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J Neurol Surg B Skull Base 2023; 84(01): 008-016
DOI: 10.1055/s-0041-1741017
Original Article

Volumetric Resection and Complications in Nonfunctioning Pituitary Adenoma by Fully Endoscopic Transsphenoidal Approach along 15 Years of Single-Center Experience

Alexis Palpan Flores 
1   Department of Neurosurgery, La Paz University Hospital, Madrid, Spain
,
Miguel Sáez Alegre
1   Department of Neurosurgery, La Paz University Hospital, Madrid, Spain
,
Catalina Vivancos Sanchez
1   Department of Neurosurgery, La Paz University Hospital, Madrid, Spain
,
Alvaro Zamarrón Pérez
1   Department of Neurosurgery, La Paz University Hospital, Madrid, Spain
,
Carlos Pérez-López 
1   Department of Neurosurgery, La Paz University Hospital, Madrid, Spain
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Abstract

Objective The aim of this study was to evaluate the rate of complications and the extent of resection (EOR) of nonfunctioning pituitary adenomas by endoscopic endonasal approach (EEA) in a 15-year learning curve.

Methods A total of 100 patients operated by the same surgical team were divided chronologically into two, three, and four groups, comparing differences in EOR measured by a semiautomatic software (Smartbrush, Brainlab), rate of immediate postoperative complications, and the visual and hormonal status at 6 months.

Results There were no significant differences over the years in rates of postoperative complications and in visual status at 6 months. A significant linear correlation between the EOR and the number of surgeries (rho = 0.259, p = 0.007) was found. The analysis was performed in three groups because of the remarkable differences among them; the EOR were: 87.2% (early group), 93.03% (intermediate group), and 95.1% (late group) (p = 0.019). Gross total resection was achieved in 30.3, 51.5, and 64%, respectively (p = 0.017); also, the rate of reoperation and the worsening of at least one new hormonal axis were worse in the early group. Consequently, the early group had a higher risk of incomplete resection compared with the late group (odds ratio: 4.2; 95% confidence interval: 1.5–11.7). The three groups were not different in demographic and volume tumor variables preoperatively.

Conclusions The first 33 interventions were associated with a lower EOR, a high volume of residual tumor, a high reoperation rate, and a higher rate of hormonal dysfunction. We did not find differences in terms of postoperative complications and the visual status at 6-month follow-up.

Keywords

nonfunctioning pituitary adenoma - learning curve - extent of resection - gross total resection - semiautomatic volumetry - transsphenoidal approach - endoscopic endonasal approach


Publication History

Received: 30 December 2020

Accepted: 12 November 2021

Article published online:
29 December 2021

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