The Effect of Surgical Approach on Outcomes following Pituitary Tumor Resection

Abstract

Objectives:

The goals of pituitary tumor resection include normalizing endocrine function, relieving mass effect, and minimizing risk of recurrence. This study sought to determine the effect of surgical approach “transsphenoidal or transfrontal” on outcomes.

Methods:

Retrospective review of the 2008-2011 Nationwide Inpatient Sample for patients undergoing pituitary lesion resection. Hospital and patient demographics and outcomes were compared between transfrontal and transsphenoidal surgical approaches.

Results:

A total of 8543 admissions for resection of pituitary lesions met our inclusion criteria. Most (>90%) were treated transsphenoidally. The transfrontal approach was most frequent in the young (<35 years) and in the South. Transfrontal resection led to significant increases in mortality and complications including central diabetes insipidus, iatrogenic panhypopituitarism, and intracerebral hemorrhage. Multivariate analysis found transsphenoidal resection reduced hospital costs and length of stay by over 50%; low-volume hospitals increased cost and length of stay. There was an increased rate of transfrontal approaches at low-volume centers.

Conclusions:

Multiple factors influence outcomes of pituitary tumor resection. Case specifics, including tumor location and size, influence approach and lead to a selection bias that cannot be controlled for in the present study. The prevalence of transfrontal resections at low-volume centers may indicate that surgeon familiarity rather than contraindication to transsphenoidal surgery serves as the basis for surgical planning.