Geographic Disparities in the Proliferation of Minimally Invasive Approaches for Sellar/Parasellar Lesions

Background The aim of this study was to understand the global trends in the proliferation of various minimal invasive approaches including the endonasal endoscopic approach (EEA) and the extended EEA. Questions about the use of the supraorbital and transorbital approach were also included. Methods We conducted an online anonymized and validated survey using a structured questionnaire on the use of EEA and EEEA, as well as periorbital approaches, in the management of sellar, suprasellar, and parasellar lesions in different parts of the world. Results A total of 261 responses were received. Of respondents, 195 (74.71%) received training in EEA, but less than half during residency. Of respondents, 108 mentioned that parasellar lesions comprised 5%–25% of the total cases encountered in the past 5 years in their practice. Only half of the respondents relied on ENT (ear, nose, and throat) colleagues for the approach. Whereas Europe and South America relied on EEA about half the time, North America and Asia used EEA only a third of the time; in Africa, EEA was hardly used at all. The proportion of respondents using EEA for >50% of giant pituitary adenoma, olfactory groove meningiomas, craniopharyngiomas, chordoma, tuberculum sella meningiomas, and malignant skull base tumors was 34.5%, 3.4%, 13%, 16%, 7%, and 10%, respectively. EEEA, the supraorbital approach, and the transorbital approach were used by 50.6%, 54.4%, and 34.5%, respectively. EEEA was used predominantly by those having an experience of 11–20 years or >30 years after residency (P = 0.018) and those from North America (64.1%). Conclusions Our survey highlights the various geographic and demographic trends in the use of the EEA for sellar, suprasellar, and parasellar diseases. Although EEA training was present in almost all countries, the approach was not used as frequently as would have been expected for giant adenomas, craniopharyngiomas, and chordomas. After 20 years of education about the technique and indications of the endoscopic endonasal approach, through countless courses and publications, the use of EEA is still lagging, particularly in developing countries.