gms | German Medical Science

Objective: Does increasing operative experience result in greater endoscopic trans-sphenoidal resection of pituitary macroadenomas.

Methods: Study design was a retrospective cohort study of a single institute experience. The subjects were 96 patients who underwent endoscopic trans-sphenoidal resection of pituitary macroadenoma between December 2010 and April 2016. Analysis of pre- and post-operative tumour volume (at three months) on MR imaging was undertaken for three neurosurgeons to compare percentage of successful resection against experience in performing surgery. Analysis of incidence of CSF leak and complications was also performed along with length of inpatient stay.

Results: A total of 96 patients (56 male, 40 female) with mean age 54 were included. Surgeon 1 performed 76 cases; Surgeon 2 performed 15 cases; and Surgeon 3 performed 5 cases. Non-functional macroadenoma was the commonest histology (46/96) with the remainder functional macroadenomas. Mean pre-operative tumour volume was 7.74cm³, 5.88cm³ and 3.85cm³ for Surgeons 1, 2 and 3 respectively. Mean post-operative tumour volumes were 1.77cm³, 0.94cm³ and 2.13cm³ for Surgeons 1,2 and 3 respectively. This demonstrated mean percentage resections of 73.6% for Surgeon 1; 79.94% for Surgeon 2; and 42.5% for Surgeon 3. Regression analysis demonstrated a significant increase in tumour resection for surgeon 1 (p 0.14), however there was no significant difference in tumour resection for Surgeons 2 and 3 with increasing experience (p 0.79 and 0.45 respectively). Incidence of intraoperative CSF leak was found to be 11/76 for Surgeon 1; 3/15 for Surgeon 2; and 1/5 for Surgeon 3. Primary closure rate was 93.4% as only one patient needed revision repair for CSF leak. Analysis did not demonstrate a difference between experience and incidence of CSF leak. Excluding CSF leak, only three other complications were recorded. Mean length of stay was 5 days for Surgeon 1; 4 days for Surgeon 2; and 4 days for Surgeon 3, with no difference observed with increasing operative experience.

Conclusion: This study has demonstrated a significant increase in the resection of pituitary macro adenoma for one neurosurgeon over a period of 68 months of experience. This study has also demonstrated no difference in resection for two considerably smaller caseloads for two neurosurgeons in our centre. This study suggests that with increasing experience, a more aggressive resection of macroadenoma is achieved with trans-sphenoidal endoscopic pituitary surgery.