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J Neurol Surg B Skull Base 2018; 79(06): 538-544
DOI: 10.1055/s-0038-1639618
Original Article
Georg Thieme Verlag KG Stuttgart · New York

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

Anthony C. Wang
1   Department of Neurosurgery, University of Miami, Miami, Florida, United States
,
Ashish H. Shah
1   Department of Neurosurgery, University of Miami, Miami, Florida, United States
,
Charif Sidani
2   Department of Radiology, University of Miami, Miami, Florida, United States
,
Brandon G. Gaynor
1   Department of Neurosurgery, University of Miami, Miami, Florida, United States
,
Simon Dockrell
1   Department of Neurosurgery, University of Miami, Miami, Florida, United States
,
S. Shelby Burks
1   Department of Neurosurgery, University of Miami, Miami, Florida, United States
,
Zoukaa B. Sargi
3   Department of Otolaryngology, University of Miami, Miami, Florida, United States
,
Roy R. Casiano
1   Department of Neurosurgery, University of Miami, Miami, Florida, United States
3   Department of Otolaryngology, University of Miami, Miami, Florida, United States
,
Jacques J. Morcos
1   Department of Neurosurgery, University of Miami, Miami, Florida, United States
3   Department of Otolaryngology, University of Miami, Miami, Florida, United States
› Author Affiliations
Further Information

Publication History

05 July 2017

21 February 2018

Publication Date:
12 April 2018 (online)

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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.

Keywords

pituitary adenoma - volumetry - endoscopy - microscopy
 

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