gms | German Medical Science

Objective: The aim of the present study was to determine the value of endoscopy in pituitary surgery and, on the other hand, to compare the endoscope-assisted microsurgical approach with the purely endoscopic operation.

Method: The study design was a prospective, randomized; double-blinded controlled clinical trial. Participants were randomized to either the pure endoscopic approach or the endoscope-assisted microsurgical technique. Outcomes measured were operative time, postoperative complications and residual tumor in postoperative MR-imaging. Also in the endoscopic assisted group, the intra-operative detection of unexpected residual tumor by endoscopic inspection was recorded.

Results: In each group, 20 patients were included. Operative time in the endoscopic group was considerably longer than in the microsurgical group (136 minutes vs. 102 minutes in the microsurgical group). In the endoscopic group, in 6 patients and in the microscopic group, in 7 patients, an intra-operative CSF-leak occurred. In the endoscopic group, we observed 2 patients and in the microscopic group, we observed one patient with a postoperative CSF- leak. No other postoperative complications were observed in this short-term analysis. Remarkably In the microsurgical group it is remarkable that we found unexpected residual tumor in 9 patients during the intraoperative endoscopic inspection. Postoperative MR images showed a total of 6 patients with residual tumor. In 4 patients, only a subtotal resection was performed and so residual tumor was expected. In one patient of each group, we found unexpected residual tumor in postoperative MR images. One of these patients in the microsurgical group had a tumor-remnant above the diaphragm. A second intervention was performed immediately after the MR imaging and the remnant was removed completely.

Conclusions: In our short-term-analysis, the efficacy of the pure endoscopic technique is comparable to the endoscope-assisted microsurgical operation. The complication rates observed in our study suggest that endoscopic pituitary surgery is at least as safe as the microscopic operation. Interesting is the fact that we found unexpected residual tumor by endoscopic inspection in almost every other patient in the microsurgical group. This emphasizes the high value of endoscopy in pituitary surgery because the endoscopic inspection and dissection resulted in a higher radicality. Further investigations are needed to prove any advantage of the pure endoscopic technique in the long-term outcome.