Volumetry in the Assessment of Pituitary Adenoma Resection: Endoscopy versus Microscopy

Anthony C. Wang, Ashish H. Shah, Charif Sidani, Brandon G. Gaynor, Simon Dockrell, S. Shelby Burks, Zoukaa B. Sargi, Roy R. Casiano, Jacques J. Morcos

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1 Scopus citations

Abstract

Background Assessment of the extent of resection after surgical resection of pituitary adenomas is most commonly reported in terms of the presence or absence of residual tumor. A quantitative comparison of volumetric resection between endonasal endoscopy (EE) and microsurgery (MS) has rarely been done. Methods A retrospective analysis was performed on a consecutive series of 154 patients with pituitary adenomas treated by the same surgeon at a single institution. We employed volumetric analysis pre- and postoperatively on two cohorts of pituitary adenoma patients treated through MS (n = 37) versus EE approach (n = 117). Results Volumetric analysis revealed a higher incidence of complete resection (64.4 vs. 56.8%) and mean volume reduction in the EE cohort (92.7 vs. 88.4%), although not significant. Recurrence rates were significantly lower in the EE group (7.7% vs 24.3%, p = 0.015). Subgroup analysis identified that patients with preoperative tumor volumes >1 mL were less likely to recur through EE (7.8 vs. MS: 29.6%; p = 0.0063). A higher incidence of complete resection was also noted in patients with favorable Knosp grades (0-1) (EE: 87.8 vs. MS: 63.2%; p = 0.036). Postoperative complication rates were not significantly different between both techniques. Conclusion Both microscopy and endoscopy are well-tolerated, effective approaches in the treatment of pituitary adenomas. Our series demonstrated that EE may be superior to MS in preventing tumor recurrence and achieving a complete resection in certain subsets of patients. EE provides a slight advantage in tumor control outcomes that may justify the paradigm shift to pure endoscopy at our center.

Original languageEnglish (US)
Pages (from-to)538-544
Number of pages7
JournalJournal of Neurological Surgery, Part B: Skull Base
Volume79
Issue number6
DOIs
StatePublished - Apr 12 2018

Keywords

  • endoscopy
  • microscopy
  • pituitary adenoma
  • volumetry

ASJC Scopus subject areas

  • Clinical Neurology

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