. In the group of patients treated with the 3D System 5 patients (10,6%) had complications (1 patient with new diabetes insipidus, 3 CSF fistula with reoperation in 1 patient). 3 months MRI depicted residual tumour in 15 (23%) and in 10 (21%) patients and in 11 (17%) and 2 (4%) patients differentiation of residual tumour and postoperative changes was uncertain in the 2D and 3D group, respectively. 9 and 10 patients developed a new endocrine deficit in any of the hormone axis during the postoperative course in the 2D and 3D group, respectively.

Conclusions: In this series the rate of residual tumour and perioperative complications after EETS was similar using a 2D HD system or the VSii 3D system. 3D impression during surgery, good detail accuracy and colour fidelity is provided by the VSii 3D system.