Transsphenoidal Extent of Resection Study
Condition: Pituitary Adenoma
MeSH terms: Adenoma; Pituitary Neoplasms; Pituitary Diseases
Study type: Interventional

Summary: 
      The purpose of this research study is to compare the extent of resection (EOR) in patients
      with nonfunctioning pituitary adenomas undergoing transsphenoidal surgery using a
      microsurgical technique to those patients who have undergone surgery with a fully endoscopic
      technique. Another goal is to compare surgical complications, endocrine outcomes, visual
      outcomes, length of surgery, length of hospital stay, and readmission rates between the two
      transsphenoidal surgery techniques. This is an observational data collection study with no
      experimental procedures or experimental medicines. Endonasal transsphenoidal removal of a
      pituitary tumor is a unique procedure and there is little information comparing the two
      surgical techniques.
    

Detailed description: 
      The treatment of choice for most patients with symptomatic nonfunctioning pituitary adenomas
      is transsphenoidal surgery to improve vision by decompression of the optic chiasm, to prevent
      the development of endocrine dysfunction, and to treat neurological symptoms such as headache
      or cranial neuropathies caused by the tumor. The most widely accepted surgical technique is
      microscopic transsphenoidal surgery, in which an operating microscope is used by the surgeon
      to provide surgical visualization and a nasal speculum is used to maintain the operative
      corridor. [1-4] Recently, fully endoscopic transsphenoidal surgery, in which surgical
      visualization is achieved using an endoscope, has been adopted by many pituitary surgeons
      because the technique offers superior panoramic and angled visualization of the surgical
      target and may permit greater tumor resection. [5-10] There is a vigorous debate in the
      neurosurgical community about the relative merits of the microscopic and endoscopic
      techniques. Proponents of the endoscopic technique argue that the superior visualization
      permits more aggressive tumor resection and better preservation of the normal pituitary
      gland. Proponents of the microscopic technique argue that it permits shorter operative times,
      results in similar surgical outcomes, and has a lower complication rate.

      Despite the adoption of fully endoscopic surgery by many surgeons, no prospective studies
      have compared the extent of tumor resection (EOR) between microscopic and endoscopic
      approaches. Numerous retrospective studies have established the efficacy of each approach,
      but only a few studies present comparative data.[11-13] Recently, McLaughlin et al. noted
      that the addition of endoscopy to microscopic pituitary surgery enhances tumor removal,
      particularly in patients with tumors greater than 20 mm in diameter. [14] This study raises
      the intriguing possibility that certain subgroups of patients (e.g. patients with larger
      tumors) may benefit from endoscopic surgery. In patients with smaller tumors with no
      cavernous sinus invasion, others have shown that the techniques achieve similar EOR. [15]
      That endoscopy may permit more complete tumor resections is a testable hypothesis.
    

Intervention name(s): transsphenoidal surgery
Intervention type(s): Procedure
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: pituitary; adenoma; transsphenoidal surgery