Korean J Otorhinolaryngol-Head Neck Surg.  2011 Feb;54(2):124-130. 10.3342/kjorl-hns.2011.54.2.124.

Clinical Results of Endoscopic Endonasal Transsphenoidal Hypophysectomy during an Acceleration Phase of Learning Curve

• Kim DW
• Park KB
• Cho SJ
• Ko JS
• Joo YH
• Jung JM
• Jeon SY

• KMID: 1446461
• DOI: http://doi.org/10.3342/kjorl-hns.2011.54.2.124

Abstract

BACKGROUND AND OBJECTIVES
The aim of this study was to compare endoscopic endonasal transsphenoidal hypophysectomy (EETSA) with microscopic transseptal transsphenoidal hypophysectomy (MTTSA) in terms of clinical results during an acceleration of learning curve.
SUBJECTS AND METHOD
A retrospective chart review was performed of the first 14 cases of EETSA and previous 14 cases of MTTSA. Resection results, endocrinologic outcomes, complication rates, operating time, and duration of hospital stay were investigated. A non-parametric analysis was performed to determine the significance of differences between groups.
RESULTS
EETSA was performed, achieving gross total removal, based on postoperative MRI, for 12 of the 14 patients (86%) and hormonal remission for 4 of the 5 patients (80%); on the other hand, MTTSA was performed, achieving gross total removal for 9 of the 14 patients (64%) and hormonal remission for 1 of the 5 patients (20%). We found better resection results in patients who underwent EETSA than in those who did MTTSA with respect to tumors extending into suprasellar area (p<0.05). Visual improvement was achieved in all the cases with visual defect (n=5) after EETSA, whereas 4 of 6 cases (66%) were improved after MTTSA. Significant differences in complication rates, operating time and hospital stay could not be determined. All cases with CSF leakage in EETSA were successfully managed by using the nasoseptal flap.
CONCLUSION
EETSA provided better resection results than MTTSA did, especially in cases extending into the suprasellar area, showing good hormonal cure and visual improvement rates. Two approaches were comparable with respect to complications during the learning curve.

Keyword

Endoscopes; Pituitary neoplasm; Hypophysectomy

MeSH Terms

Acceleration
Endoscopes
Hand
Humans
Hypophysectomy
Learning
Learning Curve
Length of Stay
Pituitary Neoplasms
Retrospective Studies