Akbari Hamideh, Malek Mojtaba, Ghorbani Mohammad, Ramak Hashemi Seyed Mahmoud, Khamseh Mohammad Ebrahim, Zare Mehrjardi Ali, Emami Zahra, Ebrahim Valojerdi Ameneh
a Endocrine Research Center , Institute of Endocrinology and Metabolism, Iran University of Medical Sciences , Tehran , Iran.
b Research Center for Prevention of Cardiovascular Disease , Institute of Endocrinology and Metabolism, Iran University of Medical Sciences , Tehran , Iran.
Br J Neurosurg. 2018 Apr;32(2):206-209. doi: 10.1080/02688697.2018.1429569. Epub 2018 Feb 8.
To compare clinical outcomes of large pituitary adenomas (≥3 cm in maximum diameter), operated on by Endoscopic Transsphenoidal Surgery (ETS), versus Microscopic Transsphenoidal Surgery (MTS).
Medical records and MRI Scans of patients with a diagnosis of pituitary adenoma for whom transphenoidal surgery was done were reviewed. Complete pre and post-operative data were available for 121 patients. Thirty five patients had large pituitary adenoma and were enrolled in this study. ETS was done in 16 patients, and 19 underwent MTS. All patients were followed for at least six months. Clinical and imaging characteristics were reported in details. Post-operative clinical outcomes were defined as clinical outcomes persisted 6 months after surgery.
The average tumor size was 36.3 ± 4.4 mm in ETS group, and 34.0 ± 4.6 mm in MTS group, (p = .46). Six months after surgery, tumor size was 4.6 ± 6.6 mm in ETS and 17.7 ± 12.2 mm in MTS group, (p = .002). Gross total resection (GTR) was observed in the 81.2% of the patient in the ETS group. In the MTS group, GTR was observed in 15.8%. Post-operative clinical outcomes including new onset hypopituitarism, visual impairment, and permanent diabetes insipidus (DI) were comparable between the two groups.
ETS is superior to MTS in treatment of large pituitary adenomas with comparable post-operative complications.
比较经鼻内镜经蝶窦手术（ETS）与显微镜下经蝶窦手术（MTS）治疗大型垂体腺瘤（最大直径≥3 cm）的临床疗效。
回顾性分析经蝶窦手术治疗的垂体腺瘤患者的病历及MRI扫描资料。121例患者有完整的术前和术后数据。35例患者为大型垂体腺瘤并纳入本研究。16例行ETS手术，19例行MTS手术。所有患者均随访至少6个月。详细报告临床和影像学特征。术后临床疗效定义为术后6个月持续存在的临床疗效。
ETS组平均肿瘤大小为36.3±4.4 mm，MTS组为34.0±4.6 mm，（p = 0.46）。术后6个月，ETS组肿瘤大小为4.6±6.6 mm，MTS组为17.7±12.2 mm，（p = 0.002）。ETS组81.2%的患者实现了肿瘤全切除（GTR）。MTS组的GTR率为15.8%。两组术后临床疗效包括新发垂体功能减退、视力损害和永久性尿崩症（DI）具有可比性。
在治疗大型垂体腺瘤方面，ETS优于MTS，且术后并发症相当。
