Transsphenoidal Extent of Resection Study
Transsphenoidal Extent of Resection Study
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.
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.
Inclusion Criteria:

 -  Patients with suspected nonfunctioning pituitary macroadenomas (≥ 1 cm) with planned
 transsphenoidal surgery

 -  Adults (age 18-80 years)

 -  Medically stable for surgery

 -  Reasonable expectation that patient will complete study and be available for follow-up
 assessments

 Exclusion Criteria:

 -  Prisoners

 -  Pregnant women

 -  Patients with suspected functioning pituitary adenoma

 -  Unable to obtain MRI of the pituitary (e.g., pacemaker, anaphylaxis to gadolinium, low
 GFR)

 -  Pituitary apoplexy