A Role for Centers of Excellence in Transsphenoidal Surgery

doi:10.1016/j.wneu.2012.11.019

World Neurosurgery

Volume 80, Issues 3–4, September–October 2013, Pages 270-271

https://doi.org/10.1016/j.wneu.2012.11.019 Get rights and content

References (3)

P.R. Bates et al.
Wide variation in surgical outcomes for acromegaly in the UK
Clin Endocrinol
(2008)

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Cited by (13)

Pituitary Tumors Centers of Excellence
2020, Endocrinology and Metabolism Clinics of North America
Citation Excerpt :
According to recent guideline recommendations, pituitary surgery remains a cornerstone for the treatment of pituitary adenoma and the most effective procedure for acromegaly, Cushing disease, thyroid-stimulating hormone (TSH)–secreting adenomas, resistant prolactinomas, and nonfunctioning pituitary adenomas causing mass symptoms, pituitary apoplexy, and rare cases of pituitary carcinomas.25–27 Although the end points for pituitary surgery include tumor removal with preservation of the normal pituitary and adjacent structures, the definition of excellence for individual pituitary surgeons is much more complex.19,20 Neurosurgeons devoted to pituitary tumors must have a deep knowledge of sellar anatomy and physiology and the principles of endocrine evaluation; from an education and training perspective, a residency program in neurosurgery with continuous exchanges with neuroendocrinologists is mandatory.
Management of Nonfunctioning Recurrent Pituitary Adenomas
2019, Neurosurgery Clinics of North America
Citation Excerpt :
Interestingly a GTR of 73% was achieved for patients previously operated on by the microscopic approach, compared with 35% for the endoscopic approach. Our impression, which has been shared by other highly experienced groups, is that inadequate exposure and reduced viewing angles provided by the microscopic approach may have been the primary determinant of subtotal resection during the initial transsphenoidal surgery.3,6,25 Preoperative and intraoperative considerations for revision surgery differ from those of primary transsphenoidal surgery.
Volume–Cost Relationship in Neurosurgery: Analysis of 12,129,029 Admissions from the National Inpatient Sample
2019, World Neurosurgery
Citation Excerpt :
There is an increasing body of evidence documenting positive relationships between hospital and surgeon volumes and outcomes of surgical procedures.3-5 As a result, several studies have debated the merits of centralizing neurosurgical operations to high-volume centers of excellence to achieve improved outcomes.6-8 However, the role of high-volume hospitals in creating a value-based health care system cannot be understood without an assessment of whether these hospitals are also cost-efficient.
Several studies have documented improved outcomes at high-volume hospitals for neurosurgery. However, the relationship between neurosurgical volume and costs remains poorly understood.
Using neurosurgery-specific Diagnosis-Related Groups (DRG) codes, we identified adult neurosurgical admissions in the National Inpatient Sample from 2002 to 2014. We stratified hospitals by annual neurosurgical volume as high-volume (top 20%) or low-volume centers (bottom 80%). We performed survey-weighted regression analyses to examine the impact of case volume on inpatient costs.
A total of 12,129,029 admissions underwent neurosurgery from 2002 to 2014, with 59.6% treated at high-volume hospitals. Patients at high-volume centers were more likely to have private insurance, higher risk of mortality scores, and higher DRG weight procedures than those at low-volume centers (P < 0.001). High-volume hospital admissions were on average 9% or $1791 more expensive than their low-volume counterparts. However, after adjustment for patient, hospital, and case-mix differences, high-volume hospitals were 4.3% less expensive than low-volume centers ($21,825 vs. $22,924; P < 0.01). The southern United States, which had the biggest volume, showed the highest savings (6.5%).
High-volume hospitals provide more cost-effective neurosurgical care. Centralization of care at high-volume neurosurgical institutions may be a promising strategy to delivering higher-value care, achieving better outcomes at lower costs.
Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-Analysis of Radiologic Criteria and Comparison of Endoscopic and Microscopic Surgery
2016, World Neurosurgery
Citation Excerpt :
This improvement with experience has never been reported objectively before. These findings mimic reports of safety and efficacy of endonasal endoscopic surgery for pituitary tumors in general and call for specialized centers of excellence.45 The endonasal endoscopic transcavernous approaches are often considered highly risky because of reports of carotid injuries, blood loss, and CN injury.
Despite the substantial impact of cavernous sinus invasion (CSI) in pituitary adenoma surgery, its radiologic determination has been inconsistent and variable, and the role of endonasal endoscopic surgery has been unclear. This is a systematic review and pooled data meta-analysis of the literature to ascertain the best radiologic criteria for CSI and verify the efficacy and safety of an endonasal endoscopic approach.
We searched the MEDLINE database (1993–2015) to identify studies on radiologic criteria for CSI and endonasal surgery. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the studies included were reviewed for CSI criteria, gross total resection (GTR), endocrine remission, cranial nerve deficits, carotid injury, and other complications.
The prevalence of CSI was 43% radiographically compared with 18% intraoperatively (P < 0.001). The radiologic criteria of inferolateral venous compartment obliteration and Knosp 3–4 had the highest correlation with intraoperative CSI and the lowest correlation with GTR. Microscopy had significantly overestimated intraoperative CSI compared with endoscopy (P < 0.001) for each Knosp grade. Endoscopy had significantly higher GTR than did microscopy particularly for Knosp 3–4 (47% vs. 21%; P = 0.001). Carotid injury and cranial nerve deficits occurred in 0.9% and 5%, respectively, with endoscopy. Among endoscopic series with CSI, GTR% showed significant correlation with number of patients in the series (P ≤ 0.01) but no correlation with complications, indicating the relative safety of endonasal endoscopy in experienced hands for removing tumors with CSI.
Knosp 3–4 remains the best objective indicator of CSI. Microscopy tends to overestimate intraoperative CSI compared with endoscopy. Among pituitary adenomas with CSI, GTR in endoscopic series is higher than microscopy and improves with experience without significant additional morbidity.
Clinical presentation and surgical outcomes of very large and giant pituitary adenomas: 80 cases in a cohort study of 306 patients
2023, Research Square
Effect of pituitary adenoma consistency on surgical outcomes in patients undergoing endonasal endoscopic transsphenoidal surgery
2022, Endocrine

View all citing articles on Scopus

: Commentary on: Endoscopic Endonasal Transsphenoidal Removal of Recurrent and Regrowing Pituitary Adenomas: Experience on a 59-Patient Series by Cavallo et al. pp. 342-350.

: Theodore H. Schwartz, M.D., Professor, Department of Neurosurgery, Weill Cornell Medical Center

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PerspectivesA Role for Centers of Excellence in Transsphenoidal Surgery

Wide variation in surgical outcomes for acromegaly in the UK

Clin Endocrinol

Perspectives
A Role for Centers of Excellence in Transsphenoidal Surgery