Reasonability of implementation of the endoscopic technique for sellar lesions in a low volume center

We evaluated the implementation of the endoscopic (E) technique by an interdisciplinary ENT/neurosurgeon
team as compared to the established classical microscopic technique (M) performed by one experienced
neurosurgeon for pituitary adenomas in a single center. A retrospective analysis of patients operated for newly
diagnosed pituitary adenomas was performed between November 2004 and August 2012. Outcome and
complications are presented.A total of 116 patientswere operated, 64 microscopically (M) and 52 endoscopically
(E).Mean followupwas 35 months (range 1.4–95), 1 patientwas lost to follow-up.Most frequent pathologywas
hormone inactive adenoma (60% E, 51%M). Operating time was stable in theM-group (±94 min). The E-group
showed a learning curve in mean operating time (2004–2007: 154 min, 2008–2012: 93 min). Postoperative CSF
leaks were seen in 9.6% (E) vs. 3.1% (M) of cases. More E-cases were re-operated (5 vs. 1) and more M-cases
received a lumbar drainage (8 vs. 19). Transient postoperative diabetes insipidus occurred more often after
E-operations (17 vs. 5%, p = 0.03) without significant long term difference. Improved visual outcome showed a
more favorable trend in E-cases. The implementation of the endoscopic technique was associated with more
surgical complications in the learning phase, however with more improved visual outcome. Our observations
should be of value for themore average neurosurgical department dealingwith pituitary adenomas and aiming to
switch from the microscopic to the endoscopic technique.