Advertisement
Mayo Clinic Proceedings Home

Sublabial Transseptal vs Transnasal Combined Endoscopic Microsurgery in Patients With Cushing Disease and MRI-Depicted Microadenomas

      OBJECTIVE

      To assess whether the type of surgical approach to the sella (sublabial transseptal vs transnasal) affects surgical outcome among patients with Cushing disease.

      PARTICIPANTS AND METHODS

      Both procedures were performed at our institution from January 1, 1995, through January 31, 2003. From a total of 106 patients with Cushing disease who had had surgery, we identified 42 adults undergoing an initial surgery, with microadenoma (<1 cm) determined by magnetic resonance imaging and a minimal follow-up of 3 months.

      RESULTS

      We identified 21 patients (4 male, 17 female) for sublabial transseptal transsphenoidal microsurgery. Mean ± SD age was 45.0±12.9 years (range, 27.0-69.0 years); median duration of symptoms was 2.5 years (range, 1.5-7.5 years). Median follow-up was 1.0 year (range, 0.3-11.0 years). We identified another 21 patients (5 male, 16 female) for endoscopic transsphenoidal microsurgery whose mean ± SD age was 43.8±14.1 years (range, 19.0-70.0 years); median duration of symptoms was 2.4 years (range, 0.2-6.0 years). Median follow-up was 2.5 years (range, 0.3-8.7 years). Complications (cerebrospinal fluid leak and transient diabetes insipidus) and cure (86% initial cure; 76% relapse-included cure) were equivalent between the 2 procedures. However, the endoscopic approach was associated with shorter anesthesia time, less blood loss, and shorter hospital stays.

      CONCLUSION

      The endoscopic transnasal surgical approach led to shorter total anesthesia time, less blood loss, and shorter hospital stay when compared with the sublabial transseptal approach. However, we found no difference between the 2 surgical procedures with respect to cure or complications, suggesting that outcome is more closely related to the experience of the operating team.
      ACTH (adrenocorticotropic hormone), CTTE (combined transnasal and transsphenoidal endoscopic), MRI (magnetic resonance imaging), STT (sublabial transseptal transsphenoidal)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Hardy J
        Transphenoidal microsurgery of the normal and pathological pituitary.
        Clin Neurosurg. 1969; 16: 185-217
        • Sheehan MT
        • Atkinson JL
        • Kasperbauer JL
        • Erickson BJ
        • Nippoldt TB
        Preliminary comparison of the endoscopic transnasal vs the sublabial transseptal approach for clinically nonfunctioning pituitary macroadenomas.
        Mayo Clin Proc. 1999; 74: 661-670
        • Nasseri SS
        • Kasperbauer JL
        • Strome SE
        • McCaffrey TV
        • Atkinson JL
        • Meyer FB
        Endoscopic transnasal pituitary surgery: report on 180 cases.
        Am J Rhinol. 2001; 15: 281-287
        • Jho HD
        Endoscopic transsphenoidal surgery.
        J Neuro-Oncol. 2001; 54: 187-195
        • Cappabianca P
        • Cavallo LM
        • Esposito F
        • Valente V
        • De Divitiis E
        Sellar repair in endoscopic endonasal transsphenoidal surgery: results of 170 cases.
        Neurosurgery. 2002; 51: 1365-1372
        • Kuroki A
        • Kayama T
        Endoscopic approach to the pituitary lesions: contemporary method and review of the literature.
        Biomed Pharmacother. 2002; 56: 158s-164s
        • White DR
        • Sonnenburg RE
        • Ewend MG
        • Senior BA
        Safety of minimally invasive pituitary surgery (MIPS) compared with a traditional approach.
        Laryngoscope. 2004; 114: 1945-1948
        • Jane Jr, JA
        • Han J
        • Prevedello DM
        • Jagannathan J
        • Dumont AS
        • Laws Jr, ER
        Perspectives on endoscopic transsphenoidal surgery.
        Neurosurg Focus. 2005; 19: E2
        • Shah S
        • Har-El G
        Diabetes insipidus after pituitary surgery: incidence after traditional versus endoscopic transsphenoidal approaches.
        Am J Rhinol. 2001; 15: 377-379
        • Cho DY
        • Liau WR
        Comparison of endonasal endoscopic surgery and sublabial microsurgery for prolactinomas.
        Surg Neurol. 2002; 58: 371-376
        • Har-El G
        Endoscopic transnasal transsphenoidal pituitary surgery—comparison with the traditional sublabial transseptal approach.
        Otolaryng Clin N Am. 2005; 38: 723-735
        • Kabil MS
        • Eby JB
        • Shahinian HK
        Fully endoscopic endonasal vs. transseptal transsphenoidal pituitary surgery.
        Minim Invas Neurosurg. 2005; 48: 348-354
        • Frank G
        • Pasquini E
        • Farneti G
        • et al.
        The endoscopic versus the traditional approach in pituitary surgery.
        Neuroendocrinology. 2006; 83: 240-248
        • Doglietto F
        • Prevedello DM
        • Jane Jr, JA
        • Han J
        • Laws Jr, ER
        Brief history of endoscopic transsphenoidal surgery—from Philipp Bozzini to the First World Congress of Endoscopic Skull Base Surgery.
        Neurosurg Focus. 2005; 19: E3
        • Couldwell WT
        Transsphenoidal and transcranial surgery for pituitary adenomas.
        J Neuro-Oncol. 2004; 69: 237-256