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Pituitary

Published in:

01-10-2018

The experience with transsphenoidal surgery and its importance to outcomes

Authors: Jürgen Honegger, Florian Grimm

Published in: Pituitary | Issue 5/2018

Abstract

Purpose

Surgical experience is considered paramount for excellent outcome of transsphenoidal surgery (TSS). However, objective data demonstrating the surgical success in relation to the experience of pituitary surgery units or individual experience of pituitary surgeons is sparse.

Methods

Based on literature data, we have investigated the influence of experience with TSS for pituitary adenomas on endocrinological remission rates and on operative complications. The surgical experience was assessed by calculating the number of transsphenoidal operations per year.

Results

For TSS of microprolactinomas, mean remission rates were 77% in centers with < 2 operations per year for microprolactinomas, 82% with 2–4 operations, 84% with 4–6 operations, and 91% with > 6 operations. A yearly experience with more than 10 initial operations for Cushing’s disease (CD) warrants a remission rate exceeding 70%. Remission rates in CD exceeding 86% have only been reported for single surgeon series. Extraordinarily high complication rates were found in some series with < 25 yearly total operations for pituitary adenomas. Major vascular complications were less than 2% and revision rates for rhinorrhea usually < 2.5% in centers performing > 25 transsphenoidal operations per year.

Conclusions

We conclude that a center with experience of > 25 transsphenoidal operations for pituitary adenomas per year provides a high likelihood of safe TSS. Surgery for CD requires a particularly high level of practice to guarantee excellent remission rates. The endocrinologist has the unique opportunity to audit the surgical success by hormone measurement and to refer patients to neurosurgeons with proven excellence.

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Title: The experience with transsphenoidal surgery and its importance to outcomes
Authors: Jürgen Honegger
Florian Grimm
Publication date: 01-10-2018
Publisher: Springer US
Published in: Pituitary / Issue 5/2018
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI: https://doi.org/10.1007/s11102-018-0904-4

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The experience with transsphenoidal surgery and its importance to outcomes

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