Reasonability of implementation of the endoscopic technique for sellar lesions in a low volume center

摘要

We evaluated the implementation of the endoscopic (E) technique by an interdisciplinary ENT/neurosurgeonteam as compared to the established classical microscopic technique (M) performed by one experiencedneurosurgeon for pituitary adenomas in a single center. A retrospective analysis of patients operated for newlydiagnosed pituitary adenomas was performed between November 2004 and August 2012. Outcome andcomplications are presented.A total of 116 patientswere operated, 64 microscopically (M) and 52 endoscopically(E).Mean followupwas 35 months (range 1.4–95), 1 patientwas lost to follow-up.Most frequent pathologywashormone inactive adenoma (60% E, 51%M). Operating time was stable in theM-group (±94 min). The E-groupshowed a learning curve in mean operating time (2004–2007: 154 min, 2008–2012: 93 min). Postoperative CSFleaks were seen in 9.6% (E) vs. 3.1% (M) of cases. More E-cases were re-operated (5 vs. 1) and more M-casesreceived a lumbar drainage (8 vs. 19). Transient postoperative diabetes insipidus occurred more often afterE-operations (17 vs. 5%, p = 0.03) without significant long term difference. Improved visual outcome showed amore favorable trend in E-cases. The implementation of the endoscopic technique was associated with moresurgical complications in the learning phase, however with more improved visual outcome. Our observationsshould be of value for themore average neurosurgical department dealingwith pituitary adenomas and aiming toswitch from the microscopic to the endoscopic technique.