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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Technical aspects, outcomes, and complications in surgery for pituitary adenomas – endoscopic versus microscopic approaches

Technische Aspekte, Ergebnisse und Komplikationen bei Operation von Hypophysenadenomen – endoskopische versus mikroskopische Zugänge

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  • presenting/speaker Julius Höhne - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Anna-Maria Scharf - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Kornelia Elisabeth Charlotte Andorfer - Universitätsklinikum Regensburg, Klinik für Hals-Nasen-Ohrenheilkunde, Regensburg, Deutschland
  • Thomas Kühnel - Universitätsklinikum Regensburg, Klinik für Hals-Nasen-Ohrenheilkunde, Regensburg, Deutschland
  • Nils-Ole Schmidt - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Karl-Michael Schebesch - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocP065

doi: 10.3205/22dgnc376, urn:nbn:de:0183-22dgnc3764

Published: May 25, 2022

© 2022 Höhne 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: Multidisciplinary endoscopic approaches in pituitary surgery are increasing despite a lack of high-quality evidence favoring transsphenoidal endoscopic over transsphenoidal microscopic or transcranial microscopic techniques. The goal of our analysis was to compare these techniques in a retrospective single-center cohort.

Methods: Technical aspects, outcomes, and complications were compared in adult patients after transsphenoidal endoscopic (endo) vs. transsphenoidal microscopic (micro) vs. transcranial microscopic (trans) surgery for pituitary adenomas. The primary endpoint was gross-total resection; secondary endpoints included complications and standard quality measures.

Results: One hundred surgeries for pituitary adenomas in 84 patients between 2015 and 2020 were included in our analysis. 44 endoscopic transsphenoidal, 40 microscopic transsphenoidal, and 16 microscopic transcranial approaches. The risk for neurological (endo=2,3%; micro=2,5%; trans=57,2%; p<,001) and significant (endo=11,4%; micro=22,5%; trans=43,8%; p<,0023) complications and residual tumor volume (endo=1,4cm3; micro=1,7cm3trans=12,3cm3 p<001) was significantly increased for patients undergoing transcranial vs. transsphenoidal surgery. Mean hospital stay (endo=10,6±3,4; micro=13,4±5,4; trans=15,7±5,1; p<,012) and intensive care treatment (endo=0,1±0,3; micro=1,7±4,5; trans=3,2±4,5; p<,019) were shorter after endoscopic transsphenoidal surgery. Between transsphenoidal techniques, no significant differences regarding gross-total resection could be detected. Electrolyte disorders were less frequent after endoscopic (15,0%) than microscopic transsphenoidal (21,5%) procedures (n.s.).

Conclusion: A tendency toward decreased residual tumor and otherwise comparable outcome measures support the transition to the multidisciplinary endoscopic technique at our institution together with the ear-nose and throat (ENT) department. Inexperienced surgeons performing endoscopic approaches yielded similar results as experienced surgeons performing microscopic approaches. The growing experience could further reduce risks for complications and improve gross-total resection.