Wang Anthony C, Shah Ashish H, Sidani Charif, Gaynor Brandon G, Dockrell Simon, Burks S Shelby, Sargi Zoukaa B, Casiano Roy R, Morcos Jacques J
Department of Neurosurgery, University of Miami, Miami, Florida, United States.
Department of Radiology, University of Miami, Miami, Florida, United States.
J Neurol Surg B Skull Base. 2018 Dec;79(6):538-544. doi: 10.1055/s-0038-1639618. Epub 2018 Apr 12.
Assessment of the extent of resection after surgical resection of pituitary adenomas is most commonly reported in terms of the presence or absence of residual tumor. A quantitative comparison of volumetric resection between endonasal endoscopy (EE) and microsurgery (MS) has rarely been done. A retrospective analysis was performed on a consecutive series of 154 patients with pituitary adenomas treated by the same surgeon at a single institution. We employed volumetric analysis pre- and postoperatively on two cohorts of pituitary adenoma patients treated through MS ( = 37) versus EE approach ( = 117). Volumetric analysis revealed a higher incidence of complete resection (64.4 vs. 56.8%) and mean volume reduction in the EE cohort (92.7 vs. 88.4%), although not significant. Recurrence rates were significantly lower in the EE group (7.7% vs 24.3%, = 0.015). Subgroup analysis identified that patients with preoperative tumor volumes >1 mL were less likely to recur through EE (7.8 vs. MS: 29.6%; = 0.0063). A higher incidence of complete resection was also noted in patients with favorable Knosp grades (0-1) (EE: 87.8 vs. MS: 63.2%; = 0.036). Postoperative complication rates were not significantly different between both techniques. Both microscopy and endoscopy are well-tolerated, effective approaches in the treatment of pituitary adenomas. Our series demonstrated that EE may be superior to MS in preventing tumor recurrence and achieving a complete resection in certain subsets of patients. EE provides a slight advantage in tumor control outcomes that may justify the paradigm shift to pure endoscopy at our center.
垂体腺瘤手术切除后切除范围的评估，最常见的报告方式是有无残留肿瘤。鼻内镜手术（EE）和显微手术（MS）之间的体积切除定量比较很少进行。
对同一机构中由同一位外科医生治疗的154例垂体腺瘤患者进行了回顾性分析。我们对通过MS（n = 37）和EE方法（n = 117）治疗的两组垂体腺瘤患者进行了术前和术后的体积分析。
体积分析显示，EE组的完全切除率更高（64.4%对56.8%），平均体积缩小率也更高（92.7%对88.4%），尽管差异不显著。EE组的复发率显著更低（7.7%对24.3%，P = 0.015）。亚组分析发现，术前肿瘤体积>1 mL的患者通过EE复发的可能性较小（7.8%对MS组：29.6%；P = 0.0063）。Knosp分级良好（0 - 1级）的患者中，完全切除率也更高（EE组：87.8%对MS组：63.2%；P = 0.036）。两种技术的术后并发症发生率无显著差异。
显微镜检查和内镜检查在垂体腺瘤治疗中都是耐受性良好的有效方法。我们的系列研究表明，在预防肿瘤复发和某些患者亚组中实现完全切除方面，EE可能优于MS。EE在肿瘤控制结果方面具有轻微优势，这可能证明我们中心向纯内镜手术模式转变的合理性。
