{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:09:42Z","timestamp":1783775382943,"version":"3.55.0"},"reference-count":50,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2013,3]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Endoscopy as a visual aid (endoscope assisted) or as the sole visual method (fully endoscopic) is increasingly used in pituitary adenoma surgery. Authors of this study assessed the value of endoscopic visualization for finding and removing residual adenoma after initial microscopic removal.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Consecutive patients who underwent endoscope-assisted microsurgical removal of pituitary adenoma were included in this study. The utility of the endoscope in finding and removing residual adenoma not visualized by the microscope was noted intraoperatively. After maximal tumor removal under microscopic visualization, surgeries were categorized as to whether additional tumor was removed via endoscopy. Tumor removal and remission rates were also noted. Patients undergoing fully endoscopic tumor removal during this same period were excluded from the study.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Over 3 years, 140 patients (41% women, mean age 50 years) underwent endoscope-assisted adenoma removal of 30 endocrine-active microadenomas and 110 macroadenomas (39 endocrine-active, 71 endocrine-inactive); 16% (23\/140) of patients had prior surgery. After initial microscopic removal, endoscopy revealed residual tumor in 40% (56\/140) of cases and the additional tumor was removed in 36% (50 cases) of these cases. Endoscopy facilitated additional tumor removal in 54% (36\/67) of the adenomas measuring \u2265 2 cm in diameter and in 19% (14\/73) of the adenomas smaller than 2 cm in diameter (p &lt; 0.0001); additional tumor removal was achieved in 20% (6\/30) of the microadenomas. Residual tumor was typically removed from the suprasellar extension and folds of the collapsed diaphragma sellae or along or within the medial cavernous sinus. Overall, 91% of endocrine-inactive tumors were gross-totally or near-totally removed, and 70% of endocrine-active adenomas had early remission.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>After microscope-based tumor removal, endoscopic visualization led to additional adenoma removal in over one-third of patients. The panoramic visualization of the endoscope appears to facilitate more complete tumor removal than is possible with the microscope alone. These findings further emphasize the utility of endoscopic visualization in pituitary adenoma surgery. Longer follow-ups and additional case series are needed to determine if endoscopic adenomectomy translates into higher long-term remission rates.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.11.jns112020","type":"journal-article","created":{"date-parts":[[2012,12,14]],"date-time":"2012-12-14T15:01:20Z","timestamp":1355497280000},"page":"613-620","source":"Crossref","is-referenced-by-count":71,"title":["Value of endoscopy for maximizing tumor removal in endonasal transsphenoidal pituitary adenoma surgery"],"prefix":"10.3171","volume":"118","author":[{"given":"Nancy","family":"McLaughlin","sequence":"first","affiliation":[{"name":"Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy A.","family":"Eisenberg","sequence":"additional","affiliation":[{"name":"Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pejman","family":"Cohan","sequence":"additional","affiliation":[{"name":"Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlene B.","family":"Chaloner","sequence":"additional","affiliation":[{"name":"Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel F.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns112020","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"398","DOI":"10.3171\/jns.1977.46.3.0398","article-title":"Neurosurgical endoscopy using the side-viewing telescope","volume":"46","author":"Apuzzo","year":"1977"},{"key":"b2-jns112020","series-title":"J Clin Endocrinol Metab","first-page":"63","article-title":"Outcomes of therapy for Cushing's disease due to adrenocorticotropin-secreting pituitary macroadenomas","volume":"83","author":"Blevins","year":"1998"},{"key":"b3-jns112020","series-title":"Neurosurgery","first-page":"1133","article-title":"Intraoperative magnetic resonance imaging to determine the extent of resection of pituitary macroadenomas during transsphenoidal microsurgery","volume":"49","author":"Bohinski","year":"2001"},{"key":"b4-jns112020","series-title":"Skull Base Surg","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1055\/s-2008-1058157","article-title":"Endoscopic endonasal transsphenoidal approach: an additional reason in support of surgery in the management of pituitary lesions","volume":"9","author":"Cappabianca","year":"1999"},{"key":"b5-jns112020","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1007\/s11102-008-0087-5","article-title":"Endoscopic pituitary surgery","volume":"11","author":"Cappabianca","year":"2008"},{"key":"b6-jns112020","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"99","DOI":"10.3171\/2009.4.JNS09182","article-title":"Endoscopic endonasal transsphenoidal approach for pituitary adenomas invading the cavernous sinus. 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