Abstract
Objective:
The resection of pituitary adenomas has evolved over the past decade, as the sublabial (SL) microscopic approach has been largely abandoned in favor of the endoscopic endonasal (EE) approach. At our institution, the senior author (J. J. M.) adopted the EE approach in 2007. We reviewed pituitary adenoma resections from 2003 to 2012 performed by the senior author to compare the extent of resection, surgical outcomes, and the incidence of complications in both the SL and EE groups. Our primary goal is to volumetrically examine the extent of tumor resection achieved by the SL and EE approaches. We present our preliminary results, which define multiple characteristics of the patient population and reflect clinical outcomes.
Methods:
Data pertaining to the resection of pituitary adenomas by the senior author from 2003 to 2012 were retrospectively analyzed. The patient population was divided based on the surgical approach (SL, EE, or hybrid). Demographic information, including, age, sex, and type of pituitary tumor (nonfunctional or functional) were recorded. The incidences of cerebrospinal fluid (CSF) leak, gross total resection (GTR) versus subtotal resection (STR), and re-resection were calculated. Using a DICOM volume measuring program, the preoperative volume of the tumor was measured on T1-weighted MRI. Postoperative MRI was performed within 2 days of surgery and the volume of residual tumor was measured as well as on latest follow-up MRI. The analysis was restricted to two epochs: 2003 to 2006 (SL group) and 2009 to 2012 (EE group), and follow-up periods were arbitrarily limited to a maximum of 3 years in both the groups to maintain follow-up equality in both.
Results:
A total of 272 patients (114 males and158 females) underwent resection of a pituitary adenoma and were eligible for the study. Ages ranged from 17 to 85 (median, 49 years) years. A total of 181 (64.3%) tumors were nonfunctional adenomas and 96 (34.8%) were functional. Overall, 132 (46.9%) patients were treated via the SL approach, whereas the EE approach was used in 139 (49.4%) patients. Tumors in 10 (3.5%) patients were resected with a hybrid approach comprised of the SL microscopic approach in which the endoscope was used to complete the resection. An intraoperative CSF leak was noted in 29.5% of SL cases and 41.4% of EE cases. Postoperative leaks were encountered in 1.5% of SL cases and 3.6% of EE cases. GTR, as judged by the operating surgeon, was reported in 81.8% of SL approaches and 72.9% of EE approaches. About, 22.3% of patients underwent a re-resection during the time period of the study. The volumetric analysis had not been completed on all patients at the time of this abstract submission and will be presented in detail. Comparison between “operative impression” and actual postoperative MRI findings will be presented, and extent of resection will be correlated with incidence of regrowth.
Conclusion:
The SL approach resulted in a lower incidence of CSF leak. The use of volumetric analysis of preoperative and postoperative MRIs is a useful tool in quantifying the degree of resection. Further conclusions will be drawn at the completion of the volumetric analysis.