| The role of outcomes data for assessing the expertise of a pituitary surgeon. | |
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MedLine Citation:
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PMID: 20453648 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE OF REVIEW: Over the past four decades, advances in surgical technique, instrumentation, and anatomical knowledge have fueled the evolution and sophistication of transsphenoidal pituitary surgery. Paralleling these advances have been major improvements in endocrinological and overall clinical outcomes in patients with pituitary adenomas and other parasellar lesions such as Rathke's cleft cysts and craniopharyngiomas. In this review, we assess the impact of neurosurgeon expertise as a determinant of outcome in pituitary surgery. RECENT FINDINGS: Published data since the 1980s indicate that remission rates, overall clinical outcomes and surgical complication rates in pituitary and parasellar surgery are related to neurosurgeon practice volume and cumulative clinical experience. More recently, pituitary surgery has been increasingly performed using an endonasal endoscopic approach. Reports over the last decade suggest when an experienced pituitary neurosurgeon performs a fully endoscopic or endoscope-assisted tumor removal; outcomes are similar if not better than when performed by a traditional microscopic transsphenoidal approach. SUMMARY: A focused clinical practice and large transsphenoidal surgical volume appear to be important outcome determinants for patients with pituitary and parasellar tumors. Strategies that may further improve patient outcomes include establishing guidelines for pituitary tumor centers of excellence and more focused residency and fellowship training in endonasal endoscopic transsphenoidal surgery. Encouraging regionalization of care to higher volume pituitary tumor centers of excellence and promoting patient education on the importance of surgical expertise may further enhance pituitary patient outcomes. |
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Authors:
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Kiarash Shahlaie; Nancy McLaughlin; Amin B Kassam; Daniel F Kelly |
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Publication Detail:
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Type: Historical Article; Journal Article; Review |
Journal Detail:
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Title: Current opinion in endocrinology, diabetes, and obesity Volume: 17 ISSN: 1752-2978 ISO Abbreviation: Curr Opin Endocrinol Diabetes Obes Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-06-30 Completed Date: 2010-09-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101308636 Medline TA: Curr Opin Endocrinol Diabetes Obes Country: England |
Other Details:
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Languages: eng Pagination: 369-76 Citation Subset: IM |
Affiliation:
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Neuroscience Institute and Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Employee Performance Appraisal
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methods* Endocrine Surgical Procedures* / history, methods, statistics & numerical data Evidence-Based Practice / statistics & numerical data History, 20th Century History, 21st Century Humans Pituitary Gland / surgery* Professional Competence* / statistics & numerical data Statistics as Topic Treatment Outcome* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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