Endoscopic approach for pituitary surgery improves rhinologic outcomes.
OBJECTIVE
We hypothesized that the endoscopic approach to pituitary surgery improves rhinology-specific quality of life and has satisfactory tumor outcomes compared with the open approach.


METHODS
Cases of pituitary surgery from the Department of Neurosurgery database included an inception cohort of all patients who had endoscopic procedures and consecutive patients who had open procedures between January 1998 and February 2008. The Sino-Nasal Outcome Test-22 was mailed.


RESULTS
Since January 1998, 71 endoscopic and 122 open pituitary surgeries had been performed. The mean followup was longer for open procedures (49.3 months) than for endoscopic procedures (18.8 months). Recurrence was more common after open surgery (28.4%) than after endoscopic surgery (18.2%; p = 0.219). The most common diagnosis was macroadenoma (77.1% of endoscopic procedures and 93.4% of open procedures). The mean hospital stay was shorter for endoscopic procedures (4.1 days) than for open procedures (6.0 days; p <0.001). Of patients who presented with visual deterioration, 53.8% with endoscopic surgery and 46.7% with open surgery had improvement. Among patients with normal preoperative hormonal function, 27.5% of patients in the endoscopy group and 29.4% of patients in the open group required medication for more than 2 months after surgery. Complications occurred in 33.3% of endoscopic procedures and 43.4% of open procedures. Cerebrospinal fluid leaks were more common in the endoscopy group (p = 0.035), and diabetes insipidus lasting more than 30 days was more common in the open group (p = 0.017). The mean Sino-Nasal Outcome Test-22 score was lower for patients in the endoscopy group (20.4) than for those in the open group (23.2; p = 0.41). Patients in the endoscopy group had a significantly lower rhinology-specific mean score (6.5) than did patients in the open group (9.2; p = 0.03).


CONCLUSIONS
The endoscopic approach to pituitary surgery offers tumor outcomes comparable to those of open surgery, with no greater incidence of complications and an improved rhinology-specific quality of life.
Graham
Scott M
SM
Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
Iseli
Tim A
TA
Karnell
Lucy H
LH
Clinger
John D
JD
Hitchon
Patrick W
PW
Greenlee
Jeremy D W
JD
D000236:Adenoma / Q000601:surgery; D000368:Aged; D004724:Endoscopy; D005260:Female; D006801:Humans; D007016:Hypophysectomy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery; D011183:Postoperative Complications; D011788:Quality of Life; D012008:Recurrence