Evidence for a 'Learning Curve' Was Sought after Neuronavigation-Guided Endoscopic Trans-sphenoidal Surgery Was Introduced in Our Unit

Autor: Ian Sabin, John P Monson, Gus Alusi, Shabin M. Joshi
Rok vydání: 2007
Předmět:
Zdroj: Skull Base. 16
ISSN: 1532-0065
1531-5010
DOI: 10.1055/s-2006-958333
Popis: objective: Evidence for a “learning curve” was sought after neuronavigation-guided endoscopic trans-sphenoidal surgery was introduced in our unit. Methods: Seventy-four consecutive patients from October 2001 to March 2005 underwent surgery by the same neurosurgeon and endoscopic rhinologist. These were divided into two sequential cohorts of 37 for analysis. Results: Thirty-four males and 40 females with an age range of 16 to 85 years (± 50.4 y) were identified. Presentations ranged from visual deficit alone (27), endocrine manifestations alone (42), and both visual and endocrine features (4); one patient was asymptomatic. Pathology included nonfunctioning pituitary adenoma, Cushing's disease, acromegaly, prolactinomas, hypophysitis, and mixed adenoma. Six had concurrent apoplexy. There was significantly more blood loss in patients from the first cohort and there was one perioperative death. CSF leakage occurred in 17 patients, but these were usually seen at surgery and repaired. Five patients in each cohort required further surgery for tumor removal (sometimes as a planned operation) or for repair of CSF leak (statistical tests performed). Conclusions: There were marginally more major complications in the initial learning phase of this procedure but strangely there were more minor complications in the later cohort. The possible reasons for this will be discussed. Neurosurgeons skilled in trans-sphenoidal surgery aided by a nasal-endoscopist can adapt with relative safety to the endoscopic approach. Undoubtedly there will be a surgeon-dependent learning curve, but certain complications can be reduced by refinement of the operative technique.
Databáze: OpenAIRE
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