Abstract
Purpose
Surgical experience is considered paramount for excellent outcome of transsphenoidal surgery (TSS). However, objective data demonstrating the surgical success in relation to the experience of pituitary surgery units or individual experience of pituitary surgeons is sparse.
Methods
Based on literature data, we have investigated the influence of experience with TSS for pituitary adenomas on endocrinological remission rates and on operative complications. The surgical experience was assessed by calculating the number of transsphenoidal operations per year.
Results
For TSS of microprolactinomas, mean remission rates were 77% in centers with < 2 operations per year for microprolactinomas, 82% with 2–4 operations, 84% with 4–6 operations, and 91% with > 6 operations. A yearly experience with more than 10 initial operations for Cushing’s disease (CD) warrants a remission rate exceeding 70%. Remission rates in CD exceeding 86% have only been reported for single surgeon series. Extraordinarily high complication rates were found in some series with < 25 yearly total operations for pituitary adenomas. Major vascular complications were less than 2% and revision rates for rhinorrhea usually < 2.5% in centers performing > 25 transsphenoidal operations per year.
Conclusions
We conclude that a center with experience of > 25 transsphenoidal operations for pituitary adenomas per year provides a high likelihood of safe TSS. Surgery for CD requires a particularly high level of practice to guarantee excellent remission rates. The endocrinologist has the unique opportunity to audit the surgical success by hormone measurement and to refer patients to neurosurgeons with proven excellence.
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References
Schloffer H (1907) Erfolgreiche Operation eines Hypophysentumors auf nasalem Wege. Wien Klin Wchnschr 20:621–624
Hardy J (1969) Transsphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg 16:185–217
Casanueva FF, Barkan AL, Buchfelder M, Klibanski A, Laws ER, Loeffler JS (2017) Criteria for the definition of pituitary tumor centers of excellence (PTCOE): a pituitary society statement. Pituitary 20:489–498
Ciric I, Ragin A, Baumgartner C, Pierce D (1997) Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40:225–237
Erturk E, Tuncel E, Kiyici S, Ersoy C, Duran C, Imamoglu S (2005) Outcome of surgery for acromegaly performed by different surgeons: importance of surgical experience. Pituitary 8:93–97
Bates PR, Carson MN, Trainer PJ, Wass JAH (2008) Wide variation in surgical outcomes for acromegaly in the UK. Clin Endocrinol (Oxf) 68:136–142
Gittoes NJL, Sheppard MC, Johnson AP, Stewart PM (1999) Outcome of surgery for acromegaly—the experience of a dedicated pituitary surgeon. Q J Med 92:741–745
Halvorsen H, Ramm-Pettersen J, Josefsen R, Rønning P, Reinlie S, Meling T et al (2014) Surgical complications after transsphenoidal microscopic and endoscopic surgery for pituitary adenoma: a consecutive series of 506 procedures. Acta Neurochir 156:441–449
Tampourlou M, Trifanescu R, Paluzzi A, Ahmed SK, Karavitaki N (2016) Surgery in microprolactinomas: effectiveness and risks based on contemporary literature. Eur J Endocrinol 175:R89–R96
Babey M, Sahli R, Vajtai I, Andres RH, Seiler RW (2011) Pituitary surgery for small prolactinomas as an alternative to treatment with dopamine agonists. Pituitary 14:222–230
Dehdashti AR, Ganna A, Karabatsou K, Gentili F (2008) Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery 62:1006–1017
D’Haens J, Van Rompaey K, Stadnik T, Haentjens P, Poppe K, Velkeniers B (2009) Fully endoscopic transsphenoidal surgery of functioning pituitary adenomas. A retrospective comparison with traditional transsphenoidal microsurgery in the same institution. Surg Neurol 72:336–350
Esposito V, Santoro A, Minniti G, Salvati M, Innocenzi G, Lanzetta G et al (2004) Transsphenoidal adenomectomy for GH-, PRL- and ACTH-secreting pituitary tumours: outcome analysis in a series of 125 patients. Neuro Sci 25:251–256
Frank G, Pasquini E, Farneti G, Mazzatenta D, Sciarretta V, Grasso V et al (2006) The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinology 83:240–248
Gondim JA, Schops M, de Almeida JPC, de Albuquerque LAF, Gomes E, Ferraz T et al (2010) Endoscopic endonasal transssphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center. Pituitary 13:68–77
Hofstetter CP, Shin BJ, Mubita L, Huang C, Anand VK, Boockvar JA et al (2011) Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas. Neurosurg Focus 30:E10
Ikeda H, Watanabe K, Tominaga T, Yoshimoto T (2013) Transsphenoidal microsurgical results of female patients with prolactinomas. Clin Neurol Neurosurg 115:1621–1625
Kreutzer J, Buslei R, Wallaschofski H, Hofmann B, Nimsky C, Fahlbusch R et al (2008) Operative treatment of prolactinomas: indications and results in a current consecutive series of 212 patients. Europ J Endocrinol 158:11–18
Kristof RA, Schramm J, Redel L, Neuloh G, Wichers M, Klingmüller D (2002) Endocrinological outcome following first time transsphenoidal surgery for GH-, ACTH-, and PRL-secreting pituitary adenomas. Acta Neurochir (Wien) 144:555–561
Losa M, Mortini P, Barzaghi R, Gioia L, Giovanelli M (2002) Surgical treatment of prolactin-secreting pituitary adenomas: early results and long-term outcome. J Clin Endocrinol Metab 87:3180–3186
Loyo-Varela M, Herrada-Pineda T, Revilla-Pacheco F, Manrique-Guzman S (2013) Pituitary tumor surgery: review of 3004 cases. World Neurosurg 79:331–336
Marić A, Kruljac I, Čerina V, Pećina HI, Šulentić P, Vrkljan M (2012) Endocrinological outcomes of pure endoscopic transsphenoidal surgery: a Croatian Referral Pituitary Center experience. Croat Med J 53:224–233
Mortini P, Losa M, Barzaghi R, Boari N, Giovanelli M (2005) Results of transsphenoidal surgery in a large series of patients with pituitary adenoma. Neurosurgery 56:1222–1233
Paluzzi A, Fernandez-Miranda JC, Stefko ST, Challinor S, Snyderman CH, Gardner PA (2014) Endoscopic endonasal approach for pituitary adenomas: a series of 555 patients. Pituitary 17:307–319
Primeau V, Raftopoulous C, Maiter D (2012) Outcomes of transsphenoidal surgery in prolactinomas: improvement of hormonal control in dopamine agonist-resistant patients. Eur J Endocrinol 166:779–786
Qu X, Wang M, Wang G, Han T, Mou C, Han L et al (2011) Surgical outcomes and prognostic factors of transsphenoidal surgery for prolactinoma in men: a single-center experience with 87 consecutive cases. Eur J Endocrinol 164:499–504
Sinha S, Sharma S, Mahapatra AK (2011) Microsurgical management of prolactinomas—clinical and hormonal outcome in a series of 172 cases. Neurol India 59:532–536
Tamasauskas A, Sinkunas K, Bunevicius A, Radziunas A, Skiriute D, Deltuva VP (2012) Transsphenoidal surgery for microprolactinomas in women: results and prognosis. Acta Neurochir 154:1889–1893
Yano S, Kawano T, Kudo M, Makino K, Nakamura H, Kai Y et al (2009) Endoscopic endonasal transsphenoidal approach through the bilateral nostrils for pituitary adenomas. Neurol Med Chir (Tokyo) 49:1–7
Acebes JJ, Martino J, Masuet C, Montanya E, Soler J (2007) Early post-operative ACTH and cortisol as predictors of remission in Cushing’s disease. Acta Neurochir (Wien) 149:471–479
Alexandraki KI, Kaltsas GA, Isidori AM, Storr HL, Afshar F, Sabin I et al (2013) Long-term remission and recurrence rates in Cushing’s disease: predictive factors in a single-centre study. Eur J Endocrinol 168:639–648
Alwani RA, de Herder WW, van Aken MO, van den Berge JH, Delwel EJ, Dallenga AHG et al (2010) Biochemical predictors of outcome of pituitary surgery for Cushing’s disease. Neuroendocrinology 91:169–178
Amlashi FG, Swearingen B, Faje AT, Nachtigall LB, Miller KK, Klibanski A et al (2015) Accuracy of late-night salivary cortisol in evaluation postoperative remission and recurrence in Cushing’s disease. J Clin Endocrinol Metab 100:3770–3777
Ammini AC, Bhattacharya S, Sahoo JP, Philip J, Tandon N, Goswami R et al (2011) Cushing’s disease: results of treatment and factors affecting outcome. Hormones 10:222–229
Aranda G, Enseñat J, Mora M, Puig-Domingo M, Martínez de Osaba MJ, Casals G (2015) Long-term remission and recurrence rate in a cohort of Cushing’s disease: the need for long-term follow-up. Pituitary 18:142–149
Arnott RD, Pestell RG, McKelvie PA, Henderson JK, NcNeill PM, Alford FP (1990) A critial evaluation of transsphenoidal pituitary surgery in the treatment of Cushing’s disease: prediction of outcome. Acta Endocrinol (Copenh) 123:423–430
Asuzu D, Chatain GP, Hayes C, Benzo S, McGlotten R, Keil M et al (2017) Normalized early postoperative cortisol and ACTH values predict nonremission after surgery for Cushing disease. J Clin Endocrinol Metab 102:2179–2187
Atkinson AB, Kennedy A, Wiggam MI, McCance DR, Sheridan B (2005) Long-term remission rates after pituitary surgery for Cushing’s disease: the need for long-term surveillance. Clin Endocrinol (Oxf) 63:549–559
Barbot M, Albiger N, Koutroumpi S, Ceccato F, Frigo AC, Manara R et al (2013) Predicting late recurrence in surgically treated patients with Cushing’s disease. Clin Endocrinol (Oxf) 79:394–401
Berker M, Işikay I, Berker D, Bayraktar M, Gürlek A (2014) Early promising results for the endoscopic surgical treatment of Cushing’s disease. Neurosurg Rev 37:105–114
Berkmann S, Fandino J, Müller B, Kothbauer KF, Henzen C, Landolt H (2012) Pituitary surgery: experience from a large network in Central Switzerland. Swiss Med Wkly 142:w13680
Carrasco CA, Coste J, Guignat L, Groussin L, Dugué MA, Gaillard S et al (2008) Midnight salivary cortisol determination for assessing the outcome of transsphenoidal surgery in Cushing’s disease. J Clin Endocrinol Metab 93:4728–4734
Cebula H, Baussart B, Villa C, Assié G, Boulin A, Foubert L et al (2017) Efficacy of endoscopic endonasal transsphenoidal surgery for Cushing’s disease in 230 patients with positive and negative MRI. Acta Neurochir (Wien) 159:1227–1236
Chandler WF, Barkan AL, Hollon T, Sakharova A, Sack J, Brahma B, Schteingart DE (2016) Outcome of transsphenoidal surgery for Cushing disease: a single-center experience over 32 years. Neurosurgery 78:216–223
Charalampaki P, Reisch R, Ayad A, Conrad J, Welschehold S, Perneczky A et al (2007) Endoscopic endonasal pituitary surgery: surgical and outcome analysis of 50 cases. J Clin Neurosci 14:410–415
Chee GH, Mathias DB, James RA, Kendall-Taylor P (2001) Transsphenoidal pituitary surgery in Cushing’s disease: can we predict outcome? Clin Endocrinol (Oxf) 54:617–626
Chone CT, Sampaio MH, Sakano E, Paschoal JR, Garnes HM, Queiroz L et al (2014) Endoscopic endonasal transsphenoidal resection of pituitary adenomas: preliminary evaluation of consecutive cases. Braz J Otorhinolarnyngol 80:146–151
Ciric I, Zhao JC, Du H, Findling JW, Molich ME, Weiss RE, Refetoff S et al (2012) Transsphenoidal surgery for Cushing disease: experience with 136 patients. Neurosurgery 70:70–81
Dehdashti AR, Gentili F (2007) Current state of the art in the diagnosis and surgical treatment of Cushing disease: early experience with a purely endoscopic endonasal technique. Neurosurg Focus 23:E9
Fomekong E, Maiter D, Grandin C, Raftopoulos C (2009) Outcome of transsphenoidal surgery for Cushing’s disease: a high remission rate in ACTH-secreting macroadenomas. Clin Neurol Neurosurg 111:442–449
Hammer GD, Tyrrell JB, Lamborn KR, Applebury CB, Hannegan ET, Bell S et al (2004) Transsphenoidal microsurgery for Cushing’s disease: initial outcome and long-term results. J Clin Endocrinol Metab 89:6348–6357
Hassan-Smith ZK, Sherlock M, Reulen RC, Arlt W, Ayuk J, Toogood AA et al (2012) Outcome of Cushing’s disease following transsphenoidal surgery in a single center over 20 years. J Clin Endocrinol Metab 97:1194–1201
Honegger J, Schmalisch K, Beuschlein F, Kaufmann S, Schnauder G, Naegele T et al (2012) Contemporary microsurgical concept for the treatment of Cushing’s disease: endocrine outcome in 83 consecutive patients. Clin Endocrinol (Oxf) 76:560–567
Höybye C, Grenbäck E, Thorén M, Hulting AL, Lundblad L, von Holst H et al (2004) Transsphenoidal surgery in Cushing disease: 10 years of experience in 34 consecutive cases. J Neurosurg 100:634–638
Jho HD, Carrau RL (1997) Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87:44–51
Johnston PC, Kennedy L, Hamrahian AH, Sandouk Z, Bena J, Hatipoglu B et al (2017) Surgical outcomes in patients with Cushing’s disease: the Cleveland clinic experience. Pituitary 20:430–440
Keskin FE, Ozkaya HM, Bolayirli M, Erden S, Kadioglu P, Tanriover N et al (2017) Outcome of primary transsphenoidal surgery in Cushing disease: experience of a tertiary center. World Neurosurg 106:374–381
Kim JH, Shin CS, Paek SH, Jung HW, Kim SW, Kim SY (2012) Recurrence of Cushing’s disease after primary transsphenoidal surgery in a university hospital in Korea. Endocr J 59:881–888
Kuo CH, Shih SR, Li HY, Chen SC, Hung PJ, Tseng FY et al (2017) Adrenocorticotropic hormone levels before treatment predict recurrence of Cushing’s disease. J Formos Med Assoc 116:441–447
Lambert JK, Goldberg L, Fayngold S, Kostadinov J, Post KD, Geer EB (2013) Predictors of mortality and long-term outcomes in treated Cushing’s disease: a study of 346 patients. J Clin Endocrinol Metab 98:1022–1030
Lampropoulos KI, Samonis G, Nomikos P (2013) Factors influencing the outcome of microsurgical transsphenoidal surgery for pituitary adenomas: a study on 184 patients. Hormones 12:254–264
Leach P, Abou-Zeid AH, Kearney T, Davis J, Trainer PJ, Gnanalingham KK (2010) Endoscopic transsphenoidal pituitary surgery: evidence of an operative learning curve. Neurosurgery 67:1205–1212
Lim JS, Lee SK, Kim SH, Lee EJ, Kim SH (2011) Intraoperative multiple-staged resection and tumor tissue identification using frozen sections provide the best result for the accurate localization and complete resection of tumors in Cushing’s disease. Endocrine 40:452–461
Lindholm J (1992) Endocrine function in patients with Cushing’s disease before and after treatment. Clin Endocrinol (Oxf) 36:151–159
Lüdecke DK (1991) Transnasal microsurgery of Cushing’s disease 1990: overview including personal experiences with 256 patients. Pathol Res Pract 187:608–612
Mayberg M, Reintjes S, Patel A, Moloney K, Mercado J, Carlson A et al (2017) Dynamics of postoperative serum cortisol after transsphenoidal surgery for Cushing’s disease: implications for immediate reoperation and remission. J Neurosurg 22:1–10
Mortini P, Barzaghi LR, Albano L, Panni P, Losa M (2018) Microsurgical therapy of pituitary adenomas. Endocrine 59:72–81
Pennacchietti V, Garzaro M, Grottoli S, Pacca P, Garbossa D, Ducati A et al (2016) Three-dimensional endoscopic endonasal approach and outcomes in sellar lesions: a single-center experience with 104 cases. World Neurosurg 89:121–125
Perreira AM, van Aken MO, van Dulken H, Schutte PJ, Biermasz NR, Smit JWA et al (2003) Long-term predictive value of postsurgical cortisol concentrations for cure and risk of recurrence in Cushing’s disease. J Clin Endocrinol Metab 88:5858–5864
Petruson K, Jakobsson KE, Petruson B, Lindstedt G, Bengtsson BA (1997) Transsphenoidal adenomectomy in Cushing’s disease via a lateral rhinotomy approach. Surg Neurol 48:37–45
Porterfield JR, Thompson GB, Young WF Jr, Chow JT, Fryrear RS, van Heerden JA et al (2008) Surgery for Cushing’s syndrome: an historical review and recent ten-year experience. World J Surg 32:659–677
Post FA, Soule SG, de Villiers JC, Levitt NS (1995) Pituitary function after selective adenomectomy for Cushing’s disease. Br J Neurosurg 9:41–46
Powell MP, Narimova GJ, Halimova ZJ (2017) The results of surgical treatment of Cushing tumors in the Republic of Uzbekistan: establishing transsphenoidal surgery in a developing nation. World Neurosurg 97:213–220
Ramm-Pettersen J, Halvorsen H, Evang JA, Rønning P, Hol PK, Bollerslev J et al (2015) Low immediate postoperative serum-cortisol nadir predicts the short-term, but not long-term, remission after pituitary surgery for Cushing’s disease. BMC Endocr Disord 15:62
Rees DA, Hanna FWF, Davies JS, Mills RG, Vafidis J, Scanlon MF (2002) Long-term follow-up results of transsphenoidal surgery for Cushing’s disease in a single centre using strict criteria for remission. Clin Endocrinol (Oxf) 56:541–551
Rudnik A, Kos-Kudła B, Larysz D, Zawadzki T, Bazowski P (2007) Endoscopic transsphenoidal treatment of hormonally active pituitary adenomas. Neuro Endocrinol Lett 28:438–444
Sarkar S, Rajaratnam S, Chacko G, Mani S, Hesargatta AS, Chacko AG (2016) Pure endoscopic transsphenoidal surgery for functional pituitary adenomas: outcomes with Cushing’s disease. Acta Neurochir (Wien) 158:77–86
Shimon I, Ram Z, Cohen ZR, Hadani M (2002) Transsphenoidal surgery for Cushing’s disease: endocrinological follow-up monitoring of 82 patients. Neurosurgery 51:57–62
Shirvani M, Motiei-Langroudi R, Sadeghian H (2016) Outcome of microscopic transsphenoidal surgery in Cushing disease: a case series of 96 patients. World Neurosurg 87:170–175
Solak M, Kraljevic I, Dusek T, Melada A, Kavanagh MM, Peterkovic V et al (2016) Management of Cushing’s disease: a single-center experience. Endocrine 51:517–523
Sonino N, Zielezny M, Fava GA, Fallo F, Boscaro M (1996) Risk factors and long-term outcome in pituitary-dependent Cushing’s disease. J Clin Endocrinol Metab 81:2647–2652
Tindall GT, Herring CJ, Clark RV, Adams DA, Watts NB (1990) Cushing’s disease: results of transsphenoidal microsurgery with emphasis on surgical failures. J Neurosurg 72:363–369
Torales J, Halperin I, Hanzu F, Mora M, Alobid I, De Notaris M et al (2014) Endoscopic endonasal surgery for pituitary tumors. Results in a series of 121 patients operated at the same center and by the same neurosurgeon. Endocrinol Nutr 61:410–416
Wagenmakers MA, Boogaarts HD, Roerink SH, Timmers HJ, Stikkelbroeck NM, Smit JW et al (2013) Endoscopic transsphenoidal pituitary surgery: a good and safe primary treatment option for Cushing’s disease, even in case of macroadenomas or invasive adenomas. Eur J Endocrinol 169:329–337
Witek P, Zielinski G (2012) Predictive value of preoperative magnetic resonance imaging of the pituitary for surgical cure in Cushing’s disease. Turk Neurosurg 22:747–752
Yamada S, Inoshita N, Fukuhara N, Yamaguchi-Okada M, Nishioka H, Takeshita A et al (2015) Therapeutic outcomes in patients undergoing surgery after diagnosis of Cushing’s disease: a single-center study. Endocr J 62:1115–1125
Ammirati M, Wei L, Ciric I (2013) Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 84:843–849
Alameda C, Lucas T, Pineda E, Brito M, Uría JG, Magallón R et al (2005) Experience in management of 51 non-functioning pituitary adenomas: indications for post-operative radiotherapy. J Endocrinol Invest 28:18–22
Barahona MJ, Sojo L, Wägner AM, Bartumeus F, Oliver B, Cano P (2005) Determinants of neurosurgical outcome in pituitary tumors. J Endocrinol Invest 28:787–795
Cappabianca P, Cavallo LM, Colao AM, de Divitiis E (2002) Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 97:293–298
Chen L, White WL, Spetzler RF, Xu B (2011) A prospective study of nonfunctioning pituitary adenomas: presentation, management, and clinical outcome. J Neurooncol 102:129–138
Dallapiazza RF, Grober Y, Starke RM, Laws ER, Jane JA (2015) Long-term results of endonasal endoscopic transsphenoidal resection of nonfunctioning pituitary macroadenomas. Neurosurgery 76:42–53
Gondim JA, Almeida JPC, Albuquerque LAF, Schops M, Gomes E, Ferraz T et al (2011) Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients. Pituitary 14:174–183
Hlavica M, Bellut D, Lemm D, Schmid C, Bernays RL (2013) Impact of ultra-low-field intraoperative magnetic resonance imaging on extent of resection and frequency of tumor recurrence in 104 surgically treated nonfunctioning pituitary adenomas. World Neurosurg 79:99–109
Jang JH, Kim KH, Lee YM, Kim JS, Kim YZ (2016) Surgical results of pure endoscopic endonasal transsphenoidal surgery for 331 pituitary adenomas: a 15-year experience from a single institution. World Neurosurg 96:545–555
Kabil MS, Eby JB, Shahinian HK (2005) Fully endoscopic endonasal vs. transseptal transsphenoidal pituitary surgery. Minim Invas Neurosurg 48:348–354
Karppinen A, Kivipelto L, Vehkavaara S, Ritvonen E, Tikkanen E, Kivisaari R et al (2015) Transition from microscopic to endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas. World Neurosurg 84:48–57
Kim JH, Lee JH, Lee JH, Hong AR, Kim YJ, Kim YH (2018) Endoscopic transsphenoidal surgery outcomes in 331 nonfunctioning pituitary adenoma cases after a single surgeon learning curve. Word Neurosurg 109:e409–e416
Koc K, Anik I, Ozdamar D, Cabuk B, Keskin G, Ceylan S (2006) The learning curve in endoscopic pituitary surgery and our experience. Neurosurg Rev 29:298–305
Magro E, Graillon T, Lassave J, Castinetti F, Boissonneau S, Tabouret E et al (2016) Complications related to the endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary macroadenomas in 300 consecutive patients. World Neurosurg 89:442–453
Messerer M, de Battista JC, Raverot G, Kassis S, Dubourg J, Lapras V et al (2011) Evidence of improved surgical outcome following endoscopy for nonfunctioning pituitary adenoma removal. Neurosurg Focus 30:E11
Rudnik A, Zawadzki T, Wojtacha M, Bazowski P, Gamrot J, Galuszka-Ignasiak B et al (2005) Endoscopic transnasal transsphenoidal treatment of pathology of the sellar region. Minim Invas Neurosurg 48:101–107
Serra C, Burkhardt JK, Esposito G, Bozinov O, Pangalu A, Valavanis A et al (2016) Pituitary surgery and volumetric assessment of extent of resection: a paradigm shift in the use of intraoperative magnetic resonance imaging. Neurosurg Focus 40:E17
Yildirim AE, Sahinoglu M, Ekici I, Cagil E, Karaoglu D, Celik H et al (2016) Nonfunctioning pituitary adenomas are really clinically nonfunctioning? Clinical and endocrinological symptoms and outcomes with endoscopic endonasal treatment. World Neurosurg 85:185–192
Zaidi HA, Awad AW, Bohl MA, Chapple K, Knecht L, Jahnke H et al (2016) Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma. J Neurosurg 124:596–604
Badie B, Nguyen P, Preston JK (2000) Endoscopic-guided direct endonasal approach for pituitary surgery. Surg Neurol 53:168–173
O’Malley BW Jr, Grady MS, Gabel BC, Cohen MA, Heuer GG, Pisapia J (2008) Comparison of endoscopic and microscopic removal of pituitary adenomas: single-surgeon experience and the learning curve. Neurosurg Focus 25:E10
Senior BA, Ebert CS, Bednarski KK, Bassim MK, Younes M, Sigounas D et al (2008) Minimally invasive pituitary surgery. Laryngoscope 118:1842–1855
Uren B, Vrodos N, Wormald PJ (2007) Fully endoscopic transssphenoidal resection of pituitary tumors: technique and results. Am J Rhinol 21:510–514
White DR, Sonnenburg RE, Ewend MG, Senior BA (2004) Safety of minimally invasive pituitary surgery (MIPS) compared with a traditional approach. Laryngoscope 114:1945–1948
Coburger J, König R, Seitz K, Bäzner U, Wirtz CR, Hlavac M (2014) Determining the ultility of intraoperative magnetic resonance imaging for transsphenoidal surgery: a retrospective study. J Neurosurg 120:346–356
Cote DJ, Burke WT, Castlen JP, King CH, Zaidi HA, Smith TR et al (2017) Safety of remifentanil in transsphenoidal surgery: a single-center analysis of 540 patients. J Clin Neurosci 38:96–99
Davis TME, Badshah I, Drinkwater J, Kusich E, Latkovic E, Knuckey N (2017) Two-year audit of outcomes of pituitary surgery at an Australian teaching hospital. Intern Med J 47:1248–1255
El-Fiki ME, Aly A, Elwany S (2012) Binasal endoscopic approach to the sellar region: experience and outcome analysis of 80 cases. J Neurol Surg B 73:287–291
Kim DH, Hong YK, Jeun SS, Park JS, Lim DJ, Kim SW (2017) Endoscopic endonasal transsphenoidal approach from the surgeon point of view. J Craniofac Surg 28:959–962
Mamelak AN, Carmichael J, Bonert VH, Cooper O, Melmed S (2013) Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases. Pituitary 16:393–401
Tao Y, Jian-wen G, Yong-qin K, Li-bin Y, Hai-dong H, Wen-tao Y et al (2011) Transsphenoidal surgery assisted by a new guidance device: results of a series of 747 cases. Clin Neurol Neurosurg 113:626–630
Wang F, Zhou T, Wei S, Meng X, Zhang J, Hou Y et al (2015) Endoscopic endonasal transsphenoidal surgery of 1,166 pituitary adenomas. Surg Endosc 29:1270–1280
Petersenn S, Beckers A, Ferone D, van der Lely A, Bollerslev J, Boscaro M et al (2015) Therapy of endocrine disease: outcomes in patients with Cushing’s disease undergoing transsphenoidal surgery: systematic review assessing criteria used to define remission and recurrence. Eur J Endocrinol 172:R227–R239
Schöfl C, Franz H, Grussendorf M, Honegger J, Jaursch-Hancke C, Mayr B et al (2013) Long-term outcome in patients with acromegaly: analysis of 1344 patients from the German Acromegaly Register. Eur J Endocrinol 168:39–47
Almutairi RD, Muskens IS, Cote DJ, Dijkman MD, Kavouridis VK, Crocker E et al (2018) Gross total resection of pituitary adenomas after endoscopic vs. microscopic transsphenoidal surgery: a meta-analysis. Acta Neurochir (Wien) 160:1005–1021
Luft HS, Bunker JP, Enthoven AC (1979) Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 301:1364–1369
Smith SJ, Eralil G, Woon K, Sama A, Dow G, Robertson I (2010) Light at the end of the tunnel: the learning curve associated with endoscopic transsphenoidal skull base surgery. Skull Base 20:69–74
Chi F, Wang Y, Lin Y, Ge J, Qiu Y, Guo L (2013) A learning curve of endoscopic transsphenoidal surgery for pituitary adenoma. J Craniofac Surg 24:2064–2067
Shou X, Shen M, Zhang Q, Zhang Y, He W, Ma Z, Zhao Y, Li S (2016) Endoscopic endonasal pituitary adenomas surgery: the surgical experience of 178 consecutive patients and learning curve of two neurosurgeons. BMC Neurol 16:247
Bokhari AR, Davies MA, Diamond T (2013) Endoscopic transsphenoidal pituitary surgery: a single surgeon experience and the learning curve. Br J Neurosurg 27:44–49
Eseonu CI, ReFaey K, Pamias-Portalatin E, Asensio J, Garcia O, Boahene KD et al (2018) Three-hand endoscopic endonasal transsphenoidal surgery: experience with an anatomy-preserving mononostril approach technique. Oper Neurosurg (Hagerstown) 14:158–165
Shikary T, Andaluz N, Meinzen-Derr J, Edwards C, Theodosopoulos P, Zimmer LA (2017) Operative learning curve after transition to endoscopic transsphenoidal pituitary surgery. Word Neurosurg 102:608–612
Mattozo CA, Dusick JR, Esposito F, Mora H, Cohan P, Malkasian D et al (2006) Suboptimal sphenoid and sellar exposure: a consistent finding in patients treated with repeat transsphenoidal surgery for residual endocrine-inactive macroadenomas. Neurosurgery 58:857–865
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Honegger, J., Grimm, F. The experience with transsphenoidal surgery and its importance to outcomes. Pituitary 21, 545–555 (2018). https://doi.org/10.1007/s11102-018-0904-4
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DOI: https://doi.org/10.1007/s11102-018-0904-4