Endoscopic versus Microscopic Pituitary Adenoma Surgery: A Single-center Study.

BACKGROUND: Transsphenoidal approach became the gold standard in the surgical treatment of pituitary adenomas in the past years, but the comparative efficacy of microscopic and endoscopic transnasal surgery has not been fully studied. AIMS: To compare the microscopic and endoscopic transnasal approaches for the treatment of pituitary adenomas. SETTINGS AND DESIGN: A retrospective analysis was performed, comparing adult patients with pituitary adenomas who had undergone transnasal microscopic surgery between January 2006 and December 2014 with the patients operated on with endoscopic surgery between March 2011 and December 2014 at Hospital Italiano de Buenos Aires. MATERIAL AND METHODS: Imaging, hormonal, and ophthalmological studies as well as complications were analyzed. STATISTICAL ANALYSIS: Due to the existence of dichotomous variables, Fisher's exact test was used for statistical analysis. RESULTS: In all, 259 patients who had undergone microsurgery and 140 patients operated on with endoscopy were included. The pathologies compared were microsurgically resected nonfunctioning adenomas: 38.2% (n = 99) versus endoscopically resected: 42.1% (n = 59), and microsurgically resected functioning adenomas: 61.8% (n = 160) versus endoscopically resected: 57.9% (n = 81). A higher number of patients with invasive macroadenomas were reported in the group operated on with endoscopy (35.5% vs. 56.4%). When the patients with invasive pathology of the cavernous sinus were compared, percentages of total resection and hormonal control were higher for endoscopic surgeries (35% vs. 46.8%; 33.3% vs. 64%); however, this difference was not statistically significant. No statistically significant differences were found when postoperative complications were individually analyzed. CONCLUSION: The microsurgical and endoscopic approaches are safe and effective techniques to treat pituitary adenomas. For invasive adenomas, the endoscopic approach may report better results.

Modified Orbitozygomatic Approach without Orbital Roof Removal for Middle Fossa Lesions

OBJECTIVE: The purpose of the present study was to describe an OrBitoZygomatic (OBZ) surgical variant that implies the drilling of the orbital roof and lateral wall of the orbit without orbitotomy. METHODS: Design : cross-sectional study. Between January 2010 and December 2014, 18 patients with middle fossa lesions underwent the previously mentioned OBZ surgical variant. Gender, age, histopathological diagnosis, complications, and percentage of resection were registered. The detailed surgical technique is described. RESULTS: Of the 18 cases listed in the study, nine were males and nine females. Seventeen cases (94.5%) were diagnosed as primary tumoral lesions, one case (5.5%) presented with metastasis of a carcinoma, and an additional one had a fibrous dysplasia. Age ranged between 27 and 73 years. Early complications were developed in four cases, but all of these were completely resolved. None developed enophthalmos. CONCLUSION: The present study illustrates a novel surgical OBZ approach that allows for the performance of a simpler and faster procedure with fewer complications, and without increasing surgical time or cerebral manipulation, for reaching lesions of the middle fossa. Thorough knowledge of the anatomy and surgical technique is essential for successful completion of the procedure.

Modified Orbitozygomatic Approach without Orbital Roof Removal for Middle Fossa Lesions

OBJECTIVE: The purpose of the present study was to describe an OrBitoZygomatic (OBZ) surgical variant that implies the drilling of the orbital roof and lateral wall of the orbit without orbitotomy.METHODS: Design : cross-sectional study. Between January 2010 and December 2014, 18 patients with middle fossa lesions underwent the previously mentioned OBZ surgical variant. Gender, age, histopathological diagnosis, complications, and percentage of resection were registered. The detailed surgical technique is described.RESULTS: Of the 18 cases listed in the study, nine were males and nine females. Seventeen cases (94.5%) were diagnosed as primary tumoral lesions, one case (5.5%) presented with metastasis of a carcinoma, and an additional one had a fibrous dysplasia. Age ranged between 27 and 73 years. Early complications were developed in four cases, but all of these were completely resolved. None developed enophthalmos.CONCLUSION: The present study illustrates a novel surgical OBZ approach that allows for the performance of a simpler and faster procedure with fewer complications, and without increasing surgical time or cerebral manipulation, for reaching lesions of the middle fossa. Thorough knowledge of the anatomy and surgical technique is essential for successful completion of the procedure.