Equivalent outcomes in nasal symptoms following microscopic or endoscopic transsphenoidal surgery: results from multi-centre, prospective study

Background T ranssphenoidal surgery (TSS) is the standard approach for resection of pituitary lesions. Historically, this has utilized the microscopic approach (mTSS); however, the past decade has seen widespread uptake of the endoscopic approach (eTSS). The purported benefits of this include improv...
Ausführliche Beschreibung

Background T ranssphenoidal surgery (TSS) is the standard approach for resection of pituitary lesions. Historically, this has utilized the microscopic approach (mTSS); however, the past decade has seen widespread uptake of the endoscopic approach (eTSS). The purported benefits of this include improved visualization and illumination, resulting in improved surgical and endocrinological patient outcomes. It is also believed that eTSS results in fewer post-operative nasal symptoms compared to mTSS; however, few papers have directly compared these groups. Objectives We sought to compare nasal symptoms after endoscopic uninostril (eTSS-uni), endoscopic binostril (eTSS-bi) and microscopic endoscopic transsphenoidal surgery (mTSS). Methods The General Nasal Patient Inventory (GNPI) was prospectively administered to 136 patients (71 non-functioning adenomas, 26 functioning adenomas, 39 other pathology) undergoing transsphenoidal surgery at multiple time points (pre-operatively; days 1, 3 and 7–14; months 1, 3 and 6 and 1 year post-operatively). All surgeries were performed by subspecialist pituitary surgeons in three subgroups — mTSS (25), eTSS-uni (74) and eTSS-bi (37). The total GNPI scores (0–135) and subscores for the 45 individual components were compared across three groups assessing for temporal and absolute changes. Results Irrespective of surgical approach used, GNPI scores were significantly higher on post-operative day 1 (p < 0.001) and day 3 (p ≤ 0.03) compared to pre-treatment baseline (mixed-effects model). By 1 month post-operatively, however, post-operative GNPI scores were no different from pre-treatment (p > 0.05, mixed-effects model). Whilst the eTSS-uni group demonstrated significantly lower GNPI scores at day 1 post-op compared to the mTSS group (p = 0.05) and eTSS-bi group (p < 0.001), there was no significant difference in post-operative scores between approaches beyond 1–2 weeks post-operatively. Similar results were obtained when the non-functioning tumour group was analysed separately. Conclusions Transsphenoidal pituitary surgery is well tolerated. Post-operative nasal symptoms transiently worsen but ultimately improve compared to pre-operative baseline. Operative approach (microscopic, endoscopic uninostril or endoscopic binostril) only has a transient effect on severity of post-operative nasal symptoms. Ausführliche Beschreibung

Autor*in:	Osborne, Charlie [verfasserIn] Lewis, Daniel Dixon, Ben Caputo, Carmela Magee, Alison Gnanalingham, Kanna Wang, Yi Yuen

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2022

Schlagwörter:	Nasal symptoms Transsphenoidal surgery Endoscopic Microscopic

Anmerkung:	© The Author(s) 2022

Übergeordnetes Werk:	Enthalten in: Acta neurochirurgica - Wien [u.a.] : Springer, 1950, 164(2022), 6 vom: 08. Feb., Seite 1589-1597
Übergeordnetes Werk:	volume:164 ; year:2022 ; number:6 ; day:08 ; month:02 ; pages:1589-1597

Links:	Volltext

DOI / URN:	10.1007/s00701-022-05138-5

Katalog-ID:	SPR047159111