Comparative Outcomes of Keyhole Supraorbital
Approach (KSA) and Endonasal Endoscopic
Transsphenoidal Approach (EETA) in Pituitary Surgery
Methee Wongsirisuwan MD*,
Krissanee Karnchanapandh MD*
Affiliation :
* Division of Neurosurgery, Department of Surgery, Rajavithi Hospital, College of Medicine,
Rangsit University, Bangkok, Thailand
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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