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Exoscopic vs. microscopic transsphenoidal surgery for Cushing’s disease: a retrospective single-center study on 388 patients

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Abstract

Microscopic and endoscopic transsphenoidal surgeries represent the standard treatment for Cushing’s disease (CD). At our institution a new exoscopic approach was implemented. After proof of the general use for transsphenoidal pituitary surgery, the aim of this study was to compare the exoscopic 4K3D video microscope with the microscopic transsphenoidal surgery for patients with CD. We conducted a retrospective analysis on 388 patients with CD treated in our medical center via microscopic transsphenoidal surgery (MTS) between January 2008 and July 2019 or via exoscopic transsphenoidal surgery (ExTS) between May 2019 and May 2021. Parameters investigated included histology, pre- and postoperative MRI with tumor size, pre- and postoperative ACTH and cortisol levels, duration of surgery, perioperative and postoperative complications as well as clinical outcome. Patients who underwent ExTS in CD experienced a lower incidence of SIADH/diabetes insipidus (p = 0.0164), a higher rate of remission (p = 0.0422), and a shorter duration of surgery (p < 0.0001), compared to MTS. However, there was no significant difference regarding new postoperative pituitary insufficiency and intraoperative CSF space opening. We found that ExTS had multiple benefits compared to MTS for tumor resection in case of CD. These results are in line with our previous publication on the general applicability of an exoscope in pituitary surgery. To our knowledge, this is the first clinical study proving the superiority of ExTS in CD. These results are promising, nevertheless further studies comparing exoscopic with the endoscopic approach are necessary to finally evaluate the utility of the new technique.

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Underlining data can be provided upon reasonable request.

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Funding

The tumors in the present study were included in the German Registry of Pituitary Tumors, which is sponsored by Novartis Pharma GmbH (Nürnberg), Novo Nordisk Pharma GmbH (Mainz), Phizer Pharma GmbH (Berlin) and Ipsen Pharma GmbH (Ettlingen).

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Authors and Affiliations

  1. Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr.52, 20246, Hamburg, Germany

    Piotr Sumisławski, Andras Piffko, Torge Huckhagel, Alice Ryba, Jörg Flitsch & Roman Rotermund

  2. Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    Piotr Sumisławski

  3. Department of Neuroradiology, University Medical Center Gottingen, Göttingen, Germany

    Torge Huckhagel

  4. Department of Neurosurgery, Friedrich-Ebert-Krankenhaus, Neumuenster, Germany

    Till Burkhardt

  5. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Jens Aberle

  6. Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Wolfgang Saeger

Authors
  1. Piotr Sumisławski
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  2. Andras Piffko
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  3. Torge Huckhagel
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  4. Alice Ryba
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  5. Till Burkhardt
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  6. Jens Aberle
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  7. Wolfgang Saeger
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  8. Jörg Flitsch
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  9. Roman Rotermund
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Contributions

Conception and design: Rotermund, Sumislawski. Acquisition of data: Sumislawski, Rotermund, Ryba, Piffko, Burkhardt, Saeger. Analysis and interpretation of data: Sumislawski, Rotermund. Drafting the article: Sumislawski, Rotermund. Critically revising the article: Rotermund, Aberle, Flitsch, Huckhagel, Burkhardt. Reviewed submitted version of manuscript: all the authors. Approved the final version of the manuscript on behalf of all the authors: Rotermund. Administrative/technical/material support: Saeger. Study supervision: Rotermund.

Corresponding author

Correspondence to Roman Rotermund.

Ethics declarations

Ethical approval and consent to participate

Approval of the study was obtained by the local ethics committee (Ethikkommission der Ärztekammer Hamburg). Informed consent was obtained from all patients (above 16 years old) and their legal guardian(s) (below 16 years of age). The study was performed in accordance with the Declaration of Helsinki.

Human and animal ethics

Not applicable.

Consent for publication

The authors affirm that informed consent for publication was given by all the participants.

Competing interests

Jörg Flitsch has been a lecturer for Olympus.

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Sumisławski, P., Piffko, A., Huckhagel, T. et al. Exoscopic vs. microscopic transsphenoidal surgery for Cushing’s disease: a retrospective single-center study on 388 patients. Neurosurg Rev 45, 3675–3681 (2022). https://doi.org/10.1007/s10143-022-01866-5

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  • DOI: https://doi.org/10.1007/s10143-022-01866-5

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