Pituitary Adenoma Surgery Survey: European Neurosurgical Centers

Introduction: This study aims to determine current practice in pituitary surgery across European neurosurgical centers.

Methods: A list of eligible departments performing pituitary adenoma surgery was created. The survey consisted of 58 questions.

Results: Data from 254 departments from 34 countries were obtained. In 108 centers (42.5%), < 30 pituitary adenomas were operated per year. Twenty (7.9%) centers performed >100 adenoma surgeries per year. Number of neurosurgeons performing endonasal surgeries: 1 in 24.9% of centers, 2 in 49.8% of centers. All residents assisted endonasal surgeries in 126 centers (49.8%). In 28 centers (21.1%), all residents performed endonasal surgery under supervision during residency. In 141 centers (56.8%). the endoscopic approach was used in >90% of the surgeries. Regular pituitary board (either weekly or once a month) meetings were held in 147 centers (56.3%). Non-functioning adenomas represent >70% of pituitary caseload in 149 centers (58.7%). Most centers surgically treat 1-5 hormone-secreting adenomas per year. GH-secreting microadenomas are often treated pharmacologically first. Debulking surgery for an invasive GH-secreting adenoma in which hormonal remission is not a realistic goal of the surgery and the patient has no visual deficit surgery is always or mostly indicated in 156 centers (62.9%). Routine postoperative hydrocortisone replacement therapy is administered in 147 centers (58.6%).

Conclusion : In our survey, most centers perform less than 100 surgeries for pituitary adenomas. In most centers, pituitary surgeries are performed by one or two neurosurgeons. Residents have a limited exposure to this type of surgery, and the formal pituitary board is not a standard. Non-functioning adenomas make up most of surgically treated adenomas, few hormone-secreting adenomas are treated per year. This survey may serve as plea for neurosurgical care centralization.