Abstract：
OBJECTIVE: Endoscopic endonasal transsphenoidal surgery (EETS) is a common treatment for sellar and suprasellar tumors. While endoscopic training has improved over the years and formal fellowship training is now broadly available, the operative nuances of EETS conjectures the existence a learning curve as a neurosurgeon matures with experience. We aim to evaluate operative outcomes of 3 different experience levels of neurosurgeons over time at a single institution.
METHODS: We reviewed all adult patients who underwent EETS at Loyola University Medical Center by 3 early career, 1 midcareer, and 2 late career neurosurgeons from 2007 to 2023. A comparative assessment of patient demographics, tumor features, and surgical outcomes was done using metrics such as length of surgery, rates of gross total resection (GTR) and symptomatic improvement, new postoperative steroid dependence, and development of diabetes insipidus (DI). T-tests and χ2 were used to statistically evaluate the study cohorts.
RESULTS: A total of 297 patients underwent EETS. One hundred three (35%) were operated on by an early career, 122 (41%) by a mid-career, and 72 (24%) by a late career neurosurgeon. Late-career surgeons had shorter operation times (144 vs. 180 minutes with early and mid-career, P = 0.029) and increased GTR rates (P = 0.008). There were no significant differences between the symptomatic improvement rates amongst various surgeon experience levels. Although not statistically significant, early-career neurosurgeons had lower rates of new postoperative steroid dependence. Patients of early career surgeons experienced significantly less DI (15% vs. 40%, P = 0.004).
CONCLUSIONS: Late-career neurosurgeons had shorter operation lengths, achieved higher rates of GTR, and their patients experienced significantly higher rates of DI. Overall outcomes remained stable throughout the course of 16 years between different surgeon experience levels.
METHODS: We reviewed all adult patients who underwent EETS at Loyola University Medical Center by 3 early career, 1 midcareer, and 2 late career neurosurgeons from 2007 to 2023. A comparative assessment of patient demographics, tumor features, and surgical outcomes was done using metrics such as length of surgery, rates of gross total resection (GTR) and symptomatic improvement, new postoperative steroid dependence, and development of diabetes insipidus (DI). T-tests and χ2 were used to statistically evaluate the study cohorts.
RESULTS: A total of 297 patients underwent EETS. One hundred three (35%) were operated on by an early career, 122 (41%) by a mid-career, and 72 (24%) by a late career neurosurgeon. Late-career surgeons had shorter operation times (144 vs. 180 minutes with early and mid-career, P = 0.029) and increased GTR rates (P = 0.008). There were no significant differences between the symptomatic improvement rates amongst various surgeon experience levels. Although not statistically significant, early-career neurosurgeons had lower rates of new postoperative steroid dependence. Patients of early career surgeons experienced significantly less DI (15% vs. 40%, P = 0.004).
CONCLUSIONS: Late-career neurosurgeons had shorter operation lengths, achieved higher rates of GTR, and their patients experienced significantly higher rates of DI. Overall outcomes remained stable throughout the course of 16 years between different surgeon experience levels.
摘要：
背景：鼻内镜经蝶入路手术（EETS）是鞍区和鞍上肿瘤的常用治疗方法。虽然内窥镜培训多年来有所改善，正式的研究金培训现已广泛提供，EETS的手术细微差别推测，随着神经外科医生的经验成熟，存在学习曲线。我们旨在评估单个机构中三种不同经验水平的神经外科医生随时间的手术结果。
方法：我们回顾了所有在洛约拉大学医学中心接受EETS的成年患者，一个职业生涯中期，和2007年至2023年的两名晚期神经外科医生。对患者人口统计学的比较评估，肿瘤特征,手术结果是用手术长度等指标来完成的，总切除率(GTR)和症状改善率(SI)，术后新的类固醇依赖，和尿崩症（DI）的发展。使用T检验和卡方检验对研究队列进行统计学评估。
结果：共有297名患者接受了EETS。一百零三（35％）是由早期职业操作的，122（41%）职业生涯中期，和72（24％）的职业生涯晚期神经外科医生。职业生涯后期的外科医生手术时间较短（144vs.职业生涯早期和中期180分钟，p=0.029）和增加的GTR率（p=0.008）。各种外科医生经验水平之间的SI率之间没有显着差异。虽然没有统计学意义，职业早期神经外科医生术后新的类固醇依赖性发生率较低.早期职业外科医生的患者经历了明显更少的DI(15%vs40%，p=0.004)。
结论：后期神经外科医生的手术时间较短，实现了更高的GTR率，他们的患者经历了明显更高的DI率。在16年的过程中，不同外科医生经验水平之间的总体结果保持稳定。
方法：我们回顾了所有在洛约拉大学医学中心接受EETS的成年患者，一个职业生涯中期，和2007年至2023年的两名晚期神经外科医生。对患者人口统计学的比较评估，肿瘤特征,手术结果是用手术长度等指标来完成的，总切除率(GTR)和症状改善率(SI)，术后新的类固醇依赖，和尿崩症（DI）的发展。使用T检验和卡方检验对研究队列进行统计学评估。
结果：共有297名患者接受了EETS。一百零三（35％）是由早期职业操作的，122（41%）职业生涯中期，和72（24％）的职业生涯晚期神经外科医生。职业生涯后期的外科医生手术时间较短（144vs.职业生涯早期和中期180分钟，p=0.029）和增加的GTR率（p=0.008）。各种外科医生经验水平之间的SI率之间没有显着差异。虽然没有统计学意义，职业早期神经外科医生术后新的类固醇依赖性发生率较低.早期职业外科医生的患者经历了明显更少的DI(15%vs40%，p=0.004)。
结论：后期神经外科医生的手术时间较短，实现了更高的GTR率，他们的患者经历了明显更高的DI率。在16年的过程中，不同外科医生经验水平之间的总体结果保持稳定。
