Related Experiment Video
Updated: Oct 26, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Outcomes in Pediatric Transsphenoidal Pituitary Surgery Stratified by the Use of Image Guidance: An Analysis of the
Benjamin D Lovin1, Justin Yu1, Jonathan S Choi1
1Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States.
Insights
Image guidance in pediatric transsphenoidal pituitary resection (TSPR) is increasingly used. This technology is cost-effective, reduces hospital stays, and may lower complication rates like diabetes insipidus (DI).
Area of Science:
- Neurosurgery
- Pediatric Endocrinology
- Medical Technology Assessment
Background:
- Transsphenoidal pituitary resection (TSPR) is a critical procedure for pediatric pituitary pathologies.
- Image guidance technology (IGT) has advanced surgical precision in various fields.
- The adoption and impact of IGT in pediatric TSPR require thorough evaluation.
Purpose of the Study:
- To assess the utilization trends of IGT in pediatric TSPR.
- To analyze complication rates, length of stay (LOS), and total costs associated with IGT in pediatric TSPR.
- To determine the impact of IGT on specific postoperative complications and resource utilization.
Main Methods:
- Analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) from 1997-2016.
- Inclusion of 1,297 pediatric TSPR cases, extracting data on demographics, IGT use, LOS, cost, and complications (panhypopituitarism, DI, CSF rhinorrhea, CN palsies).
- Multivariate logistic regression and generalized linear models to evaluate the effect of IGT on outcomes and costs.
Main Results:
- IGT utilization in pediatric TSPR significantly increased after 2006.
- IGT use was associated with a lower risk of postoperative diabetes insipidus (DI) (p=0.05).
- IGT led to a shorter LOS by 2.84 days (p<0.001) without increasing total costs (p=0.663).
Conclusions:
- IGT adoption in pediatric TSPR has rapidly grown, demonstrating significant benefits.
- IGT is a cost-effective tool that reduces hospital LOS in pediatric TSPR.
- The use of IGT may contribute to decreased complication rates, specifically DI, in pediatric TSPR.
Abstract:
Background To evaluate the utilization of image guidance technology for pediatric transsphenoidal pituitary resection (TSPR) and analyze the complication rates, length of stay (LOS), and total cost for such surgeries as function of time and utilization of image guidance. Methods The Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) was queried for all cases of TSPR between 1997 and 2016. Factors extracted included patient demographics, use of image guidance, LOS, total cost, and complications, including panhypopituitarism, diabetes insipidus (DI), cerebrospinal fluid (CSF) rhinorrhea, and cranial nerve (CN) III, IV, and VI palsies. Multivariate logistic regression was utilized to determine the odds ratio of developing panhypopituitarism, DI, CSF rhinorrhea, and CN palsies for image-guided versus nonimage-guided cases. A generalized linear model was used to determine the effect of image guidance on inflation-adjusted total cost and LOS. Results A total of 1,297 cases of TSPR were included in the KID over this time period. The majority were female, Caucasian, and older than 15 years. Utilization of image guidance has rapidly increased since 2006. Complication rates were comparable, but when controlling for other factors, the use of image guidance showed a lower risk of postoperative DI ( p = 0.05). The use of image guidance also resulted in a shorter LOS by 2.84 days ( p < 0.001) with no associated increase in total cost ( p = 0.663). Conclusion The use of imaging guidance for pediatric TSPR has precipitously increased in recent years, as it is cost-effective, decreases LOS, and may lead to lower complication rates, such as DI.
