Dehdashti Amir R, Ganna Ahmed, Karabatsou Konstantina, Gentili Fred
Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Neurosurgery. 2008 May;62(5):1006-15; discussion 1015-7. doi: 10.1227/01.neu.0000325862.83961.12.
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.
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.
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.
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.
本研究旨在报告一系列连续接受单纯内镜下经鼻垂体手术患者的结果，并评估该手术的疗效和安全性。
我们回顾了200例连续接受单纯内镜经蝶窦切除垂体腺瘤病变的患者。评估患者的临床结局，包括缓解率、肿瘤切除程度及并发症，并与既往显微镜手术系列进行比较。
有111例无功能性腺瘤，34例生长激素分泌型、27例促肾上腺皮质激素分泌型、25例催乳素分泌型及3例促甲状腺激素分泌型腺瘤。鞍上或鞍旁扩展且未累及海绵窦的肿瘤全切率为96%，鞍内病变为98%。中位随访期19个月后，功能性腺瘤患者的缓解结果为：生长激素分泌型腺瘤71%，促肾上腺皮质激素分泌型腺瘤81%，催乳素分泌型腺瘤88%，末次随访时无复发。这与采用标准显微手术方法系列报道的类似结果相比（生长激素分泌型腺瘤67%；促肾上腺皮质激素分泌型腺瘤78%；催乳素分泌型腺瘤62%）。对于先前采用显微镜手术治疗过的复发性或残留无功能性腺瘤，内镜手术在大多数情况下显示初次手术时暴露范围更有限，肿瘤常切除不完全。并发症发生率较低，平均住院时间缩短。
单纯内镜治疗垂体腺瘤是传统显微镜手术的一种安全有效的替代方法。虽然我们的结果显示肿瘤切除率极佳，功能性肿瘤缓解率相当，且并发症发生率极低，但需要更长随访期的进一步研究来证实该方法是否应被视为垂体手术的首选方法。
