Pure endoscopic endonasal approach for pituitary adenomas: Early surgical results in 200 patients and comparison with previous microsurgical series
Pure endoscopic endonasal approach for pituitary adenomas: Early surgical results in 200 patients and comparison with previous microsurgical series
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DOI：
10.1227/01.neu.0000325862.83961.12
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发表时间：
2008-05-01
期刊：
影响因子：
4.8
通讯作者：
Gentili, Fred
中科院分区：
文献类型：
--
作者：
Dehdashti, Amir R.;Garma, Ahmed;Gentili, Fred
目的：本研究的目的是报道一系列使用纯内窥镜下经鼻入路进行垂体手术的患者的结果，并评价这种手术的有效性和安全性。结果：无功能腺瘤111例，生长激素34例，促肾上腺皮质激素27例，催乳素25例，促甲状腺激素3例。累及鞍上或鞍旁且无海绵窦侵犯的肿瘤大体全切除率为96%，鞍内肿瘤全切率为98%。经过19个月的中位随访期，功能性腺瘤患者的生长激素分泌缓解率为71%，促肾上腺皮质激素缓解率为81%，催乳素腺瘤缓解率为88%，在最后一次随访时没有复发。这与使用标准显微外科方法的系列报道的结果类似(生长激素分泌腺瘤，67%；促肾上腺皮质激素分泌腺瘤，78%；和催乳素分泌腺瘤，62%)。对于以前使用显微镜方法治疗的复发或残留的无功能腺瘤的内窥镜手术，大多数病例在最初的手术中暴露得更有限，往往伴随着肿瘤的不完全切除。并发症发生率低，平均住院时间减少。结论：单纯内窥镜手术治疗垂体腺瘤是一种安全有效的替代传统显微手术的方法。尽管我们的结果显示肿瘤切除率很高，功能性肿瘤的缓解率与之相当，并且并发症发生率非常低，但需要更多的研究和更长的随访期来证实这种方法是否应该被认为是垂体手术的首选手术方式。
OBJECTIVE: The aim of this study was to report the results of a consecutive series of patients undergoing pituitary surgery using a pure endoscopic endonasal approach and to evaluate the efficacy and safety of this procedure.PATIENTS AND METHODS: We reviewed 200 consecutive patients with pituitary adenoma who underwent purely endoscopic transsphenoidal resection of their lesions. The patients' clinical outcomes, including remission rates, degrees of tumor removal, and complications, were evaluated and compared with a previous microscopic series.RESULTS: There were 111 nonfunctioning adenomas and 34 growth hormone-secreting, 27 adrenocorticotropin hormone-secreting, 25 prolactin-secreting, and 3 thyroid-stimulating hormone-secreting adenomas. The degree of gross total removal for tumors with suprasellar or parasellar extension and without cavernous sinus involvement was 96% and for intrasellar lesions was 98%. After a median follow-up period of 19 months, the remission results for patients with functioning adenomas were 71% for growth hormone-secreting, 81% for adrenocorticotropin hormone-secreting, and 88% for prolactin-secreting adenomas, with no recurrence at the time of the last follow-up. This compares with similar results reported from series using a standard microsurgical approach (growth hormone-secreting adenomas, 67%; adrenocorticotropin hormone-secreting adenomas, 78%; and prolactin-secreting adenomas, 62%). Endoscopic surgery for recurrent or residual nonfunctioning adenomas that had been previously treated using a microscopic approach revealed in the majority of cases a more limited exposure during the initial surgery, frequently with incomplete tumor removal. Complication rates have been low, and the average length of hospital stay was reduced.CONCLUSION: A purely endoscopic approach for pituitary adenoma treatment is a safe and effective alternative to the traditional microscopic procedure. Although our results reveal excellent tumor-removal rates, comparable remission rates in functioning tumors, and a very low rate of complications, additional studies with longer follow-up periods are required to confirm whether this approach should be considered the preferred procedure for pituitary surgery.