Volumetry in the Assessment of Pituitary Adenoma Resection: Endoscopy versus Microscopy
| Autor: | Simon Dockrell, Zoukaa Sargi, Charif Sidani, Ashish H. Shah, Roy R. Casiano, Brandon G. Gaynor, S. Shelby Burks, Anthony C. Wang, Jacques J. Morcos |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Clinical Sciences pituitary adenoma Subgroup analysis Resection 03 medical and health sciences 0302 clinical medicine Clinical Research Pituitary adenoma medicine endoscopy Cancer volumetry Neurology & Neurosurgery medicine.diagnostic_test business.industry Incidence (epidemiology) Postoperative complication Microsurgery medicine.disease Brain Disorders Endoscopy 030220 oncology & carcinogenesis Cohort microscopy Neurology (clinical) Radiology business 030217 neurology & neurosurgery |
| Zdroj: | Journal of neurological surgery. Part B, Skull base, vol 79, iss 6 |
| ISSN: | 2193-634X 2193-6331 |
| DOI: | 10.1055/s-0038-1639618 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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