Differential independent impact of the intraoperative use of navigation and angled endoscopes on the surgical outcome of endonasal endoscopy for pituitary tumors: a prospective study
Differential independent impact of the intraoperative use of navigation and angled endoscopes on the surgical outcome of endonasal endoscopy for pituitary tumors: a prospective study
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DOI：
10.1007/s10143-020-01416-x
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发表时间：
2020-10-22
影响因子：
2.8
通讯作者：
Gupta, Sunil K.
中科院分区：
文献类型：
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作者：
Patil, Ninad R.;Dhandapani, Sivashanmugam;Gupta, Sunil K.
尽管导航内窥镜和倾斜内窥镜在鼻内窥镜检查中广泛流行，但关于其对切除或再治疗范围的疗效的研究却很少。这可能是第一项评估这些辅助药物对垂体肿瘤的独立影响的研究。对接受鼻内镜检查的垂体瘤患者的人口统计学、临床放射学特征、术中使用导航和倾斜内窥镜进行前瞻性研究，并与大体全切除（GTR）、近全切除（NTR）、内分泌缓解和再治疗相关。进行了相关的统计分析。在总共 139 名患者中，导航内窥镜和倾斜内窥镜可分别用于 54 名和 48 名患者，具体取决于其可用性，而不是根据情况进行选择。与其使用相关的基线特征没有显着差异。 51.9% 的外科医生认为使用导航时能立即受益。在切除即将结束时使用倾斜内窥镜可以帮助 62.5% 的患者进一步切除肿瘤。总体而言，导航的使用导致显着较高的 GTR（80.8% vs. 59.7%，OR 2.83，p = 0.01）、更高的 GTR/NTR（86.5% vs. 70.8%，OR 2.65，p = 0.04）和较低的再治疗率（7.7% vs. 20.8%，OR 3.15，p = 0.05）比其他人。在侵犯海绵窦的功能性肿瘤中，导航显着提高了缓解率（69.2% vs. 0%，p = 0.03）。仅在无功能腺瘤中，使用倾斜内窥镜可显着提高 GTR/NTR（91.7% 对比 70.6%，p = 0.04），并降低再治疗率（0% 对比 15.7%，p = 0.05）。在多变量分析中，神经导航的使用与 GTR 和再治疗率均显着相关（p 值分别为 0.005 和 0.02），与其他混杂因素无关。术中选择性使用导航对整体切除和再治疗的范围具有显着的独立影响。虽然导航可以使侵犯海绵窦的功能性肿瘤获得更好的缓解率，但斜角内窥镜检查与无功能性肿瘤的手术结果具有显着相关性。
Despite widespread popularity of navigation and angled endoscopes in endonasal endoscopy, there are hardly few studies on their efficacy with the extent of resection or retreatment. This is probably the first study to assess the independent impact of these adjuncts among pituitary tumors. Patients with pituitary tumors undergoing endonasal endoscopy were prospectively studied for their demographics, clinico-radiological features, intraoperative use of navigation, and angled endoscopes, in relation to gross total resection (GTR), near total resection (NTR), endocrine remission, and retreatment. Pertinent statistical analyses were performed. Among a total of 139 patients, navigation and angled endoscopes could be used in 54 and 48 patients, respectively, depending upon their availability rather than chosen as per the case. There was no significant difference in baseline characteristics in relation to their use. The surgeon's perception of immediate benefit was noted among 51.9% while using navigation. The use of angled endoscopes towards the end of resection could help with additional tumor removal in 62.5% of patients. Overall, the use of navigation resulted in a significantly higher GTR (80.8% vs. 59.7%, OR 2.83,p = 0.01), a higher GTR/NTR (86.5% vs. 70.8%, OR 2.65,p = 0.04), and a lower retreatment rate (7.7% vs. 20.8%, OR 3.15,p = 0.05) than the others. In functioning tumors with cavernous sinus invasion, navigation had significantly increased remission rates (69.2% vs. 0%,p = 0.03). The use of angled endoscopes yielded a significantly higher GTR/NTR (91.7% vs. 70.6%,p = 0.04) and a lower retreatment rate (0% vs. 15.7%,p = 0.05) among only non-functioning adenomas. In multivariate analyses, the use of neuronavigation had a significant association with both GTR and retreatment rates (pvalues 0.005 and 0.02 respectively), independent of other confounding factors. The elective intraoperative use of navigation has a significant independent impact on the extent of resection and retreatment overall. While navigation results in better remission rates among functioning tumors with cavernous sinus invasion, angled endoscopy has a significant association with surgical outcomes in non-functioning tumors.