Accepted Manuscript Transition from microscopic to endoscopic transsphenoidal surgery for nonfunctional pituitary adenomas Atte Karppinen, M.D., Leena Kivipelto, M.D., Ph.D., Satu Vehkavaara, M.D., Ph.D., Elina Ritvonen, B.M., Emmi Tikkanen, M.Sc., Ph.D., Riku Kivisaari, M.D., Ph.D., Juha Hernesniemi, M.D., Ph.D., Kirsi Setälä, M.D., Ph.D., Camilla Schalin-Jäntti, M.D., Ph.D., Mika Niemelä, M.D., Ph.D. PII:
S1878-8750(15)00131-X
DOI:
10.1016/j.wneu.2015.02.024
Reference:
WNEU 2734
To appear in:
World Neurosurgery
Received Date: 15 July 2014 Revised Date:
15 February 2015
Accepted Date: 17 February 2015
Please cite this article as: Karppinen A, Kivipelto L, Vehkavaara S, Ritvonen E, Tikkanen E, Kivisaari R, Hernesniemi J, Setälä K, Schalin-Jäntti C, Niemelä M, Transition from microscopic to endoscopic transsphenoidal surgery for nonfunctional pituitary adenomas, World Neurosurgery (2015), doi: 10.1016/ j.wneu.2015.02.024. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Transition from microscopic to endoscopic transsphenoidal surgery for
RI PT
nonfunctional pituitary adenomas
Atte Karppinena, Leena Kivipeltob, Satu Vehkavaarac, Elina Ritvonend, Emmi Tikkanene, Riku Kivisaarif, Juha Hernesniemig, Kirsi Setäläh, Camilla Schalin-
Department of Neurosurgery, Helsinki University Central Hospital, PBOX 266, FI-00029 HUS,
M AN U
a
SC
Jänttii, Mika Niemeläj
Helsinki, Finland, email: [email protected] b
Department of Neurosurgery, Helsinki University Central Hospital, PBOX 266, FI-00029 HUS,
Helsinki, Finland, email: [email protected]
Division of Endocrinology, Department of Medicine, University of Helsinki and
TE D
c
Helsinki University Central Hospital, PBOX 340, FI-00029 HUS, Helsinki, Finland, email: [email protected]
Division of Endocrinology, Department of Medicine, University of Helsinki and
EP
d
Helsinki University Central Hospital, PBOX 340, FI-00029 HUS, Helsinki, Finland, email:
e
AC C
[email protected]
Institute for Molecular Medicine Finland, National Institute for Health and Welfare,
Haartmanninkatu 8, FI-00290, Helsinki, Finland, email: [email protected] f
Department of Neurosurgery, Helsinki University Central Hospital, PBOX 266, FI-00029 HUS,
Helsinki, Finland, email: [email protected] g
Department of Neurosurgery, Helsinki University Central Hospital, PBOX 266, FI-00029 HUS,
Helsinki, Finland, email: [email protected] 1
ACCEPTED MANUSCRIPT
Department of Ophthalmology, Helsinki University Central Hospital, PBOX 220, FI-00029
RI PT
h
HUS, Helsinki, Finland, email: [email protected] i
Division of Endocrinology, Department of Medicine, University of Helsinki and
SC
Helsinki University Central Hospital, PBOX 340, FI-00029 HUS, Helsinki, Finland, email: [email protected] j
M AN U
Department of Neurosurgery, Helsinki University Central Hospital, PBOX 266, FI-00029 HUS,
Helsinki, Finland, email: [email protected]
TE D
Corresponding author: Atte Karppinen, Department of Neurosurgery, Helsinki University Central Hospital, PBOX 266, FI-00029, HUS, Helsinki, Finland.,Phone: +358-50-4272522,Fax:
Academic degrees:
AC C
Atte Karppinen, M.D.
EP
+358-9-47187560
Leena Kivipelto, M.D., Ph.D., Satu Vehkavaara, M.D., Ph.D. Elina Ritvonen, B.M.
Emmi Tikkanen, M.Sc., Ph.D. Riku Kivisaari, M.D., Ph.D. Juha Hernesniemi, M.D., Ph.D. 2
ACCEPTED MANUSCRIPT
Kirsi Setälä, M.D., Ph.D. Camilla Schalin-Jäntti, M.D., Ph.D.
RI PT
Mika Niemelä, M.D., Ph.D.
Key words: nonfunctioning pituitary adenoma, transsphenoidal surgery, endoscopy
SC
Abbreviations:
CSF: cerebrospinal fluid CT: computerized tomography DI: diabetes insipidus GH: growth hormone
TE D
GHRH: growth-hormone-releasing hormone
M AN U
ANOVA: analysis of variance
IGF-1: insulin-like growth factor 1 MR: magnetic resonance
AC C
NS: non significant
EP
NFPA: non-functional pituitary adenoma
3
ACCEPTED MANUSCRIPT
Abstract Objective. A total of 320 patients were operated on between 2000 and 2010 for a newly
RI PT
diagnosed pituitary adenoma at our institution. In an attempt to improve quality of tumor resection, the transsphenoidal microscopic technique was replaced by the endoscopic technique in June 2008. This retrospective single-center study compares the outcomes after microscopic
SC
(n=144) and endoscopic (n=41) tumor surgery of all patients operated on for a non-functional pituitary adenoma (NFPA).
M AN U
Methods. Tumor size and location, Knosp grade, prevalence of anterior hypopituitarism, diabetes insipidus (DI), visual acuity/fields, complication rates, and operation time were compared between the groups.
Results. At the 3-month follow-up, hypopituitarism had improved in 7% of patients in the
TE D
Microscopic group and in 9% in the Endoscopic group, and had further impaired in 13% and 9%, respectively.
At the 3-month follow-up MRI, a total tumor removal was achieved in 45% versus 56% of cases,
EP
respectively (P=NS). Visual fields had normalized or improved in 90% versus 88% of patients, respectively (P=NS). Postoperative cerebrospinal fluid (CSF) leak occurred in 3.5% versus 2.4%
AC C
(P=NS), and DI (transient or permanent) in 7.6% versus 4.9% (P=NS) of cases, respectively. Larger tumor size (P
S1878-8750(15)00131-X
DOI:
10.1016/j.wneu.2015.02.024
Reference:
WNEU 2734
To appear in:
World Neurosurgery
Received Date: 15 July 2014 Revised Date:
15 February 2015
Accepted Date: 17 February 2015
Please cite this article as: Karppinen A, Kivipelto L, Vehkavaara S, Ritvonen E, Tikkanen E, Kivisaari R, Hernesniemi J, Setälä K, Schalin-Jäntti C, Niemelä M, Transition from microscopic to endoscopic transsphenoidal surgery for nonfunctional pituitary adenomas, World Neurosurgery (2015), doi: 10.1016/ j.wneu.2015.02.024. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Transition from microscopic to endoscopic transsphenoidal surgery for
RI PT
nonfunctional pituitary adenomas
Atte Karppinena, Leena Kivipeltob, Satu Vehkavaarac, Elina Ritvonend, Emmi Tikkanene, Riku Kivisaarif, Juha Hernesniemig, Kirsi Setäläh, Camilla Schalin-
Department of Neurosurgery, Helsinki University Central Hospital, PBOX 266, FI-00029 HUS,
M AN U
a
SC
Jänttii, Mika Niemeläj
Helsinki, Finland, email: [email protected] b
Department of Neurosurgery, Helsinki University Central Hospital, PBOX 266, FI-00029 HUS,
Helsinki, Finland, email: [email protected]
Division of Endocrinology, Department of Medicine, University of Helsinki and
TE D
c
Helsinki University Central Hospital, PBOX 340, FI-00029 HUS, Helsinki, Finland, email: [email protected]
Division of Endocrinology, Department of Medicine, University of Helsinki and
EP
d
Helsinki University Central Hospital, PBOX 340, FI-00029 HUS, Helsinki, Finland, email:
e
AC C
[email protected]
Institute for Molecular Medicine Finland, National Institute for Health and Welfare,
Haartmanninkatu 8, FI-00290, Helsinki, Finland, email: [email protected] f
Department of Neurosurgery, Helsinki University Central Hospital, PBOX 266, FI-00029 HUS,
Helsinki, Finland, email: [email protected] g
Department of Neurosurgery, Helsinki University Central Hospital, PBOX 266, FI-00029 HUS,
Helsinki, Finland, email: [email protected] 1
ACCEPTED MANUSCRIPT
Department of Ophthalmology, Helsinki University Central Hospital, PBOX 220, FI-00029
RI PT
h
HUS, Helsinki, Finland, email: [email protected] i
Division of Endocrinology, Department of Medicine, University of Helsinki and
SC
Helsinki University Central Hospital, PBOX 340, FI-00029 HUS, Helsinki, Finland, email: [email protected] j
M AN U
Department of Neurosurgery, Helsinki University Central Hospital, PBOX 266, FI-00029 HUS,
Helsinki, Finland, email: [email protected]
TE D
Corresponding author: Atte Karppinen, Department of Neurosurgery, Helsinki University Central Hospital, PBOX 266, FI-00029, HUS, Helsinki, Finland.,Phone: +358-50-4272522,Fax:
Academic degrees:
AC C
Atte Karppinen, M.D.
EP
+358-9-47187560
Leena Kivipelto, M.D., Ph.D., Satu Vehkavaara, M.D., Ph.D. Elina Ritvonen, B.M.
Emmi Tikkanen, M.Sc., Ph.D. Riku Kivisaari, M.D., Ph.D. Juha Hernesniemi, M.D., Ph.D. 2
ACCEPTED MANUSCRIPT
Kirsi Setälä, M.D., Ph.D. Camilla Schalin-Jäntti, M.D., Ph.D.
RI PT
Mika Niemelä, M.D., Ph.D.
Key words: nonfunctioning pituitary adenoma, transsphenoidal surgery, endoscopy
SC
Abbreviations:
CSF: cerebrospinal fluid CT: computerized tomography DI: diabetes insipidus GH: growth hormone
TE D
GHRH: growth-hormone-releasing hormone
M AN U
ANOVA: analysis of variance
IGF-1: insulin-like growth factor 1 MR: magnetic resonance
AC C
NS: non significant
EP
NFPA: non-functional pituitary adenoma
3
ACCEPTED MANUSCRIPT
Abstract Objective. A total of 320 patients were operated on between 2000 and 2010 for a newly
RI PT
diagnosed pituitary adenoma at our institution. In an attempt to improve quality of tumor resection, the transsphenoidal microscopic technique was replaced by the endoscopic technique in June 2008. This retrospective single-center study compares the outcomes after microscopic
SC
(n=144) and endoscopic (n=41) tumor surgery of all patients operated on for a non-functional pituitary adenoma (NFPA).
M AN U
Methods. Tumor size and location, Knosp grade, prevalence of anterior hypopituitarism, diabetes insipidus (DI), visual acuity/fields, complication rates, and operation time were compared between the groups.
Results. At the 3-month follow-up, hypopituitarism had improved in 7% of patients in the
TE D
Microscopic group and in 9% in the Endoscopic group, and had further impaired in 13% and 9%, respectively.
At the 3-month follow-up MRI, a total tumor removal was achieved in 45% versus 56% of cases,
EP
respectively (P=NS). Visual fields had normalized or improved in 90% versus 88% of patients, respectively (P=NS). Postoperative cerebrospinal fluid (CSF) leak occurred in 3.5% versus 2.4%
AC C
(P=NS), and DI (transient or permanent) in 7.6% versus 4.9% (P=NS) of cases, respectively. Larger tumor size (P
