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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Endoscopic endonasal surgery for removal of pituitary adenomas – treatment results using different two- and three-dimensional visualization systems

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  • Shefqet Hajdari - Helios Klinikum Erfurt, Erfurt, Deutschland
  • Christoph Jacobi - Helios Klinikum Erfurt, Erfurt, Deutschland
  • Christian Schönfelder - Helios Klinikum Erfurt, Erfurt, Deutschland
  • Geralf Kellner - Helios Klinikum Erfurt, Erfurt, Deutschland
  • Almuth Meyer - Helios Klinikum Erfurt, Erfurt, Deutschland
  • Steffen Rosahl - Helios Klinikum Erfurt, Erfurt, Deutschland
  • Rüdiger Gerlach - Helios Klinikum Erfurt, Erfurt, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.17.01

doi: 10.3205/17dgnc476, urn:nbn:de:0183-17dgnc4767

Published: June 9, 2017

© 2017 Hajdari et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Endoscopic endonasal transsphenoidal surgery (EETSS) is the treatment of choice for patients with pituitary adenomas (PA). Three-dimensional high definition (3D-HD) visualization offers stereoscopic depth perception (SDP) compared to two-dimensional (2D-HD) and three-dimensional standard definition (3D-SD) endoscopy techniques. However, it is undisclosed, if this perception improvement for surgeons is accompanied with better outcomes for operated patients with PA. In this regard, we intend to compare the effectiveness of 3 different system 2D-HD, 3D-SD and 3D-HD.

Methods: A database of patients treated with EETSS is established. Between 12/2008 and 11/2016, 238 patients were identified. Using SPSS software, collected data, those with primary PA in particular, were analyzed for pre- and post-OP characterization and EETSS efficiency. Correspondingly, non-parametric statistical tests (Mann–Whitney, Kruskal-Wallis and Wilcoxon) were performed, in order to compare three different EETSS-techniques.

Results: 151 (63.5%) of 238 patient had surgery for primary PA using the following systems 2D-HD (Storz, Germany; 54 patients), 3D-SD (VisionSense vsii; 76 patients) and 3D-HD (VisionSense vsiii; 21 patients). Preoperatively no statistical differences were found for tumor size, extension, endocrine and ophthalmologic status. Complete tumor resection was achieved in 39 (72%), 54 (71%) and 17 (81%) patients in 2D HD, 3D SD and 3D-HD groups, respectively. The better resection rate in the 3D-HD group was due to better resection of parasellar tumor parts (p = .025). The number of complications, such as postoperative bleeding, CSF leaks and meningitis was not different between visualization systems (p= .211). Ophthalmological outcome did not differ between EETSS techniques. The number of cases with new pituitary insufficiency is smaller in patients operated with 3D-HD (4.8%) vs. 2D-HD (16.6%) and 3D-SD (9.2%). Concerning endocrinological remission, no difference for was found between 3 EETSS groups.

Conclusion: Although primary PA patients had the same pre-OP characterization, application 3D-HD operative technique leads to less residual tumor and fewer new postoperative endocrine deficit.