Long-term Outcomes and Complications from Endoscopic Versus Microscopic Transsphenoidal Surgery for Cushing’s Disease – a 15-year Single-center Study

Abstract

Background

Endoscopic endonasal surgery is the main transsphenoidal approach for pituitary surgery in many centers, however few studies compare the endoscopic and microscopic surgical approach with regard to long-term follow-up. This single-center study aimed to compare the two techniques over 15 years.

Methods

Medical records and magnetic resonance images from 40 patients with primary transsphenoidal surgery for Cushing’s disease at Sahlgrenska University Hospital between 2003 and 2018 were reviewed. Fourteen patients who underwent microscopic surgery and 26 patients who underwent endoscopic surgery were included in this study.

Results

In the microscopic group, 12 of 14 patients achieved endocrine remission, compared to 19 of 26 patients in the endoscopic group (n. s.). Three patients in each group developed a late recurrence. Complications were seen in 5 patients in the microscopic group and in 8 patients in the endoscopic group (n. s.). No serious complications, such as carotid artery damage, cerebrovascular fluid leakage, epistaxis, or meningitis, occurred in any group. The postoperative hospital stay was shorter in the endoscopic than the microscopic group.

Conclusion

Endoscopic endonasal surgery for Cushing’s disease showed no difference in remission, recurrence, and complication rates compared to the microscopic approach. The endoscopic group had a shorter postoperative hospital stay than the microscopic group, which in part may be due to the minimal invasiveness of the endoscopic approach.

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Conflicts of interest

The authors have no conflicts of interest.

Author statements

Conceptualization: D. Farahmand, E. Backlund, O. Ragnarsson and P. Trimpou

Data curation: Dan Farahmand, Erica Backlund, J. Carlqvist, T. Skoglund, T. Hallén, O. Ragnarsson, P. Trimpou.

Formal Analysis: D. Farahmand, E. Backlund

Funding acquisition: D. Farahmand

Investigation: D. Farahmand, E. Backlund, O. Ragnarsson and P. Trimpou

Methodology: D. Farahmand, E. Backlund, O. Ragnarsson and P. Trimpou

Project administration: D. Farahmand, E. Backlund, O. Ragnarsson and P. Trimpou

Supervision: D. Farahmand

Writing – original draft: Penelope Trimpou

Writing – review & editing: E. Backlund, O. Ragnarsson, T. Skoglund, T. Hallén, G. Gudnadottir, J. Carlqvist and D. Farahmand.

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From https://www.sciencedirect.com/science/article/abs/pii/S1878875022009640

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