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|Year : 2019 | Volume
| Issue : 4 | Page : 1022-1023
Commentary on “Endoscopic versus Microscopic Pituitary Adenoma Surgery: A Single-center Study ”
Yad Ram Yadav
Super Specialty Hospital and School of Excellence in Neurosurgery, Department of Neurosurgery, NSCB (Government) Medical College, Jabalpur, Madhya Pradesh, India
|Date of Web Publication||10-Sep-2019|
Prof. Yad Ram Yadav
Director, Super Specialty Hospital and School of Excellence in Neurosurgery, Department of Neurosurgery, NSCB (Government) Medical College, Jabalpur - 482 003, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Yadav YR. Commentary on “Endoscopic versus Microscopic Pituitary Adenoma Surgery: A Single-center Study ”. Neurol India 2019;67:1022-3
The article “Endoscopic versus microscopic pituitary adenoma surgery, a single center study” is very well written. A total of 259 patients underwent microsurgery and 140 patients were managed by endoscopy in this series. A higher number of invasive macroadenomas (35.5% vs. 56.4%) were operated by endoscopic technique reflecting that endoscopy was the preferred choice for invasive lesions in this series. Percentages of total resection (35% vs. 46.8%) and hormonal control (33.3% vs. 64%) were higher in endoscopic group with invasion in cavernous sinus when compared with microscopic group. Although the difference was not statistically significant, there was a tendency favouring the endoscopic technique (P = 0.052976). There were more complications in microscopy group (26.3%) when compared with endoscopy (15%). No statistically significant differences were found in complete resection in patients without cavernous sinus invasion indicating that both techniques are equally effective in lesions without cavernous sinus invasion. No statistically significant differences were found in visual field outcome and in the incidence of diabetes insipidus, panhypopituitarism, rhinosinusal complications, cerebrospinal fluid (CSF) fistula, meningitis, and deaths between both the groups.
Although it is difficult to comment about superiority of one approach over other without large-scale prospective randomized controlled trials, recent reports favor endoscopic techniques especially for invasive lesions due to superior visualizations.,,, Even though microsurgical removal is equally safe and effective in pituitary tumor especially for small lesions without cavernous sinus invasion, various modern techniques such as endoscopic visualization, ultrasonic aspirators, neuronavigation, and ultrasonic bone curette can add to the safety in lesions extending laterally in cavernous sinus, recurrent tumor, extension in retrosellar, parasellar, and subfrontal region and in giant tumor. Gross tumor removal was higher in most of the recent reports by experienced endoscopic surgeons.,,
Endoscopic technique provides wider surgical field especially lateral vision which makes easier distinction of tumor tissue from normal gland thereby allowing greater extent of lesion excision with less postoperative complication. Overall, 23 studies with 2272 patients with pituitary adenoma were assessed by Li et al. Tumor removal was better with endoscopic surgery compared with microscopic technique without any significant risk of CSF leak. Risk of diabetes insipidus was reduced by 22% in endoscopic surgery. A total of 15 studies with 1014 patients were studied by Gao et al. Although there was no significant difference between the two techniques regarding the incidence of meningitis, diabetes insipidus, CSF leak, epistaxis, and hypopituitarism, gross tumor removal was higher in the endoscopic group than in the microscopic group.
Although endoscopic surgery provides superior visualization in most patients, conversion to a microscopic or endoscopic-assisted microsurgical approach may be required in selected patients especially with profuse bleeding.
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