4K 3-dimensional video microscope system (orbeye) for transsphenoidal pituitary surgery

Abstract Background In previous reports on experiences with an exoscope, this new technology was not found to be applicable for transsphenoidal pituitary surgery. As a specialized center for pituitary surgery, we were using a 4K 3D video microscope (Orbeye, Olympus) to evaluate the system for its use in transsphenoidal pituitary surgery in comparison to conventional microscopy. Method We report on 296 cases performed with the Orbeye at a single institution. An observational study was conducted with standardized subjective evaluation by the surgeons after each procedure. An objective measurement was added to compare the exoscopic and microscopic methods, involving surgery time and the initial postoperative remission rate in matched cohorts. Results The patients presented with a wide range of pathologies. No serious events or minor complications occurred based on the usage of the 4K 3D exoscope. There was no need for switching back to the microscope in any of the cases. Compared to our microsurgically operated collective, there was no significant difference regarding duration of surgery, complications, or extent of resection. The surgeons rated the Orbeye beneficial in regard to instrument size, positioning, surgeon’s ergonomics, learning curve, image resolution, and high magnification. Conclusions The Orbeye exoscope presents with optical and digital zoom options as well as a 4K image resolution and 3D visualization resulting in better depth perception and flexibility in comparison to the microscope. Split screen mode offers the complementary benefit of the endoscope which may increase the possibilities of lateral view but has to be evaluated in comparison to endoscopic transsphenoidal procedures in the next step.

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Endoscopic vs. microscopic transsphenoidal pituitary surgery: a single centre study

Scientific Reports ◽

10.1038/s41598-020-78823-z ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Morten Winkler Møller ◽

Marianne Skovsager Andersen ◽

Dorte Glintborg ◽

Christian Bonde Pedersen ◽

Bo Halle ◽

...

Keyword(s):

Visual Impairment ◽

Tumour Size ◽

Pituitary Surgery ◽

Endoscopic Technique ◽

Electronic Patient Records ◽

Beneficial Effects ◽

Duration Of Surgery ◽

Single Centre Study ◽

Transsphenoidal Pituitary Surgery ◽

Endoscopic Group

AbstractEndoscopic pituitary surgery has shown promising results. This study reports the experiences of experienced microscopic pituitary surgeons changing to the endoscopic technique, and the beneficial effects on the postoperative outcomes. 45 transsphenoidal endoscopic-assisted surgeries performed in 2016–2017 were compared with 195 microscope-assisted surgeries performed in 2007–2017 for pituitary adenoma. Tumour size, hormonal status and vision were assessed preoperatively and 3–5 months postoperatively. Cases were identified through electronic patient records. GTR was achieved in 39% of the endoscopic operations vs. 22% of microscopic operations, p = 0.018. Mean duration of surgery was 86 min (77–95) with the endoscopic technique vs. 106 min (101–111) with the microscopic technique, p < 0.001. New hypothalamus–pituitary–adrenal axis deficiencies were observed after 3% of endoscopic vs. 34% microscopic operations, p = 0.001, and overall fewer postoperative pituitary deficiencies were observed in the endoscope-assisted group. Complications within 30 days of surgery occurred in 17% of endoscopic operations vs. 27% of microscopic operations (p > 0.05). Normalization of visual impairment occurred in 37% of the cases with preoperative visual impairment in the endoscopic group vs. 35% of those in the microscopic group (p > 0.05). The endoscopic technique performed better as a surgical procedure for pituitary adenomas. We found no statistically significant differences in complication rate or visual improvement between the two techniques.

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Endoscopic transsphenoidal pituitary surgery: a good and safe primary treatment option for Cushing's disease, even in case of macroadenomas or invasive adenomas

Acta Endocrinologica ◽

10.1530/eje-13-0325 ◽

2013 ◽

Vol 169 (3) ◽

pp. 329-337 ◽

Cited By ~ 48

Author(s):

M A E M Wagenmakers ◽

H D Boogaarts ◽

S H P P Roerink ◽

H J L M Timmers ◽

N M M L Stikkelbroeck ◽

...

Keyword(s):

Treatment Option ◽

Cushing’S Disease ◽

Remission Rate ◽

Pituitary Surgery ◽

Primary Treatment ◽

Endoscopic Technique ◽

Cushing's Disease ◽

Recurrence Rates ◽

Transsphenoidal Pituitary Surgery

ContextAlthough the endoscopic technique of transsphenoidal pituitary surgery (TS) has been widely adopted, reports on its results in Cushing's disease (CD) are still scarce and no studies have investigated long-term recurrence rates. This is the largest endoscopic series published till now.ObjectiveTo gain insight into the role of endoscopic TS as a primary treatment option for CD, especially in patients with magnetic resonance imaging (MRI)-negative CD and (invasive) macroadenomas.DesignRetrospective cohort study.Patients and methodsThe medical records of 86 patients with CD who underwent endoscopic TS were examined. Data on preoperative and postoperative evaluation, perioperative complications, and follow-up were collected. Remission was defined as disappearance of clinical symptoms with a fasting plasma cortisol level ≤50 nmol/l either basal or after 1 mg dexamethasone.ResultsThe remission rate in different adenoma subclasses varied significantly: 60% in MRI-negative CD (n=20), 83% in microadenomas (n=35), 94% in noninvasive macroadenomas (n=16), and 40% in macroadenomas that invaded the cavernous sinus (n=15). The recurrence rate was 16% after 71±39 months of follow-up (mean±s.d., range 10–165 months).ConclusionsEndoscopic TS is a safe and effective treatment for all patients with CD. Recurrence rates after endoscopic TS are comparable with those reported for microscopic TS. Our data suggest that in patients with noninvasive and invasive macroadenomas, the endoscopic technique of TS should be the treatment of choice as remission rates seem to be higher than those reported for microscopic TS, although no comparative study has been performed.

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Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery: clinical evaluation and cadaver study

Journal of Neurosurgery ◽

10.3171/2015.6.jns142637 ◽

2016 ◽

Vol 125 (2) ◽

pp. 334-345 ◽

Cited By ~ 11

Author(s):

Jens Conrad ◽

Ali Ayyad ◽

Christian Wüster ◽

Wael Omran ◽

Matthias M. Weber ◽

...

Keyword(s):

Clinical Evaluation ◽

Hormone Secretion ◽

Surgical Techniques ◽

Residual Tumor ◽

Pituitary Surgery ◽

Cadaver Study ◽

Significant Difference ◽

Transsphenoidal Pituitary Surgery ◽

Time Required ◽

Surgical Aspects

OBJECTIVE Over the past 2 decades, endoscopy has become an integral part of the surgical repertoire for skull base procedures. The present clinical evaluation and cadaver study compare binostril and mononostril endoscopic transnasal approaches and the surgical techniques involved. METHODS Forty patients with pituitary adenomas were treated with either binostril or mononostril endoscopic surgery. Neurosurgical, endocrinological, ophthalmological, and neuroradiological examinations were performed. Ten cadaver specimens were prepared, and surgical aspects of the preparation and neuroradiological examination were documented. RESULTS In the clinical evaluation, 0° optics were optimal in the nasal and sphenoidal phase of surgery for both techniques. For detection of tumor remnants, 30° optics were superior. The binostril approach was significantly more time consuming than the mononostril technique. The nasal retractor limited maneuverability of instruments during mononostril approaches in 5 of 20 patients. Endocrinological pituitary function, control of excessive hormone secretion, ophthalmological outcome, residual tumor, and rates of adverse events, such as CSF leaks and diabetes insipidus, were similar in both groups. In the cadaver study, there was no significant difference in the time required for dissection via the binostril or mononostril technique. The panoramic view was superior in the binostril group; this was due to the possibility of wider opening of the sella in the craniocaudal and horizontal directions, but the need for removal of more of the nasal septum was disadvantageous. CONCLUSIONS Because of maneuverability of instruments and a wider view in the sphenoid sinus, the binostril technique is superior for resection of large tumors with parasellar and suprasellar expansion and tumors requiring extended approaches. The mononostril technique is preferable for tumors with limited extension in the intra- and suprasellar area.

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Transsphenoidal pituitary surgery via the endoscopic technique: results in 35 consecutive patients with Cushing’s disease

Acta Endocrinologica ◽

10.1530/eje.1.02133 ◽

2006 ◽

Vol 154 (5) ◽

pp. 675-684 ◽

Cited By ~ 63

Author(s):

R T Netea-Maier ◽

E J van Lindert ◽

M den Heijer ◽

A van der Eerden ◽

G F F M Pieters ◽

...

Keyword(s):

Cushing’S Disease ◽

Remission Rate ◽

Clinical Signs ◽

Pituitary Surgery ◽

Endoscopic Technique ◽

Cushing's Disease ◽

Cerebrospinal Fluid Leakage ◽

Failure Group ◽

Initial Surgery ◽

Transsphenoidal Pituitary Surgery

Objective and design: The endoscopic technique has been recently introduced in the field of transsphenoidal pituitary surgery. This technique allows inspection of sellar, supra- and parasellar structures and removal of the tumor under direct visualization, is minimally traumatic and permits easier reoperations. This is the first report on the results of endoscopic surgery for patients with Cushing’s disease. Our aim was to retrospectively analyze the results of pituitary surgery in 35 consecutive patients with Cushing’s disease operated in our hospital after the introduction of the endoscopic technique (1998–2004). Methods: Remission was defined as suppression of plasma cortisol (≤50 nmol/L) after 1 mg dexamethasone overnight determined in the first 3 months after surgery and disappearance of clinical signs and symptoms of hypercortisolism. The patients were followed for an average of 27 months (range 4 to 81 months, median 20 months). Results: Pituitary MRI showed a macroadenoma in 6 patients, a microadenoma in 17 patients and no adenoma in 12 patients. After the initial surgery 27 patients (77%) were in remission. None of the patients had a relapse during follow-up. In the remaining 8 patients hypercortisolemia persisted after surgery. Three of them had a second endoscopic pituitary surgery resulting in remission in two patients. In one patient a second endoscopic pituitary surgery will soon follow. The remaining four patients were treated with radiotherapy postoperatively. Two of them were at the time of data collection in remission. One patient from the remission group had a serious epistaxis and three patients had cerebrospinal fluid leakage, one requiring an external lumbar drain, shortly after surgery. No complications were recorded in the failure group. Postoperatively 34% of all patients required substitution with levothyroxine, 40% required substitution with glucocorticoids, 17% received estrogens or testosterone and 6% still required desmopressin. Conclusions: Endoscopic transsphenoidal pituitary surgery resulted in our series of patients with Cushings disease in an excellent postoperative remission rate. A randomized clinical trial, comparing endoscopic and conventional pituitary surgery in patients with Cushings disease, is needed to determine the pros and cons of both techniques.

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159 Factors Associated with Postoperative Complications Following Transsphenoidal Surgery for Pituitary Tumor resection from the national Surgical Quality Improvement Program (NSQIP)

Neurosurgery ◽

10.1093/neuros/nyx417.159 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 239-240

Author(s):

Andrew Karl Rock ◽

Charles Frederick Opalak ◽

Kathryn Workman ◽

Matthew Carr ◽

William C Broaddus

Keyword(s):

Postoperative Complications ◽

Transsphenoidal Surgery ◽

Tumor Resection ◽

Pituitary Tumors ◽

Pituitary Surgery ◽

Improvement Program ◽

Surgical Quality ◽

Duration Of Surgery ◽

Transsphenoidal Pituitary Surgery ◽

Complications And Mortality

Abstract INTRODUCTION Pituitary tumors are the second most common brain tumor (15.9%) in the United States. Transsphenoidal surgery is commonly indicated for pituitary tumors and few studies have investigated postoperative complications following this procedure. Our objective was to utilize the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to estimate the prevalence of and risk factors for complications following transsphenoidal pituitary surgery. METHODS Patients undergoing transsphenoidal surgery for pituitary tumor resection (CPT codes: 61 548, 62 165) from 2005 to 2015 were extracted from the ACS-NSQIP. The prevalence of postoperative complications was determined. Multivariable logistic regression was used to identify demographic, comorbid, and perioperative characteristics associated with any morbidity, severe (Clavien IV) complications, and mortality. RESULTS >Within 1177 transsphenoidal surgeries, there were 105 (8.92%) cases with at least one non-fatal complication, 29 (2.46%) cases with a severe complication, and 11 (0.93%) cases of mortality. The three most common complications were: reoperation (3.40%), transfusion (2.04%), and unplanned intubation (2.70%). In multivariable logistic regression analysis, the only significant predictors for postoperative complications were: 1) duration of surgery in hours for any morbidity (Odds Ratio [OR]: 1.30; 95% Confidence Interval [CI]: 1.15-1.46; P < 0.001), severe complications (OR: 1.38; 95% CI; 1.18-1.61; P < 0.001), and mortality (OR: 1.36; 95% CI: 1.11-1.67; P < 0.01); and 2) American Society of Anesthesiologists (ASA) class III-V for any morbidity (OR: 1.99; 95% CI: 1.23-3.21; P < 0.05) and severe complications (OR: 2.99; 95% CI: 1.13-7.94; P < 0.05). The area under the curve for any morbidity, severe complications, and mortality were 0.67, 0.74, and 0.77, respectively. CONCLUSION Transsphenoidal pituitary surgery is a relatively safe procedure with any morbidity occurring in approximately 1 in 10 patients and mortality occurring in approximately 1 in 100 patients. Our findings demonstrate duration of surgery and higher ASA classification is associated with increased risk for postoperative complications following transsphenoidal pituitary surgery.

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Intraoperative low field MRI in transsphenoidal pituitary surgery

Endocrine Connections ◽

10.1530/ec-18-0140 ◽

2018 ◽

Vol 7 (7) ◽

pp. 897-906 ◽

Cited By ~ 2

Author(s):

Morten Winkler Møller ◽

Marianne Skovsager Andersen ◽

Christian Bonde Pedersen ◽

Bjarne Winther Kristensen ◽

Frantz Rom Poulsen

Keyword(s):

Pituitary Surgery ◽

Hormone Deficiency ◽

Pituitary Hormone ◽

Hormonal Function ◽

Low Field ◽

Duration Of Surgery ◽

Adrenal Deficiency ◽

Transsphenoidal Pituitary Surgery ◽

Low Field Mri ◽

Tumor Remnant

Background Intraoperative low field MRI (iMRI, 0.15 T) during transsphenoidal surgery on pituitary adenomas (PAs) may significantly improve tumor removal. However, extensive surgery can lead to pituitary hormone deficiency. Furthermore, introduction of iMRI will prolong duration of surgery, which may elevate risk of postoperative infections. Methods Overall, 180 transsphenoidal surgeries for PAs from 2007 to 2015 were included. IMRI was available from 2011 to 2015, during this period 67/78 (86%) surgeries were with iMRI (iMRI, n = 67). A total of 113 surgeries were performed without iMRI (controls). All surgical procedures were performed by microscopic technique. Tumor size, hormonal status and vision were assessed before surgery and 3–5 months postoperatively. Results Gross total resection (GTR), mean tumor remnant volume and ∆-volumes were comparable between iMRI and controls: 15% (10/66) vs 23% (26/109) (P = 0.17), 2.97 cm3 (0.9–5) vs 2.1 cm3 (1.6–2.6) (P = 0.3) and 4.5 cm3 (3.6–5.5) vs 5.1 cm3 (4.2–6) (P = 0.4), respectively. Duration of surgery was significantly longer during iMRI vs controls: 126 min (117–135) vs 98 min (92–103) (P < 0.001). New pituitary–adrenal deficiency in iMRI vs controls was seen in 35% (17/48) and 35% (23/66) of surgeries, respectively (P = 0.95). New thyroid deficiency was found in 33% (13/29) and 41% (28/69) and visual field deficiencies improved in 44% (19/43) and 38% (23/60) in iMRI vs controls, respectively (P > 0.1). Conclusion Tumor remnant after pituitary surgery was not significantly reduced using intraoperative low field MRI. Duration of surgery was increased in iMRI, but was not associated with increased infection rate. Pituitary hormonal function and vision were comparable between iMRI and controls.

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A Comparative Study of Endoscopic Versus Navigation Guided Microscopic Transsphenoidal Pituitary Surgery at Tertiary Care Centre in India

Romanian Neurosurgery ◽

10.2478/romneu-2018-0055 ◽

2018 ◽

Vol 32 (3) ◽

pp. 443-457

Author(s):

Anurag Sahu ◽

Sharad Pandey ◽

Kulwant Singh ◽

Vivek Sharma

Keyword(s):

Operative Time ◽

Tertiary Care ◽

Pituitary Surgery ◽

Controlled Study ◽

Complication Rates ◽

Care Hospital ◽

Significant Difference ◽

Transsphenoidal Pituitary Surgery ◽

Group A ◽

Group B

Abstract Introduction: The transsphenoidal route for pituitary surgery is considered the standard treatment for pituitary adenomas. The disadvantage of the smaller exposure of this route is partially compensated for by the introduction of the microscope with its coaxial illumination, stereoscopic view, adequate magnification, and microsurgical instruments. However, there are only few reports about the outcome of endonasal endoscopic transphenoidal technique. Aims & Objectives: Current study has been conducted to compare the efficacy, advantages and dis advantages of endoscopic versus navigation guided microscopic transsphenoidal Pituitary surgery. Material and methods: A controlled study was done in the department of neurosurgery, at tertiary care hospital in India, from the period of August 2012 to December 2017 prospectively. In Group A- 30 patients in whom endoscopic transnasal trans Sphenoidal pituitary surgery and in Group B - 30 patients, intraoperative neuronavigation was used. Observations and Results: Both the groups were similar in demographic variables. The most common age group of pituitary tumor patients was 30-40 years. Fourteen (46.6 %) patients in group A and fifteen (50 %) of the patients in group B had tumor volume less than 5 ml. In group A, thirteen (43%) patients had intrasellar tumors with no suprasellar extension, while in group B, fifteen (50%) patients had intrasellar tumors with no extension. Operative time was noted from incision to closure and average time taken in both the groups was compared. Twenty five (83%) cases of group A took between 2-3 hours and only four cases (13%) took more than 3 hours. While in group B, twenty (66%) cases took between 4-5 hours. This shows a significant difference by fisher extact test (p<0.001) in the operative time required in both the groups. Eighteen (60%) patients in group B had a residual volume between 1-1.5 ml while only two patients in group A had so. This difference is also significant Fischer Exact test (p<0.001). Four (13.3%) patients in group A had diabites insipidus while only half of this, i.e. two (6.6%) had so in group B. however this difference in postoperative complication rate is not statistically significant between two groups. Conclusion: The results of our study correlate with many previous studies to compare endoscopic and microscopic transsphenoidal surgery. These two approaches are equally efficacious in oncological outcomes and the complication rates are comparable.

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Outcomes of Transsphenoidal Microsurgery for Prolactinomas – A Contemporary Series of 162 Cases

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-1247-4908 ◽

2021 ◽

Author(s):

Sabrina Giese ◽

Isabella Nasi-Kordhishti ◽

Jürgen Honegger

Keyword(s):

Remission Rate ◽

Therapeutic Option ◽

Treatment Options ◽

Cerebrospinal Fluid Leak ◽

Pituitary Surgery ◽

Pituitary Function ◽

Significant Difference ◽

Remission Rates ◽

Transsphenoidal Microsurgery ◽

Fluid Leak

Abstract Introduction Renewed interest in transsphenoidal surgery (TSS) as a therapeutic option for prolactinomas has emerged. This study is aimed at defining the current role of pituitary surgery in the management of prolactinomas. Materials and Methods In this retrospective, consecutive single-center study, 162 patients who underwent primary microscopic TSS for prolactinomas between 2006 and 2019 were analyzed regarding surgical indication, previous dopamine-agonist (DA) treatment, early remission rates (3 months postoperatively), surgical complications and pituitary function. Results Seventy-four microprolactinomas and 88 macroprolactinomas were operated by TSS. 62.3% of the patients had received prior DA treatment. For microprolactinomas, the predominant indication for surgery was patient’s wish (41.9%), while indications for macroprolactinomas varied. For enclosed microprolactinomas, the initial remission rate was 92.1%, while for macroprolactinomas, the rate was 70.4%. No significant difference of remission rates was found between DA-pretreated (65.3%) and non-pretreated (72.1%) patients (p=0.373).None of the patients suffered a significant complication. Re-operation for a postoperative cerebrospinal fluid leak was required in one patient (0.6%). Permanent postoperative deterioration of pituitary function was only observed in one of 158 patients with surgery for a prolactinoma (0.6%). Improvement of pituitary function was observed in 8 of 25 patients (32%) with preoperative deficits. Conclusion Transsphenoidal microsurgery is safe and efficient for treatment of prolactinomas. It is particularly suitable for enclosed prolactinomas. The patient should be well informed of the pros and cons of the treatment options, which include DA medication and TSS, and the patient’s preference should be taken into account during decision-making.

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