Clinic of Neurosurgery, Saarland University Hospital, Homburg, Germany -
Clinic of Neurosurgery, Saarland University Hospital, Homburg, Germany.
J Neurosurg Sci. 2020 Dec;64(6):515-524. doi: 10.23736/S0390-5616.18.04242-X. Epub 2018 Mar 28.
The endonasal endoscopic approach is still currently under investigation for sellar tumor surgery: a higher resection rate is to be expected and complications should be minimized. The authors report their surgical results of endonasal endoscopic neurosurgery with special focus on postoperative hypopituitarism in comparison to microsurgical procedures.
Sixty patients received endoscopic endonasal transsphenoidal procedures for sellar pathologies. All patients were followed up prospectively. A second group of 60 patients received microsurgical transsphenoidal procedures for sellar pathologies in our neurosurgical department before and were prospectively followed until now. Special attention was paid to hormonal insufficiency and medical substitution.
Sixty-eight percent (41 of 60) of the patients who underwent microsurgical procedures showed a new persisting pituitary insufficiency postoperatively. Twenty-three patients (55.5%) were substituted with thyroxine, hydrocortisone and sexual hormones and one patient (2.5%) also with ADH cause of global pituitary insufficiency. In 19 cases without any hormonal insufficiency after microsurgical procedures nine patients (47%) showed remnant tumor in follow-up MRI. The patients who underwent endoscopic procedures for pituitary adenomas revealed significant (P<0.01) less new persistent hormonal insufficiency with 13% of all cases (8/60). Five patients (62.5%) were substituted with thyroxine and hydrocortisone, two patients (25%) substituted with thyroxine, hydrocortisone and sexual hormones and one patient also with ADH because of global pituitary insufficiency. Thereby, in follow-up MRI and hormonal testing, radical tumor resection was detected in 92% in the endoscopic group.
This study seems to indicate that a better intraoperative identification and preservation of pituitary gland is possible in endoscopic transsphenoidal surgery with consecutive lower postoperative hypopituitarism rate.
经鼻内镜入路在鞍区肿瘤手术中仍在研究中：预计切除率更高，并发症应最小化。作者报告了他们经鼻内镜神经外科手术的结果，特别关注与微创手术相比术后垂体功能减退症。
60 例患者因鞍区病变接受经鼻内镜经蝶窦手术。所有患者均前瞻性随访。我们神经外科部门之前有 60 例接受经蝶窦显微镜手术治疗鞍区病变的患者，作为第二组，前瞻性随访至现在。特别注意激素不足和药物替代。
68%（41/60 例）接受显微镜手术的患者术后出现新的持续垂体功能减退症。23 例（55.5%）患者接受甲状腺素、氢化可的松和性激素替代治疗，1 例（2.5%）患者因全垂体功能减退症而接受 ADH 替代治疗。在没有任何激素不足的 19 例显微镜手术后患者中，9 例（47%）在随访 MRI 中显示残留肿瘤。经内镜治疗垂体腺瘤的患者新出现持续性激素不足的比例明显较低（所有患者的 13%，8/60）。5 例（62.5%）患者接受甲状腺素和氢化可的松替代治疗，2 例（25%）患者接受甲状腺素、氢化可的松和性激素替代治疗，1 例患者因全垂体功能减退症而接受 ADH 替代治疗。因此，在内镜组的随访 MRI 和激素检测中，92%的患者发现肿瘤完全切除。
本研究似乎表明，经鼻内镜经蝶窦手术中可能更好地识别和保护垂体，从而导致术后垂体功能减退症发生率降低。
