J Med Assoc Thai 2014; 97 (4):386

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Comparative Outcomes of Keyhole Supraorbital Approach (KSA) and Endonasal Endoscopic Transsphenoidal Approach (EETA) in Pituitary Surgery
Wongsirisuwan M Mail, Karnchanapandh K

Background: Currently, minimal invasive surgery (the endonasal endoscopic transsphenoidal approach-EETA or keyhole supraorbital approach-KSA) is widely accepted as the best choice for pituitary tumor removal. To the best of the authors’ knowledge, there is no study comparing the relative safety of these methods.

Objective: To evaluate safety and compare the complications resulting from pituitary surgery using EETA and KSA.

Material and Method: The retrospective review was performed between January 2003 and September 2013. One hundred thirty patients with pituitary adenomas were operated by using either EETA or KSA. The KSA was used on 92 cases, and the EETA was utilized on the other 38. Postoperative complications were analyzed using statistical methodologies to show statistical significance. The study was approved by the ethical committee of Rajavithi Hospital.

Results: After statistical analysis, KSA provided better outcome in term of “headache improvement” than EETA. For complications, EETA had higher incidences of unimproved vision and reoperation rate than KSA. The other major finding of the present study was that in the early year of the operations, there was higher incidence of complications. This could be associated with the level of skills of the surgeons.

Conclusion: KSA had better outcome in term of operative time, length of hospital stay, estimated blood loss, and headache improvement than EETA. For complications, EETA had higher incidence of unimproved vision and reoperation rate than KSA.

Keywords: Pituitary adenoma, Endoscope, Transsphenoid, Keyhole, Minimal invasive surgery

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