Transsphenoidal Endoscopic versus Microscopic Approach in Treatment of Pituitary Adenomas: CSF Leak and GTR Systematic review

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ibrahim M Omran ◽  
Hamdy Ibrahim ◽  
Emad Maamon ◽  
Ahmed Yousry
Keyword(s):  
Brain Tumors ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Csf Leak ◽  
Endoscopic Transsphenoidal Surgery ◽  
Microscopic Surgery ◽  
Cochrane Database ◽  
Number Of Patients ◽  
Significant Difference ◽  
Endoscopic Group

Abstract Background Pituitary adenomas (PAs) are the second most common brain tumors, 10% to 20% of all primary brain tumors. Transsphenoidal approach is now the gold standard for treatment of PAs either microscopic or endoscopic. Aim of the Work to analyze the collective outcomes from studies comparing the microscopic transsphenoidal surgery (MTS) with the endoscopic transsphenoidal surgery (ETS) regarding gross total resection (GTR) and postoperative cerebrospinal fluid (CSF) leak. Patients and Methods we searched PubMed, Google scholar search engine, Cochrane database of systematic reviews, EMBASE and science Direct, using the following keywords “Pituitary adenoma/tumor, endoscopy or endoscopic, microscopy or microscopic, gross total/subtotal/near total/radicular resection/excision, hypophysectomy, debulking, CSF leak/leakage ". The mentioned databases were searched for studies published during period from the 1st of Jan 2015 to 31 Aug. 2020. Results Total number of patients in included studies was 1211 of which 621 (51.3%) underwent endoscopic surgery and 590 (48.7%) underwent microscopic surgery. Of 990 patient analysed for GTR, it was achieved in 334 patients (69.4%) in endoscopic group compared with 287 patients (56.4%) in microscopic group. Of 1211 patients, Postoperative CSF leak developed in 30 patients (5.7%) compared with 32 patients (4.7%) in endoscopic and microscopic group respectively. Conclusion GTR was found to be slightly higher in the endoscopic group especially in cases of suprasellar and lateral cavernous extensions. CSF leak showed no significant difference between the two groups.

Complication Rates after Endoscopic Transsphenoidal Surgery for ACTH-Secreting Pituitary Adenomas: A Comparative Analysis with GH and Nonfunctioning Adenomas

2021 ◽  
Author(s):  
Juan Á. Aibar-Durán ◽  
Michael Oladotun-Anka ◽  
Carlos Asencio-Cortés ◽  
Elena Valassi ◽  
Susan Webb ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Statistical Analysis ◽  
Diabetes Insipidus ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Csf Leak ◽  
Complication Rates ◽  
Endoscopic Transsphenoidal Surgery ◽  
Number Of Patients ◽  
Acth Secreting

Abstract Objectives Some complications have been more frequently reported after surgery for adrenocorticotropin hormone (ACTH)-secreting pituitary adenomas. We compared complication rates in patients with ACTH-secreting pituitary adenomas with those in patients with growth hormone secreting pituitary adenomas (growth hormone [GH] group) and nonfunctioning adenomas (nonfunctioning group). Design A comparative three-group analysis was performed for all patients who had endoscopic transsphenoidal surgery for pituitary adenomas at our center between January 2011 and May 2019. Variables included demographics, preoperative clinical and radiological characteristics, and postoperative radiological and endocrinological outcomes. Complications were divided into four categories: endocrinological, neurosurgical, medical, and ENT (ear–nose–throat)-related complications. Univariate and multivariate statistical analysis were performed. Results A total of 111 patients with pituitary adenomas and a mean age of 53.7 years were included (25 ACTH, 35 GH, and 51 nonfunctioning adenomas). Overall, 28 patients had microadenomas (25.2%) and 83 had macroadenomas (74.8%). Univariate statistical analysis for complications between groups showed no differences in neurosurgical and medical complications. Transient diabetes insipidus and postsurgical bacterial sinusitis were the only variables more frequently seen in the ACTH group (p = 0.01 and 0.04, respectively). Multivariate analysis for transient diabetes insipidus showed no differences between groups (p = 0.58). Conclusion Complication rates were similar in all three adenoma groups, particularly concerning major infections, thrombotic events, postoperative cerebrospinal fluid (CSF) leak, and transient diabetes insipidus. Transient diabetes insipidus was related with adenoma size and intraoperative CSF leak. Despite postoperative bacterial sinusitis was statistically higher in the ACTH group, this data should be interpreted with caution given the low number of patients with this complication.

Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center

2010 ◽  
Vol 29 (4) ◽  
pp. E7 ◽  
Author(s):  
Jackson A. Gondim ◽  
João Paulo Almeida ◽  
Lucas Alverne F. de Albuquerque ◽  
Erika Gomes ◽  
Michele Schops ◽  
...  
Keyword(s):  
Growth Factor ◽  
Disease Control ◽  
Endoscopic Surgery ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Insulin Like Growth Factor ◽  
Endoscopic Transsphenoidal Surgery ◽  
Factor I ◽  
Transsphenoidal Endoscopic Surgery ◽  
Growth Factor I

Object Acromegaly is a chronic disease related to the excess of growth hormone (GH) and insulin-like growth factor–I secretion, usually by pituitary adenomas. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The introduction of endoscopy as an additional tool for surgical treatment of pituitary adenomas and, therefore, acromegaly represents an important advance of pituitary surgery in the recent years. The aim of this retrospective study is to evaluate the results of pure transsphenoidal endoscopic surgery in a series of patients with acromegaly who were operated on by a pituitary specialist surgeon. The authors discuss the advantages, outcome, complications, and factors related to the success of the endoscopic approach in cases of GHsecreting adenomas. Methods The authors retrospectively analyzed data from cases involving patients with GH-secreting adenomas who underwent pure transsphenoidal endoscopic surgery at the Department of Neurosurgery of the General Hospital in Fortaleza, Brazil, between 2000 and 2009. Tumors were classified according to size as micro- or macroadenomas, and tumor extension was analyzed based on suprasellar/parasellar extension and sella floor destruction. All patients were followed up for at least 1 year. The criteria of disease control were GH levels < 1 ng/L after oral glucose tolerance test and normal insulin-like growth factor–I levels for age and sex. Results During the study period, 67 patients underwent pure endoscopic transsphenoidal surgery for treatment of acromegaly. Disease control was obtained in 50 cases (74.6%). The rate of treatment success was higher in patients with microadenomas (disease control achieved in 12 [85.7%] of 14 cases) than in those with larger lesions. Suprasellar/parasellar extension and high levels of sella floor erosion were associated with lower rates of disease control (p = 0.01 and p = 0.02, respectively). Complications related to the endoscopic surgery included epistaxis (6.0%), transitory diabetes insipidus (4.5%), and 1 case of seizure (1.5%). Conclusions Endoscopic transsphenoidal surgery represents an effective option for treatment of patients with acromegaly. High disease control rates and a small number of complications are some of the most important points related to the technique. Factors related to the success of the endoscopic surgery are lesion size, suprasellar/parasellar extension, and the degree of sella floor erosion. Although presenting important advantages, there is no conclusive evidence that endoscopy is superior to microsurgery in treatment of GH-secreting adenomas.

Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study

2020 ◽  
Vol 132 (4) ◽  
pp. 1043-1053 ◽  
Author(s):  
Andrew S. Little ◽  
Daniel F. Kelly ◽  
William L. White ◽  
Paul A. Gardner ◽  
Juan C. Fernandez-Miranda ◽  
...  
Keyword(s):  
Endoscopic Surgery ◽  
Surgical Outcomes ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Endoscopic Technique ◽  
Controlled Study ◽  
Nonfunctioning Pituitary Adenomas ◽  
Microscopic Surgery

OBJECTIVEMany surgeons have adopted fully endoscopic over microscopic transsphenoidal surgery for nonfunctioning pituitary tumors, although no high-quality evidence demonstrates superior patient outcomes with endoscopic surgery. The goal of this analysis was to compare these techniques in a prospective multicenter controlled study.METHODSExtent of tumor resection was compared after endoscopic or microscopic transsphenoidal surgery in adults with nonfunctioning adenomas. The primary end point was gross-total tumor resection determined by postoperative MRI. Secondary end points included volumetric extent of tumor resection, pituitary hormone outcomes, and standard quality measures.RESULTSSeven pituitary centers and 15 surgeons participated in the study. Of the 530 patients screened, 260 were enrolled (82 who underwent microscopic procedures, 177 who underwent endoscopic procedures, and 1 who cancelled surgery) between February 2015 and June 2017. Surgeons who used the microscopic technique were more experienced than the surgeons who used the endoscopic technique in terms of years in practice and number of transsphenoidal surgeries performed (p < 0.001). Gross-total resection was achieved in 80.0% (60/75) of microscopic surgery patients and 83.7% (139/166) of endoscopic surgery patients (p = 0.47, OR 0.8, 95% CI 0.4–1.6). Volumetric extent of resection, length of stay, surgery-related deaths, and unplanned readmission rates were similar between groups (p > 0.2). New hormone deficiency was present at 6 months in 28.4% (19/67) of the microscopic surgery patients and 9.7% (14/145) of the endoscopic surgery patients (p < 0.001, OR 3.7, 95% CI 1.7–7.7). Microscopic surgery cases were significantly shorter in duration than endoscopic surgery cases (p < 0.001).CONCLUSIONSExperienced surgeons who performed microscopic surgery and less experienced surgeons who performed endoscopic surgery achieved similar extents of tumor resection and quality outcomes in patients with nonfunctioning pituitary adenomas. The endoscopic technique may be associated with lower rates of postoperative pituitary gland dysfunction. This study generally supports the transition to endoscopic pituitary surgery when the procedure is performed by proficient surgeons, although both techniques yield overall acceptable surgical outcomes.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: prospective cohort trial; evidence: class III.Clinical trial registration no.: NCT02357498 (clinicaltrials.gov)

scholarly journals Early outcomes of endoscopic transsphenoidal surgery for adult craniopharyngiomas

2010 ◽  
Vol 28 (4) ◽  
pp. E9 ◽  
Author(s):  
John A. Jane ◽  
Erin Kiehna ◽  
Spencer C. Payne ◽  
Stephen V. Early ◽  
Edward R. Laws
Keyword(s):  
Mr Imaging ◽  
Transsphenoidal Surgery ◽  
Tumor Resection ◽  
Imaging Study ◽  
High Rate ◽  
Transsphenoidal Approach ◽  
Gross Total Resection ◽  
Csf Leak ◽  
Total Resection ◽  
Endoscopic Transsphenoidal Surgery

Object Although the transsphenoidal approach for subdiaphragmatic craniopharyngiomas has been performed for many years, there are few reports describing the role of the endoscopic transsphenoidal technique for suprasellar craniopharyngiomas. The purpose of this study was to report the outcomes of the endoscopic transsphenoidal approach for adults with craniopharyngiomas in whom the goal was gross-total resection. Methods Twelve patients were identified who were older than 18 years at the time of their pure endoscopic transsphenoidal surgery. Their medical records and imaging studies were retrospectively reviewed. Results Gross-total resection was achieved in 42% of cases when assessed by intraoperative impression alone and in 75% when assessed by the first postoperative MR imaging study. However, 83% of patients achieved at least a 95% resection when assessed by both intraoperative impression and the first postoperative MR imaging study. Permanent diabetes insipidus occurred postoperatively in 44% of patients. Six (67%) of 9 patients who had a functioning hypothalamic-pituitary axis preoperatively developed panhypopituitarism after surgery. Visual improvement or normalization occurred in 78% of patients with preoperative visual deficits. Although no patient experienced a postoperative CSF leak, 1 patient was treated for meningitis. Conclusions The authors have achieved a high rate of radical resection and symptomatic improvement with the endoscopic transsphenoidal technique for both subdiaphragmatic (sellar/suprasellar) and supradiaphragmatic (suprasellar) craniopharyngiomas. However, this is also associated with a high incidence of new endocrinopathy. Endoscopic assessment of tumor resection may be more sensitive for residual tumor than the first postoperative MR imaging study.

scholarly journals Quantitative evaluation of headache severity before and after endoscopic transsphenoidal surgery for pituitary adenoma

2016 ◽  
Vol 124 (6) ◽  
pp. 1627-1633 ◽  
Author(s):  
Amparo Wolf ◽  
Sandy Goncalves ◽  
Fateme Salehi ◽  
Jeff Bird ◽  
Paul Cooper ◽  
...  
Keyword(s):  
Mental Health ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Short Form ◽  
Significant Proportion ◽  
Endoscopic Transsphenoidal Surgery ◽  
Headache Severity ◽  
Younger Age ◽  
Sf 36 ◽  
The Impact

OBJECT The relationship between headaches, pituitary adenomas, and surgical treatment of pituitary adenomas remains unclear. The authors assessed the severity and predictors of self-reported headaches in patients referred for surgery of pituitary adenomas and evaluated the impact of endoscopic transsphenoidal surgery on headache severity and quality of life (QOL). METHODS In this prospective study, 79 patients with pituitary adenomas underwent endoscopic transsphenoidal resection and completed the Headache Impact Test (HIT-6) and the 36-Item Short Form Health Survey (SF-36) QOL questionnaire preoperatively and at 6 weeks and 6 months postoperatively. RESULTS Preoperatively, 49.4% of patients had mild headache severity, 13.9% had moderate severity, 13.9% had substantial severity, and 22.8% had intense severity. Younger age and hormone-producing tumors predisposed greater headache severity, while tumor volume, suprasellar extension, chiasmal compression, and cavernous sinus invasion of the pituitary tumors did not. Preoperative headache severity was found to be significantly associated with reduced scores across all SF-36 QOL dimensions and most significantly associated with mental health. By 6 months postoperatively, headache severity was reduced in a significant proportion of patients. Of the 40 patients with headaches causing an impact on daily living (moderate, substantial, or intense headache), 70% had improvement of at least 1 category on HIT-6 by 6 months postoperatively, while headache worsened in 7.6% of patients. The best predictors of headache response to surgery included younger age, poor preoperative SF-36 mental health score, and hormone-producing microadenoma. CONCLUSIONS The results of this study confirm that surgery can significantly improve headaches in patients with pituitary adenomas by 6 months postoperatively, particularly in younger patients whose preoperative QOL is impacted. A larger multicenter study is underway to evaluate the long-term effect of surgery on headaches in this patient group.

Sign in / Sign up

Export Citation Format

Share Document