Endoscopic transsphenoidal pituitary surgery: a single surgeon experience and the learning curve.
Endoscopic transsphenoidal surgery for pituitary adenomas has been introduced as an alternative to transsphenoidal microsurgery. This is the first Australian study to evaluate a single surgeon's experience by comparing our results with other series and attempting to identify a learning curve. Retrospective analysis was carried out on 79 consecutively treated patients by fully endoscopic transsphenoidal surgery by a single neurosurgeon over a period spanning from July 1998 to September 2010 at St George Public and Private hospitals. The mean age at time of surgery was 56.7 years (SD ± 16.3, range 26-85) and the mean follow-up period was 38.2 months (SD ± 33, range 1-136). Gross total resection (GTR) was noted in 63% of patients, endocrinological cure was achieved in 53% and visual field improvements were noted in 86% of patients. Intra-operative CSF leaks occurred in 19% of procedures, while the rates of post-operative CSF rhinorrhea was 3% and post-operative diabetes insipidus was 13%. There was one post-operative death (1%). Compared to microsurgery, intra-operative CSF leaks and meningitis seem less frequent with an endoscopic approach. With increasing experience, we found a non-statistically significant trend towards higher rates of GTR, and improved visual fields. Endocrinological cure rates were clearly better with experience (p < 0.01). There may be a learning curve that can be overcome in 30-40 cases. Endoscopic transsphenoidal surgery provides similar tumour and patient outcomes when compared to transsphenoidal microsurgery. In this single surgeon's experience, there was a trend to indicate improved performance with more case experience.
Faculty of Medicine, The University of New South Wales, Sydney, Australia. a.bokhari33@gmail.com
Ali R
AR
Bokhari
Mark A
MA
Davies
Terrence
T
Diamond
D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology; D002983:Clinical Competence / Q000592:standards; D020790:Diabetes Insipidus, Neurogenic / Q000209:etiology; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D044583:Neuroendoscopy / Q000379:methods*; D009493:Neurosurgery / Q000592:standards; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013100:Sphenoid Bone; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology / Q000601:surgery; D014794:Visual Fields