Exoskop versus Mikroskop in der transsphenoidalen Chirurgie bei Sellar-/Suprasellarmeningeom: eine retrospektive, monozentrische Studie an 58 Patienten

Meningiomas situated within the sellar region are commonly managed through transsphenoidal approaches, involving microscopic and endoscopic techniques. Recently, our institution has introduced a novel strategy using 4K 3D orbital camera system (Orbeye, Olympus) for exoscopic transsphenoidal procedures. To date, no study has yet provided validation for the efficacy of this method in resecting tuberculum sellae meningioma (TSM).

In this study, a total of n=58 histologically confirmed TSM, who underwent transsphenoidal surgery between 2013 and 2022 were included. Assessed parameters included surgical duration, duration of hospitalization, postoperative complications (SIADH, diabetes insipidus, CSF leak, visual impairment) and rate of recurrence to compare the outcomes of exoscopic transsphenoidal surgery (ExTS) with microscopic transsphenoidal surgery (MTS).

We identified a total of n=58 patients with confirmed TSM, that underwent transsphenoidal surgery at our institution. Out of these, MTS was performed in 71.9% (n=41) and ExTS in 28.1% (n=16). Both groups showed comparable output characteristics including gender distribution, initial tumor volume and occurrence of preoperative deficits. Mean age at diagnosis was 55.26+17.97 years. A notable female predominance was observed (Female to male ratio 4.2:1). ExTS depicted a significantly shorter surgical duration (116.0+43.29 vs 147.3+63.28 minutes, p=0.038). Postoperative complications, including diabetes insipidus, SIADH, CSF leak, hypopituitarism and visual impairment did not significantly differ between MTS and ExTS cohorts. MTS and ExTS showed similar recurrence rates (36.6% vs. 23.5%, p=0.3775).

Overall, both ExTS and MTS exhibited comparable outcomes in terms of postoperative complications and recurrence rates. Nonetheless, this study revealed that MTS was associated with a significantly longer surgical duration.