Skull Base 2010; 20(2): 069-074
DOI: 10.1055/s-0029-1238214
ORIGINAL ARTICLE

© Thieme Medical Publishers

Light at the End of the Tunnel: The Learning Curve Associated with Endoscopic Transsphenoidal Skull Base Surgery

Stuart James Smith1 , George Eralil1 , Kelvin Woon1 , Anshul Sama2 , Graham Dow1 , Iain Robertson1
  • 1Departments of Neurosurgery and ENT Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
  • 2Department of Otorhinolaryngology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
Further Information

Publication History

Publication Date:
22 September 2009 (online)

ABSTRACT

Endoscopic transsphenoidal resection of skull base lesions has been introduced widely as an alternative to microscopic transmucosal approaches. We report the introduction of this technique to our unit, including the learning curve recognized for this procedure, comparing techniques in a concurrent case-control fashion. All patients operated on for sellar, suprasellar, or clival lesions were considered for endoscopic surgery, with 51 patients undergoing endoscopic surgery and 46 having microscopic surgery with the operating method determined by the availability of the ear, nose, and throat surgeon involved with the procedures. Endoscopic surgery compared favorably with microscopic surgery with respect to endocrine control, length of stay, diabetes insipidus, and cerebrospinal fluid leakage. A learning curve was found with a significant fall in complication rates between the first third and most recent third of the cohort. Endoscopic skull base surgery has superior results to microscopic approaches once the initial learning curve is overcome, but this can be done quickly and safely.

REFERENCES

  • 1 Doglietto F, Prevedello D M, Jane J A, Han J, Laws E R. A brief history of endoscopic transsphenoidal surgery—from Philipp Bozzini to the First World Congress of Endoscopic Skull Base Surgery Neurosurg Focus 19(6):E3. 2005
  • 2 Apuzzo M L, Heifietz M D, Weiss M H, Kurze T. Neurosurgical endoscopy using the side-viewing telescope.  J Neurosurg. 1977;  46 398-400
  • 3 Jankowski R, Auque J, Simon C, Marchal J C, Hepner H, Wayoff M. Endoscopic pituitary tumor surgery.  Laryngoscope. 1992;  102 198-202
  • 4 Jho H D, Carrau R L. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients.  J Neurosurg. 1997;  87 44-51
  • 5 Jho H D. Endoscopic transsphenoidal tumor surgery.  Operative Tech Neurosurg. 2002;  5 218-225
  • 6 Cho D Y, Liau W R. Comparison of endonasal endoscopic surgery and sublabial microsurgery for prolactinomas.  Surg Neurol. 2002;  58 371-375 discussion 375-376
  • 7 Cappabianca P, Cavallo L M, Colao A, de Divitiis E. Surgical complications associated with the endoscopic endonasal approach for pituitary adenomas.  J Neurosurg. 2002;  97 293-298
  • 8 O'Malley Jr B W, Grady M S, Gabel B C et al.. Comparison of endoscopic and microscopic removal of pituitary adenomas: single-surgeon experience and the learning curve.  Neurosurg Focus. 2008;  25 E10
  • 9 Koc K, Anik I, Ozdamar D et al.. The learning curve in endoscopic pituitary surgery and our experience.  Neurosurg Rev. 2006;  29 298-305
  • 10 Sonnenburg R E, White D, Ewend M G, Senior B. The learning curve in minimally invasive pituitary surgery.  Am J Rhinol. 2004;  18 259-263
  • 11 Couldwell W T. Transsphenoidal and transcranial surgery for pituitary adenomas.  J Neurooncol. 2004;  69 237-256
  • 12 Charalampaki P, Reisch R, Ayad A et al.. Endoscopic endonasal pituitary surgery: surgical and outcome analysis of 50 cases.  J Clin Neurosci. 2007;  14 410-415
  • 13 Yano S, Kawano T, Kudo M et al.. Endoscopic endonasal transsphenoidal approach through the bilateral nostrils for pituitary adenomas.  Neurol Med Chir (Tokyo). 2009;  49 1-7
  • 14 Tabaee A, Anand V K, Barrón Y et al.. Predictors of short-term outcomes following endoscopic pituitary surgery.  Clin Neurol Neurosurg. 2009;  111 119-122
  • 15 Higgins T S, Courtemanche C, Karakla D et al.. Analysis of transnasal endoscopic versus transseptal microscopic approach for excision of pituitary tumors.  Am J Rhinol. 2008;  22 649-652
  • 16 Neal J G, Patel S J, Kulbersh J S, Osguthorpe J D, Schlosser R J. Comparison of techniques for transsphenoidal pituitary surgery.  Am J Rhinol. 2007;  21 203-206
  • 17 Casler J D, Doolittle A M, Mair E A. Endoscopic surgery of the anterior skull base.  Laryngoscope. 2005;  115 16-24
  • 18 White D R, Sonnenburg R E, Ewend M G, Senior B A. Safety of minimally invasive pituitary surgery (MIPS) compared with a traditional approach.  Laryngoscope. 2004;  114 1945-1948
  • 19 Dehdashti A R, Ganna A, Karabatsou K, Gentili F. Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series.  Neurosurgery. 2008;  62 1006-1015
  • 20 Jain A K, Gupta A K, Pathak A, Bhansali A, Bapuraj J R. Excision of pituitary adenomas: randomized comparison of surgical modalities.  Br J Neurosurg. 2007;  21 328-331
  • 21 Tabaee A, Anand V K, Barron Y et al.. Endoscopic pituitary surgery: a systematic review and meta-analysis.  J Neurosurg. 2009;  , E-pub ahead of print PMID 19199461
  • 22 Jho H D, Alfieri A. Endoscopic transsphenoidal pituitary surgery: various surgical techniques and recommended steps for procedural transition.  Br J Neurosurg. 2000;  14 432-440

Stuart James SmithB.A. B.M. B.Ch. F.R.C.S. 

27 Kingfisher Way, Loughborough, Leicestershire

LE11 3NF, UK

Email: sjsmith@doctors.net.uk