Pituitary Surgery in Germany - Findings from the European Pituitary Adenoma Surgery Survey.

Background Surgery is, next to medical and radiation therapy, the mainstay therapy for pituitary adenomas. While scientific consensus regarding the key aspects of pituitary surgery exists among neurosurgeons, procedures are not standardized and might vary significantly between hospitals and surgeons. Objective Providing an overview of how neurosurgical departments in Germany manage pituitary surgery. Methods Responses from the European Pituitary Adenoma Surgery Survey (EU-PASS) were analyzed. The survey contained 60 questions regarding demographics, training, surgical aspects, endocrinological aspects and patient management. Results 60 neurosurgical centers from Germany responded to the survey. 35.3% (n=18) of centers exclusively use the microscopic and 31.1% (n=14) the endoscopic technique exclusively, all other centers (n=28) use both approaches. 20% (n=12) of responding centers perform less than 10 transsphenoidal pituitary surgeries per year and 1,7% (n=1) more than 100 operations. The number of transcranial pituitary operations is significantly smaller 53,3% of centers performing only 0-2 per year, 35% performing 3-5 and only one center (1,7%) performing more than 15 transcranial operations per year. In 8 centers (13,3%) surgeries are always performed together with an ENT surgeon, in 29 center (48,4%) ENT surgeons are never involved. . In most centers (n=54, 90%) intraoperative MRI is not available. Image guidance (with preoperative CT and/or MRI data) is used by 91.7% of respondents (n=55). 42 centers (72.4%) prescribe hydrocortisone after pituitary surgery routinely. 75% (n=45) have pituitary board meetings with endocrinologists, radiologists and radiosurgeons. 52 (86.7%) respondents perform the first follow-up scan by MRI 3-4 months after surgery. Conclusions The data showed differences as well as similarities between centers and could help to discuss standardization of methods as well as the formation of networks and certification to improve patient care.