{"id":"71ce6db5-c976-41e9-bbbc-5161e0bdbd0a","slug":"cost-outcomes-of-pituitary-adenoma-resection-the-use-of-a-hybrid-microscopic-endoscopic-surgery","title":"Cost outcomes of pituitary adenoma resection: The use of a hybrid microscopic/endoscopic surgery","authors":["Kyril L. Cole","Robert C. Rennert","Cameron A. Rawanduzy","Michael G. Brandel","Matthew C. Findlay","Mohammed A. Azab","Michael Karsy","William T. Couldwell"],"abstract":"Background: The pathogenesis, surgical techniques, and outcomes of pituitary adenomas (PAs) remain variable. We compared our surgical techniques and perioperative/long-term PA outcomes to highlight the hybrid microscopic/endoscopic technique used to optimize efficiency, cost savings, and outcomes in PA surgery. Methods: Consecutive PA cases performed from January 2017 through February 2020 were evaluated retrospectively. A cost analysis by surgical approach was performed combining this primarily microscopic series, with endoscopic visual assist, and a separate cohort of consecutive intra-institutional endoscopic-only PA resections. Results: Among 160 patients included in the main cohort analysis (mean age 51.5 ± 16.2; 89 females [55.6%]), a microscope was used in 81.9% of cases, with endoscopic assistance (hybrid) or the endoscope alone used in the remaining cases. Surgical complications occurred in 5 cases (3.1%): postoperative diabetes insipidus in 3 (1.9%), electrolyte imbalances requiring additional drug treatment in 3 (1.9%), and syndrome of inappropriate anti-diuretic hormone release in 2 (1.2%). Thirty-three additional patients were included in the cost analysis (193 total). Patients treated with a microscopic-only approach had the lowest operating time (mean normalized operating room costs 1.00 [95% confidence interval (CI) 0.95, 1.04], P P = 0.008), with hybrid and endoscopic-only approaches having higher comparable operating times and costs. Conclusion: PA surgery using a primarily microscopic approach (with endoscopic assistance for complex cases) remains a safe, efficient, and cost-effective strategy and results in shorter anesthesia time to reduce patient complications while maintaining excellent endocrinologic outcomes.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/71ce6db5-c976-41e9-bbbc-5161e0bdbd0a/featured/hero-1781558872895.png","publishDate":"2025-02-14T00:00:00.000Z","doi":"10.25259/SNI_1043_2024","categories":["Neuro-oncology","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2025/02/13388/SNI-16-50.pdf"}