Data Show Trend Toward Increased Use of and Improved Complication Rates for Endoscopic Transsphenoidal Approach to Pituitary Tumors

by Linda Kossoff •

What are the current trends and outcomes from microscopic and endoscopic transsphenoidal (TSS) approaches to pituitary tumors?

BOTTOM LINE

Endoscopic approach (EA) use for TSS in the U.S. has increased since 2013; complication rates have improved for EA compared to the microscopic approach (MA).

BACKGROUND: The first MA for TSS pituitary surgery took place in the 1960s; the first TSS pituitary surgery that solely used EA was performed in 1992. In recent years, rates of EA use have increased. Literature comoparing postoperative outcomes of the two approaches has been mixed. No population-based studies have trended postoperative outcomes over different periods among approaches.

STUDY DESIGN: Database study.

SETTING: Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Penn.

SYNOPSIS: Researchers queried the TriNetX national healthcare database for patients undergoing TSS between 2010 and 2021 and determined that 8,902 total endoscopic and microscopic TSS hypophysectomies were performed. MA rates were highest until 2013, when rates of EA (52%) surpassed MA (48%), and continued to increase through 2021. EA use increased compared to MA use over time in all U.S. regions, although there were geographic differences. From 2010 to 2015, EA had higher odds of a postoperative cerebrospinal fluid leak and diabetes insipidus versus MA, but those differences were not significant from 2016 to 2021. Although there was no significant difference among approaches from 2010 to 2015 for syndrome of inappropriate antidiuretic hormone (SIADH), hyponatremia, or bacterial meningitis, from 2016 to 2021 EA had lower odds of SIADH and hyponatremia, and higher odds of meningitis versus MA. Overall, researchers ascertained that complication rates have improved for EA compared to MA. Study limitations include potential reporting bias.

CITATION: Naimi B, Duffy A, Garvey E, et al. Trends in endoscopic and microscopic approaches to transsphenoidal pituitary surgery in the US. Laryngoscope. 2023;133:2135–2140.