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Background: Endoscopic endonasal transsphenoidal surgery (EETS) is a common treatment for patients with pituitary adenomas (PAs). A disadvantage of endoscopic surgery has been the lack of stereoscopic vision and depth perception. Recent developments offer high-definition 3-dimensional (3D-HD) visualization with a higher resolution and better image quality compared with 3D standard endoscopy (3D-SD). In this study, we compared treatment results of surgically treated patients with PAs using 3 different visualization systems: 2-dimensional (2D)-HD, 3D-SD, and 3D-HD., Methods: Data from patients with primary PAs that were surgically treated between December 2008 and December 2017 were analyzed. Preoperative and postoperative tumor size and location, perioperative complications, and ophthalmologic, endocrine, and clinical outcomes were compared., Results: A total of 170 patients underwent endoscopic resection of a primary PA (54 patients with 2D-HD, 75 with 3D-SD, and 41 with 3D-HD). Preoperatively, no statistical differences were found for tumor size, extension, and endocrine and ophthalmologic status. Tumor resection was not statistically different among the 3 groups. Complete resection was performed in 33 patients (80%) in the 3D-HD group, 54 patients (72%) in the 3D-SD group, and 39 patients (72%) in the 2D-HD group. The number of complications was not different across the groups (P = 0.436). Ophthalmologic outcomes did not differ based on EETS technique. The rate of new pituitary insufficiency was slightly lower in the 3D-HD group compared with 2D-HD and 3D-SD groups (4.8%, 16.6%, and 12%, respectively; P = 0.290)., Conclusions: Although the resection rate was higher in the 3D-HD group, and subjective advantages of the 3D-HD endoscopes were noted, there were no significant differences in terms of gross total resection or new hormonal deficits among the 3 groups., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Muscle injury is inevitable during surgical exposure of the spine. This study compared paraspinal muscle injury after 4 surgical techniques: microdiscectomy (MD), percutaneous endoscopic lumbar discectomy (PELD), percutaneous endoscopic interlaminar discectomy (PEID), unilateral biportal endoscopic discectomy (UBED)., Methods: Eighty patients who underwent MD, PELD, PEID, and UBED were prospectively observed. Creatine phosphokinase (CPK) and C-reactive protein levels were measured on admission and postoperative days 1, 3, 5, and 7. CPK ratio was calculated as CPK on postoperative day 1/CPK on admission. Cross-sectional area of the high-intensity lesion in the paraspinal muscle was measured on magnetic resonance imaging after surgery. Operative time and hospital stay duration were also examined. Clinical outcome was evaluated using the visual analog scale for back and leg pain., Results: MD group had the highest CPK levels on postoperative days 1 and 3 and CPK ratio (P < 0.01, P = 0.02, P = 0.04). Serial C-reactive protein levels were highest in MD group (P < 0.01). PELD and PEID groups had lower C-reactive protein level on postoperative day 1 than UBED group. MD group had largest cross-sectional area (P < 0.01). Cross-sectional area was larger in UBED group than in PELD and PEID groups (P < 0.01). Operative time and hospital stay duration were shortest in PELD group (P < 0.01, P < 0.01). MD group had significantly higher visual analog scale scores for back pain on postoperative days 1 and 3 than the other groups (P < 0.01, P = 0.02)., Conclusions: PELD is the least invasive spinal surgical technique., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To determine the predictive factors for endocrinological remission of patients with growth hormone (GH)-secreting pituitary adenomas., Methods: In 47 patients with GH-secreting pituitary adenomas who underwent endoscopic endonasal transsphenoidal surgery with intraoperative GH measurements from 2002 to 2011, the relationship between the intraoperative GH levels and postoperative remission was analyzed, and 2 items that predicted remission (GH half-life obtained 30 minutes or less after removal and a minimum surgical GH level less than 2.5 ng/mL) were determined. In addition, 2 surgical observations (endoscopic confirmation of no tumor remnants and pathologic confirmation of the absence of tumor remnants in the bordering tissue) were also considered. Positive items resulted in one point, and scores ranged from 0 to 4. For 27 patients who underwent surgery from 2012 onwards, this scoring system was applied by 3 independent operators, and the remission rates and predictive values were estimated., Results: Twenty-six of the 47 (55.3%) patients achieved remission. The remission rates were significantly different for different scores. In the 27 patients treated from 2012 onward, repeat residual tumor examinations were performed if the GH score did not reach 2 at the end of the removal. Nine patients had final scores of 3 or 4. All of these patients achieved remission. In 16 patients with final scores of 2 or less, only 2 with Knosp grades of 0 and 1 achieved remission., Conclusions: Our scoring system, which incorporated GH measurements and surgical observations, predicted postoperative remission. Complete tumor removal was critical to achieve intraoperative scores over 3., (Copyright © 2017. Published by Elsevier Inc.)

Objective: We describe the setup and use of different 3-dimensional (3-D) recording modalities (macroscopic, endoscopic, and microsurgical) in our laboratory and operating room and discuss their implications in neurosurgical research and didactics. We also highlight the utility of 3-D images in providing depth perception and discernment of structures compared with 2-dimensional (2-D) images., Methods: The technical details for equipment and laboratory setup for obtaining 3-D images were described. The stereoscopic pair of images was obtained using a modified "shoot-shift-shoot" method and later converged to a 3-D image. For microsurgical procedures, 3-D images were obtained using an integrated 3-D video camera coupled to the surgical microscope in both the laboratory and the operating room. Illustrative cases were used to compare 2-D and 3-D images., Results: Side-by-side comparisons of 2-D and 3-D images obtained using all modalities revealed that 3-D imaging was superior to 2-D imaging in providing depth perception and structure identification., Conclusions: This is the first report in the literature of the methodology for obtaining 3-D endoscopic endonasal images using the 2-D endoscope. The use of 3-D imaging is invaluable in neurosurgical research and education, as it provides immediate depth perception (third dimension), allowing efficient understanding of key spatial relationships. Integration of 3-D imaging in neurosurgical residency programs may increase learning efficiency and shorten learning curves. However, use of 3-D imaging should not replace direct hands-on practice., (Copyright © 2016 Elsevier Inc. All rights reserved.)