Abstract
The introduction of the endoscope to transsphenoidal pituitary surgery is relatively new, but represents a major advancement in the field. The use of the endoscope to visualize the sella via a direct endonasal approach offers the surgeon dramatically better visualization as well as improved range of motion compared to the operating microscope. Growing evidence confirms that these improvements directly translate into better surgical resections and outcomes. Further, patient comfort and satisfaction are higher with the endonasal method compared with other transsphenoidal approaches, and it is a cost effective technology. This position paper will outline the reasons that endoscopic endonasal transsphenoidal surgery is the preferred method for pituitary surgery, and why it will likely be adopted as the standard technique for transsphenoidal surgery worldwide.
Similar content being viewed by others
References
G. Lanzino, E.R. Laws, Pioneers in the development of transsphenoidal surgery: Theodor Kocher, Oskar Hirsch, and Norman Dott. J. Neurosurg. 95(6), 1097–1103 (2001)
J.K. Liu, K. Das, M.H. Weiss, E.R. Laws Jr, W.T. Couldwell, The history and evolution of transsphenoidal surgery. J. Neurosurg. 95(6), 1083–1096 (2001)
A.A. Cohen-Gadol, E.R. Laws, D.D. Spencer, A.A. De Salles, The evolution of Harvey Cushing’s surgical approach to pituitary tumors from transsphenoidal to transfrontal. J. Neurosurg. 103(2), 372–377 (2005)
A.S. Kanter, A.S. Dumont, A.R. Asthagiri, R.J. Oskouian, J.A. Jane Jr, E.R. Laws Jr, The transsphenoidal approach. A historical perspective. Neurosurg. Focus 18(4), e6 (2005)
G. Lanzino, E.R. Laws, Key personalities in the development and popularization of the transsphenoidal approach to pituitary tumors: an historical overview. Neurosurg. Clin. N. Am. 14(1), 1–10 (2003)
W.R. Spencer, K. Das, C. Nwagu, E. Wenk, S.D. Schaefer, A. Moscatello, W.T. Couldwell, Approaches to the sellar and parasellar region: anatomic comparison of the microscope versus endoscope. Laryngoscope 109(5), 791–794 (1999)
P. Cappabianca, L.M. Cavallo, O. de Divitiis, D. Solari, F. Esposito, A. Colao, Endoscopic pituitary surgery. Pituitary 11(4), 385–390 (2008)
R.X. Cheng, H.L. Tian, W.W. Gao, Z.Q. Li, A comparison between endoscopic trans-sphenoidal surgery and traditional trans-sphenoidal microsurgery for functioning pituitary adenomas. J. Int. Med. Res. 39(5), 1985–1993 (2011)
D.Y. Cho, W.R. Liau, Comparison of endonasal endoscopic surgery and sublabial microsurgery for prolactinomas. Surg. Neurol. 58(6), 371–375 (2002); discussion 375–376
C.P. Hofstetter, R.H. Mannaa, L. Mubita, V.K. Anand, J.W. Kennedy, A.R. Dehdashti, T.H. Schwartz, Endoscopic endonasal transsphenoidal surgery for growth hormone-secreting pituitary adenomas. Neurosurg. Focus 29(4), E6 (2010)
J.A. Jane, R.M. Starke, M.A. Elzoghby, D.L. Reames, S.C. Payne, M.O. Thorner, J.C. Marshall, E.R. Laws Jr, M.L. Vance, Endoscopic transsphenoidal surgery for acromegaly: remission using modern criteria, complications, and predictors of outcome. J. Clin. Endocrinol. Metab. 96(9), 2732–2740 (2011)
A.N. Mamelak, J. Carmichael, V.H. Bonert, O. Cooper, S. Melmed, Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases. Pituitary 16(3), 393–401 (2013)
M.A. Wagenmakers, R.T. Netea-Maier, E.J. van Lindert, G.F. Pieters, A.J. Grotenhuis, A.R. Hermus, Results of endoscopic transsphenoidal pituitary surgery in 40 patients with a growth hormone-secreting macroadenoma. Acta Neurochir. (Wien) 153(7), 91–99 (2011)
A.R. Dehdashti, A. Ganna, K. Karabatsou, F. Gentili, Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery 62(5), 1006–1015 (2008); discussion 1015–1007
K.D. Nielson, C. Watts, K. Clark, Transsphenoidal microsurgery for selective removal of functional pituitary microadenomas. World J. Surg. 1(1), 79–84 (1977)
M. Powell, Microscope and endoscopic pituitary surgery. Acta Neurochir. (Wien) 151(7), 723–728 (2009)
A. Rudnik, B. Kos-Kudła, D. Larysz, T. Zawadzki, P. Bazowski, Endoscopic transsphenoidal treatment of hormonally active pituitary adenomas. Neuro Endocrinol. Lett. 28(4), 438–444 (2007)
R.M. Starke, D.L. Reames, C.J. Chen, E.R. Laws, J.A. Jane Jr, Endoscopic transsphenoidal surgery for cushing disease: techniques, outcomes, and predictors of remission. Neurosurgery 72(2), 240–247 (2013); discussion 247
R.M. Starke, D.M. Raper, S.C. Payne, M.L. Vance, E.H. Oldfield, J.A. Jane Jr, Endoscopic vs microsurgical transsphenoidal surgery for acromegaly: outcomes in a concurrent series of patients using modern criteria for remission. J. Clin. Endocrinol. Metab. 98(8), 3190–3198 (2013)
H.L. Storr, W.M. Drake, J. Evanson, M. Matson, D.M. Berney, A.B. Grossman, S.A. Akker, J.P. Monson, G. Alusi, M.O. Savage, I. Sabin, Endonasal endoscopic transsphenoidal pituitary surgery: early experience and outcome in paediatric Cushing’s disease. Clin. Endocrinol. (Oxf) 80(2), 270–276 (2014)
A. Tabaee, V.K. Anand, Y. Barrón, D.H. Hiltzik, S.M. Brown, A. Kacker, M. Mazumdar, T.H. Schwartz, Endoscopic pituitary surgery: a systematic review and meta-analysis. J. Neurosurg. 111(3), 545–554 (2009)
R.J. Oskouian, D.F. Kelly, E.R. Laws Jr, Vascular injury and transsphenoidal surgery. Front Horm. Res. 34, 256–278 (2006)
M. Berker, D.B. Hazer, T. Yücel, A. Gürlek, A. Cila, M. Aldur, M. Onerci, Complications of endoscopic surgery of the pituitary adenomas: analysis of 570 patients and review of the literature. Pituitary 15(3), 288–300 (2012)
P. Charalampaki, A. Ayyad, R.A. Kockro, A. Perneczky, Surgical complications after endoscopic transsphenoidal pituitary surgery. J. Clin. Neurosci. 16(6), 786–789 (2009)
J.R. Dusick, F. Esposito, D. Malkasian, D.F. Kelly, Avoidance of carotid artery injuries in transsphenoidal surgery with the Doppler probe and micro-hook blades. Neurosurgery 60(4 Suppl 2), 322–328 (2007); discussion 328–329
N. Fatemi, J.R. Dusick, M.A. De Paiva Neto, D.F. Kelly, The endonasal microscopic approach for pituitary adenomas and other parasellar tumors: a 10-year experience. Neurosurgery 63(4 Suppl 2), 244–256 (2008); discussion 256
A.B. Kassam, D.M. Prevedello, R.L. Carrau, C.H. Snyderman, A. Thomas, P. Gardner, A. Zanation, B. Duz, S.T. Stefko, K. Byers, M.B. Horowitz, Endoscopic endonasal skull base surgery: analysis of complications in the authors’ initial 800 patients. J. Neurosurg. 114(6), 1544–1568 (2011)
E.R. Laws, Vascular complications of transsphenoidal surgery. Pituitary 2(2), 163–170 (1999)
H. Raja, T. Upile, W. Jerjes, N. Charakias, V. Dewan, R.M. Redfern, Microscopic endonasal access in pituitary surgery for tumour removal: eight-year review of nasal complications. Head Neck Oncol. 4, 76 (2012)
J.K. Goudakos, K.D. Markou, C. Georgalas, Endoscopic versus microscopic trans-sphenoidal pituitary surgery: a systematic review and meta-analysis. Clin. Otolaryngol. 36(3), 212–220 (2011)
M. Ammirati, L. Wei, I. Ciric, Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. J. Neurol. Neurosurg. Psychiatry 84(8), 843–849 (2013)
B.Y. Kim, H.L. Son, S.G. Kang, S.W. Kim, Y.K. Hong, S.S. Jeun, S.W. Kim, J.H. Cho, Y.J. Park, Postoperative nasal symptoms associated with an endoscopic endonasal transsphenoidal approach. Eur. Arch. Otorhinolaryngol. 270(4), 1355–1359 (2013)
I. Koren, T. Hadar, Z.H. Rappaport, E. Yaniv, Endoscopic transnasal transsphenoidal microsurgery versus the sublabial approach for the treatment of pituitary tumors: endonasal complications. Laryngoscope 109(11), 1838–1840 (1999)
J. Strychowsky, S. Nayan, K. Reddy, F. Farrokhyar, D. Sommer, Purely endoscopic transsphenoidal surgery versus traditional microsurgery for resection of pituitary adenomas: systematic review. J. Otolaryngol. Head Neck Surg. 40(2), 175–185 (2011)
A. Colao, M. Boscaro, D. Ferone, F.F. Casanueva, Managing Cushing’s disease: the state of the art. Endocrine (2014). doi:10.1007/s12020-013-0129-2
P. Leach, A.H. Abou-Zeid, T. Kearney, J. Davis, P.J. Trainer, K.K. Gnanalingham, Endoscopic transsphenoidal pituitary surgery: evidence of an operative learning curve. Neurosurgery 67(5), 1205–1212 (2010)
Z. Zador, K. Gnanalingham, Endoscopic transnasal approach to the pituitary–operative technique and nuances. Br. J. Neurosurg. 27(6), 718–726 (2013)
J.R. Dusick, F. Esposito, C.A. Mattozo, C. Chaloner, D.L. McArthur, D.F. Kelly, Endonasal transsphenoidal surgery: the patient’s perspective-survey results from 259 patients. Surg. Neurol. 65(4), 332–341 (2006); discussion 341–332
G. Zada, D.F. Kelly, P. Cohan, C. Wang, R. Swerdloff, Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions. J. Neurosurg. 98(2), 350–358 (2003)
J.A. Gondim, J.P. Almeida, L.A. Albuquerque, M. Schops, E. Gomes, T. Ferraz, W. Sobreira, M.T. Kretzmann, Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients. Pituitary 14(2), 174–183 (2011)
G. Kahilogullari, S. Beton, E.S. Al-Beyati, O. Kantarcioglu, M. Bozkurt, E. Kantarcioglu, A. Comert, M.A. Unlu, C. Meco, Olfactory functions after transsphenoidal pituitary surgery: endoscopic versus microscopic approach. Laryngoscope 123(9), 2112–2119 (2013)
S. Lwu, I. Edem, B. Banton, M. Bernstein, A. Vescan, F. Gentili, G. Zadeh, Quality of life after transsphenoidal pituitary surgery: a qualitative study. Acta Neurochir. (Wien) 154(10), 1917–1922 (2012)
N. McLaughlin, A.A. Eisenberg, P. Cohan, C.B. Chaloner, D.F. Kelly, Value of endoscopy for maximizing tumor removal in endonasal transsphenoidal pituitary adenoma surgery. J. Neurosurg. 118(3), 613–620 (2013)
I. Ciric, S. Rosenblatt, J.C. Zhao, Transsphenoidal microsurgery. Neurosurgery 51(1), 161–169 (2002)
A.C. Chan, S.C. Chung, A.P. Yim, J.Y. Lau, E.K. Ng, A.K. Li, Comparison of two-dimensional vs three-dimensional camera systems in laparoscopic surgery. Surg, Endosc. 11(5), 438–440 (1997)
A.N. Mamelak, t Nobuto, G. Berci, Initial clinical experience with a high-definition exoscope system for microneurosurgery. Neurosurgery 67(2), 476–483 (2010)
A.N. Mamelak, D. Drazin, A. Shirzadi, K.L. Black, G. Berci, Infratentorial supracerebellar resection of a pineal tumor using a high definition video exoscope (VITOM®). J. Clin. Neurosci. 19(2), 306–309 (2012)
E. Kari, N.M. Oyesiku, V. Dadashev, S.K. Wise, Comparison of traditional 2-dimensional endoscopic pituitary surgery with new 3-dimensional endoscopic technology: intraoperative and early postoperative factors. Int. Forum Allergy Rhinol. 2(1), 2–8 (2012)
I. Yang, M.B. Wang, M. Bergsneider, Making the transition from microsurgery to endoscopic trans-sphenoidal pituitary neurosurgery. Neurosurg. Clin. N. Am. 21(4), 643–651 (2010)
Acknowledgments
The author would like to thank Vivien Bonert, MD, Odelia Cooper, MD and Anat BenShlomo MD for their constructive comments.
Conflict of interest
The author declares he has no conflicts of interests. He has previously (2011) served as a paid consultant to Karl Storz Endoscopy, but at present has no such relationships.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mamelak, A.N. Pro: endoscopic endonasal transsphenoidal pituitary surgery is superior to microscope-based transsphenoidal surgery. Endocrine 47, 409–414 (2014). https://doi.org/10.1007/s12020-014-0294-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12020-014-0294-y