Artikel
Endoscopic versus microscopic transsphenoidal resection of sellar pathologies: new and learning against the advanced expert
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Veröffentlicht: | 21. Mai 2013 |
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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.