Transition From Microscopic to Endoscopic Transsphenoidal Surgery for Nonfunctional Pituitary Adenomas.
OBJECTIVE
At our institution, a total of 320 patients were operated on between 2000 and 2010 for a newly diagnosed pituitary adenoma. In an attempt to improve quality of tumor resection, the transsphenoidal microscopic technique was replaced by the endoscopic technique in June 2008. This retrospective single center study compares the outcomes after microscopic (n = 144) and endoscopic (n = 41) tumor surgery of all patients operated on for a nonfunctional pituitary adenoma.


METHODS
Tumor size and location, Knosp grade, prevalence of anterior hypopituitarism, diabetes insipidus, visual acuity/fields, complication rates, and operation time were compared between the groups.


RESULTS
At the 3-month follow-up, hypopituitarism had improved in 7% of patients in the microscopic group and in 9% in the endoscopic group, and had further impaired in 13% and 9%, respectively. At the 3-month follow-up magnetic resonance imaging, a total tumor removal was achieved in 45% versus 56% of patients, respectively (P = not significant [NS]). Visual fields had normalized or improved in 90% versus 88% of patients, respectively (P = NS). Postoperative cerebrospinal fluid leak occurred in 3.5% versus 2.4% (P = NS), and diabetes insipidus (transient or permanent) in 7.6% versus 4.9% (P = NS) of cases, respectively. Larger tumor size (P < 0.0005) and endoscopic technique (P = 0.03) were independent predictors of increased mean operative time.


CONCLUSIONS
Initial results with the endoscopic technique were statistically similar to those achieved with the microscopic technique. However, there was a trend toward improved outcomes and fewer complications in the endoscopic group.
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: atte.karppinen@hus.fi.
Atte
A
Karppinen
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Leena
L
Kivipelto
Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Satu
S
Vehkavaara
Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Elina
E
Ritvonen
Department of Public Health, University of Helsinki, Institute for Molecular Medicine Finland FIMM, Helsinki, Finland.
Emmi
E
Tikkanen
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Riku
R
Kivisaari
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Juha
J
Hernesniemi
Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Kirsi
K
Setälä
Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Camilla
C
Schalin-Jäntti
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Mika
M
Niemelä
D000236:Adenoma / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000008:administration & dosage; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000009:adverse effects; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000473:pathology; D044583:Neuroendoscopy / Q000009:adverse effects / Q000379:methods; D010902:Pituitary Gland / Q000378:metabolism*; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D013101:Sphenoid Sinus; D013739:Testosterone / Q000008:administration & dosage; D013974:Thyroxine / Q000008:administration & dosage; D016896:Treatment Outcome; D014667:Vasopressins / Q000008:administration & dosage
D014667:Vasopressins; D019382:Human Growth Hormone; D013739:Testosterone; D013974:Thyroxine; D006854:Hydrocortisone
Endoscopy; Nonfunctioning pituitary adenoma; Transsphenoidal surgery