Artikel
Comparison of endoscopic and endoscope-assisted microscopic transsphenoidal surgery for pituitary adenoma resection
Vergleich von endoskopischer und endoskopisch-assistierter transsphenoidaler Operationstechnik bei Resektion von Hypophysenadenomen
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Autoren
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Marton Eördögh
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Christian Rosenstengel
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Werner Hosemann
- Universitätsmedizin Greifswald, Klinik für Hals-Nasen-Ohrenkrankheiten, Kopf- und Hals-Chirurgie, Greifswald, Deutschland
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Antje Steveling
- Universitätsmedizin Greifswald, Klinik und Poliklinik Innere Medizin „A“, Greifswald, Deutschland
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Stefan Clemens
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Augenheilkunde, Greifswald, Deutschland
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Michael Kirsch
- Universitätsmedizin Greifswald, Institut für Diagnostische Radiologie und Neuroradiologie, Greifswald, Deutschland
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László Bárány
- Semmelweis-Universität, Anatomisches, Histologisches und Embryologisches Institut, Budapest, Ungarn
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Henry W. S. Schroeder
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: The value of endoscopic transsphenoidal surgery of pituitary adenomas compared to the traditional microscopic technique is still discussed in the literature. Here we analyse our long-term results of both approaches in 38 consecutive cases, using patient- as well as clinician-related outcome measurements.
Methods: This double-blind randomised prospective study involves 20 patients who underwent endoscopic (E) and 18 patients treated with endoscope-assisted microscopic (M) transsphenoidal surgery of pituitary adenoma between 2009-2012. 2 cases were lost to follow-up. We analysed history, perioperative course as well as quality of life, resection rate, ophthalmological, rhinological and endocrinological outcomes with focus on patients´ satisfaction. The average follow-up was 5.7 years (E) and 4.7 years (M), range: 1.5 – 10.1 years.
Results: Most pathologies were non-secreting adenomas (E: 50.0%, M: 61.1%). Tumor sizes were comparable (p=0.1), mainly °II according to Hardy classification (E: 40.0%, M: 66.6%). The duration of surgery was shorter in microscopic cases (p<0.05). Angled endoscopes revealed residual tumor in 65.0% (E) and 33.3% (M) during surgery. There were no major complications. Surgical revision of CSF-leak was necessary in 1-1 cases. At a patient (M), early postoperative MRI revealed residual tumor with consecutive surgery. Gross total tumor removal was achieved in 91.1% (E), 84.6% (M) at the earliest and in 75.0% and 84.6% at the latest examination. Subjective well-being was timely achieved comparable in both groups (p=0.27), however, 13.2% of patients still had complaints at the latest evaluation. Ophthalmological results improved in 100.0% (E) and 85.7% (M). Pathologic hormone excess normalised in 85.7% (E) and 100.0% (M). Subjective and objective olfactory tests showed highly varying results.
Conclusion: Long-term results were similar. Endoscopic inspection offers better tumor removal, serving as an aid for microscopic surgeons. Patient-related outcomes mostly did not align clinical results, thus a comparison of subjective and objective evaluation is necessary.
