gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Endoscopic versus microscopic transsphenoidal resection of sellar pathologies: new and learning against the advanced expert

Meeting Abstract

  • Doortje Engel - Klinik für Neurochirurgie, Kantonsspital St. Gallen
  • Cem Yetimoglu - Klinik für Neurochirurgie, Kantonsspital St. Gallen
  • Heidrun Lange - Klinik für Neurochirurgie, Kantonsspital St. Gallen
  • Karen Huscher - Klinik für Neurochirurgie, Kantonsspital St. Gallen
  • Gerhard Hildebrandt - Klinik für Neurochirurgie, Kantonsspital St. Gallen
  • Jean-Yves Fournier - Klinik für Neurochirurgie, Kantonsspital St. Gallen

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocDI.01.05

doi: 10.3205/13dgnc186, urn:nbn:de:0183-13dgnc1869

Published: May 21, 2013

© 2013 Engel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Endoscopic neurosurgery is emerging for transsphenoidal resection of sellar lesions. From a technical point of view endoscopic (E) resections should be better than microscopic (M) resections due to improved visibility.

Method: Data were collected retrospectively of patients operated for a sellar lesion in our institution between November 2004 and August 2012. Statistics were conducted by Fisher’s exact and student's t-tests.

Results: In total 117 patients were operated (E: n=52, M: n=65; ± 10-19 cases/yr.). Age and gender distribution did not differ between groups (mean=54yrs, 67% male). Mean follow-up was 36 months (range 0-95). Most frequent pathology was hormone inactive adenoma (60% E, 51% M). E-group consisted of more invasive, larger lesions: giant lesions (≥ 40 mm; 19% E vs. 8% M), Knosp grade IV (19 E vs. 8% M). Neuronavigation was used in 80% of E-cases, but never in M-cases. OR duration was stable in the experienced M-group (± 94 min). The E-group showed a learning curve in mean OR-time (2004-2007: 154 min, 2008-2012: 93 min). Intraoperative CSF leaks were seen in 31% (E) vs. 42% (M) of cases. More E-cases were reoperated and more M-cases received a lumbar drainage (5 vs. 1, 8 vs. 19 patients resp.). In both groups 2 patients were reoperated because of a large residual tumor. ICA was damaged in 1 E-case with mild residual symptoms. Postoperative diabetes insipidus occurred more often after an E-operation (17 vs. 5%, p=0.03). Postoperative anterior pituitary dysfunction rate in formerly intact patients was higher in the micro group (25% vs. 19%). Improved visual outcome was shown in 46% (E, longer visual preoperative deficits than M) vs. 61% (M) of patients. Clinical performance improved in 38% (E, less hormonal preoperative deficits than M) vs. 78% (M) of patients. Total resection was better in microscopic patients (48% vs. 42%), whereas after endoscopic operations a small residuum (<10mm) was seen more often (38% vs. 29%). A large residuum (>10mm) was seen in 20% (E) vs. 23% (M) of patients.

Conclusions: In the past 8 years endoscopic technique was not better, yet not worse either. Considering the small sample size and the comparison of a learning endoscopic neurosurgeon and a very experienced microscopic one better results are to be expected in the future with refinements of operative techniques.