Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2020, vol. 29, nr 8, August, p. 921–928

doi: 10.17219/acem/123351

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

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The quality of life after transnasal microsurgical and endoscopic resection of nonfunctioning pituitary adenoma

Maciej Bryl1,A,B,C,D, Jowita Woźniak2,B,C,D, Krzysztof Dudek3,C, Bogdan Czapiga4,A,C,E,F, Paweł Tabakow2,A,C,D,E,F

1 Department of Neurosurgery and Neurooncology, Medical University of Lodz, Barlicki University Hospital, Poland

2 Department of Neurosurgery, Wroclaw Medical University, Poland

3 Faculty of Natural Sciences and Technology, Karkonosze College, Jelenia Góra, Poland

4 Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Poland

Abstract

Background. A pituitary tumor can be reached by a transsphenoidal approach with the use of a microscope or an endoscope. The impact of the surgical technique on the patient’s quality of life (QOL) is of great interest to us. Currently, the development of both surgical techniques, especially the endoscopic one, is very rapid. Treatment outcomes are extremely important, especially in terms of patients’ QOL after pituitary tumor resection, irrespective of the technical aspects.
Objectives. To compare the quality of life between patients who had undergone either transsphenoidal microscopic (MTS) or endoscopic (ETS) non-functioning pituitary adenoma resection.
Material and Methods. The study population consisted of 32 consecutive patients (21 for the endoscopic and 11 for the microscopic method) who had undergone pituitary adenoma resection. Their QOL was evaluated using the World Health Organization’s Quality of Life assessment tool (WHOQOL-BREF), the Sino-Nasal Outcome Test (SNOT-22) and the Visual Functioning Questionnaire (VFQ-25). Questionnaires were collected before and after surgery during the patients’ hospital stay and 3 months after the surgery.
Results. The patients in the 2 groups did not differ significantly in terms of age, sex, tumor size, length of hospital stay, or QOL before the surgery. Vision-related QOL (VR-QOL) significantly improved in patients undergoing endoscopic surgery (p < 0.001). There were no statistically significant differences in QOL between the study groups at any stage of the trial (p > 0.05). Significantly more patients had improved QOL after endoscopic surgery according to the WHOQOL-BREF (p = 0.005) and the VFQ-25 (p = 0.002).
Conclusion. The novel observation in this study is the significant improvement of VR-QOL in patients after endoscopic non-functioning pituitary adenoma resection in comparison to patients having microscopic resection. The microscopic method does not exacerbate rhinological symptoms more than the endoscopic one. Endoscopic surgery seems to be more beneficial for patients with pituitary adenoma, which deteriorates VR-QOL.

Key words

pituitary adenoma, health-related quality of life, neuroendoscopy, transsphenoidal approach, microsurgery

References (29)

  1. Cohen-Gadol AA, Liu JK, Laws ER Jr. Cushing’s first case of transsphenoidal surgery: The launch of the pituitary surgery era. J Neurosurg. 2005;103(3):570–574.
  2. Fatemi N, Dusick JR, de Paiva Neto MA, Kelly DF. The endonasal microscopic approach for pituitary adenomas and other parasellar tumors: A 10-year experience. Neurosurgery. 2008;63(4):244–256.
  3. Okamoto Y, Okamoto F, Yamada S, Honda M, Hiraoka T, Oshika T. Vision-related quality of life after transsphenoidal surgery for pituitary adenoma. Invest Ophthalmol Vis Sci. 2010;51(7):3405–3410.
  4. The WHOQOL Group: Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28(3):551–558.
  5. Wołowicka L, Jaracz K. Polska wersja WHOQOL – WHOQOL 100 i WHOQOL-BREF [In:] Jakość życia w naukach medycznych. Poznań, Poland: Wydawnictwo Akademii Medycznej w Poznaniu; 2001:235–280.
  6. Morley AD, Sharp HR. A review of sinonasal outcome scoring systems: Which is best? Clin Otolaryngol. 2006;31(2):103–109.
  7. Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD; National Eye Institute Visual Function Questionnaire Field Test Investigators. Development of the 25-item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol. 2001;119(7):1050–1058.
  8. Little AS, Kelly D, Milligan J, et al. Predictors of sinonasal quality of life and nasal morbidity after fully endoscopic transsphenoidal surgery. J Neurosurg. 2001;122(6):1458–1465.
  9. Dekkers OM, van der Klaauw AA, Pereira AM, et al. Quality of life is decreased after treatment for nonfunctioning pituitary macro­adenoma. J Clin Endocrinol Metab. 2006;91(9):3364–3369.
  10. Wolf A, Goncalves S, Salehi F, et al. Quantitative evaluation of headache severity before and after endoscopic transsphenoidal surgery for pituitary adenoma. J Neurosurg. 2016;124(6):1627–1633.
  11. Tanemura E, Nagatani T, Aimi Y, Kishida Y, Takeuchi K, Wakabayashi T. Quality of life in nonfunctioning pituitary macroadenoma patients before and after surgical treatment. Acta Neurochir. 2012;154(10):1895–1902.
  12. Fathalla H, Cusimano MD, Alsharif OM, Jing R. Endoscopic transsphenoidal surgery for acromegaly improves quality of life. Can J Neurol Sci. 2014;41(6):735–741.
  13. Karppinen A, Ritvonen E, Roine R, et al. Health-related quality of life in patients treated for non-functioning pituitary adenomas during the years 2000–2010. Clin Endocrinol (Oxf). 2016;84(4):532–539. doi:10.1111/cen.12967
  14. Johnson MD, Woodburn CJ, Vance ML. Quality of life in patients with a pituitary adenoma. Pituitary. 2003;6(2):81–87.
  15. Goudakos JK, Markou KD, Georgalas C. Endoscopic versus microscopic trans-sphenoidal pituitary surgery: A systematic review and meta-analysis. Clin Otolaryngol. 2011;36(2):212–220.
  16. Rotenberg B, Tam S, Ryu WHA, Duggal N. Microscopic versus endoscopic pituitary surgery: A systematic review. Laryngoscope. 2010;120(7):1292–1297.
  17. Schaberg MR, Vijay KA, Schwartz TH, Cobb W. Microscopic versus endoscopic transnasal pituitary surgery. Curr Opin Otolaryngol Head Neck Surg. 2010;18(1):8–14.
  18. Graham SM, Iseli TA, Karnell LH, Clinger JD, Hitchon PW, Greenlee JDW. Endoscopic approach for pituitary surgery improves rhinologic outcomes. Ann Otol Rhinol Laryngol. 2009;118(9):630–635.
  19. Little AS, Kelly DF, Milligan J, et al. Comparison of sinonasal qua­lity of life and health status in patients undergoing microscopic and endoscopic transsphenoidal surgery for pituitary lesions: A prospective cohort study. J Neurosurg. 2015;123(3):799–807.
  20. McCoul ED, Patel AS, Bedrosian JC, Anand VK, Schwartz TH. Intranasal cross-sectional area and quality of life changes following endoscopic transsphenoidal skull base surgery. Int Forum Allergy Rhinol. 2015;5(12):1124–1128. doi:10.1002/alr.21602
  21. Hong SD, Nam H, Seol HJ, et al. Endoscopic binostril versus transnasal transseptal microscopic pituitary surgery: Sinonasal quality of life and olfactory function. Am J Rhinol Allergy. 2015;29(3):221–225.
  22. Wang S, Chen Y, Li J, Wei L, Wang R. Olfactory function and quality of life following microscopic endonasal transsphenoidal pituitary surgery. Medicine (Baltimore). 2015;94(4):e465. doi:10.1097/MD.0000000000000465
  23. McCoul ED, Bedrosian JC, Akselrod O, Anand VK, Schwartz TH. Preservation of multidimensional quality of life after endoscopic pituitary adenoma resection. J Neurosurg. 2015;123(3):813–820.
  24. Rudmik L, Starreveld YP, Vandergrift WA, Banglawala SM, Soler ZM. Cost-effectiveness of the endoscopic versus microscopic approach for pituitary adenoma resection. Laryngoscope. 2015;125(1):16–24.
  25. Little AS, Chapple K, Jahnke H, White WL. Comparative inpatient resource utilization for patients undergoing endoscopic or microscopic transsphenoidal surgery for pituitary lesions. J Neurosurg. 2014;121(1):84–90.
  26. Yadav Y, Sachdev S, Parihar V, Namdev H, Bhatele PR. Endoscopic endonasal trans-sphenoid surgery of pituitary adenoma. J Neurosci Rural Pract. 2012;3(3):328–337.
  27. Strychowsky J, Nayan S, Reddy K, Farrokhyar F, Sommer D. Purely endoscopic transsphenoidal surgery versus traditional micro­surgery for resection of pituitary adenomas: Systematic review. J Otolaryngol Head Neck Surg. 2011;40(2):175–185.
  28. Iwai Y, Yoshimura M, Terada A, Yamanaka K, Koshimo N. Transsphenoidal surgery for pituitary tumors from microsurgery to the endoscopic surgery: Single surgeon’s experience [in Japanese]. No Shinkei Geka. 2011;39(2):141–147.
  29. Zaidi HA, Awad AW, Bohl MA, et al. 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. 2015;16:1–9.
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