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Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases

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Abstract

The objective of this study was to evaluate outcomes of endoscopic transsphenoidal surgery using a single-surgeon technique as an alternative to the more commonly employed two-surgeon, three-hand method. Three hundred consecutive endoscopic transsphenoidal procedures performed over a 5 year period from 2006 to 2011 were reviewed. All procedures were performed via a binasal approach utilizing a single surgeon two handed technique with a pneumatic endoscope holder. Expanded enodnansal cases were excluded. Surgical technique, biochemical and surgical outcomes, and complications were analyzed. 276 patients underwent 300 consecutive surgeries with a mean follow-up period of 37 ± 22 months. Non-functioning pituitary adenoma (NFPA) was the most common pathology (n = 152), followed by growth hormone secreting tumors (n = 41) and Rathke’s cleft cysts (n = 30). Initial gross total cyst drainage based on radiologic criteria was obtained in 28 cases of Rathke’s cleft cyst, with 5 recurrences. For NFPA and other pathologies (n = 173) gross total resection was obtained in 137 cases, with a 92 % concordance rate between observed and expected extent of resection. For functional adenoma, remission rates were 30/41 (73 %) for GH-secreting, 12/12 (100 %) for ACTH-secreting, and 8/17 (47 %) for prolactin-secreting tumors. Post-operative complications included transient (11 %) and permanent (1.4 %) diabetes insipidus, hyponatremia (13 %), and new anterior pituitary hormonal deficits (1.4 %). CSF leak occurred in 42 cases (15 %), and four patients required surgical repair. Two carotid artery injuries occurred, both early in the series. Epistaxis and other rhinological complications were noted in 10 % of patients, most of which were minor and diminished as surgical experience increased. Fully endoscopic single surgeon transsphenoidal surgery utilizing a binasal approach and a pneumatic endoscope holder yields outcomes comparable to those reported with a two-surgeon method. Endoscopic outcomes appear to be better than those reported in microscope-based series, regardless of a one or two surgeon technique.

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Acknowledgments

The authors would like to thank William Gellipis, Lori Korsakoff, RN, and Ilana Litwin for assistance in gathering the data presented.

Conflict of interest

None of the authors have a perceived or real conflict of interest with any of the products or medical devices described in this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Cedars-Sinai Medical Center, 8631 W. Third St., Ste. 800E, Los Angeles, CA, 90048, USA

    Adam N. Mamelak

  2. Division of Endocrinology and Metabolism, Cedars-Sinai Medical Center, 8631 W. Third St., Ste. 800E, Los Angeles, CA, 90048, USA

    John Carmichael, Vivien H. Bonert, Odelia Cooper & Shlomo Melmed

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  2. John Carmichael
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Correspondence to Adam N. Mamelak.

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Mamelak, A.N., Carmichael, J., Bonert, V.H. et al. Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases. Pituitary 16, 393–401 (2013). https://doi.org/10.1007/s11102-012-0437-1

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