Analysis of transnasal endoscopic versus transseptal microscopic approach for excision of pituitary tumors.
BACKGROUND
The traditional method of pituitary tumor excision is transseptal microscopic excision; however, the transnasal transsphenoidal endoscopic approach has shown comparable results with the transseptal microscopic approach at some institutions. The objective of this study is to compare the two types of sellar and parasellar mass resection: transnasal transsphenoidal endoscopic excision versus transseptal microscopic excision.


METHODS
A retrospective cohort analysis was performed on subjects who were referred to a tertiary hospital for surgical management of sellar or parasellar masses. The two groups of patients either underwent a transnasal endoscopic approach with endoscopic excision or transseptal microscopic excision. Demographics, tumor characteristics, operative details, length of hospital stay, intraoperative and postoperative complications, level of postoperative pain, recurrence rate, use of computed tomography (CT) image guidance, and length of follow-up were gathered. The data between the two groups were then compared.


RESULTS
The analysis included 19 subjects who underwent endoscopic excision and 29 subjects who underwent transseptal microscopic excision. Null macroadenoma was the most common sellar mass followed by prolactinoma. There were no statistical differences in rates of perioperative complications and suprasellar or cavernous sinus invasion. Patients who underwent an endoscopic approach had shorter operative times, lower estimated blood loss, less lumbar drain use, less pain, and a shorter postoperative hospital stay (p < 0.05).


CONCLUSIONS
The two approaches show similar intraoperative characteristics and immediate complication rates. Transnasal transsphenoidal endoscopic excision is a reasonable alternative to the traditional method of sellar mass excision.
Higgins
Thomas S
TS
Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.
Courtemanche
Chad
C
Karakla
Daniel
D
Strasnick
Barry
B
Singh
Ran Vijay
RV
Koen
Joseph L
JL
Han
Joseph K
JK
D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007016:Hypophysectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome