Aiyer R G, Upreti Garima
1Department of ENT and Head Neck Surgery, Baroda Medical College and SSG Hospital, Vadodara, Gujarat India.
Department of ENT and Head Neck Surgery, Government Medical College Silvassa, Shri Vinoba Bhave Civil Hospital, Silvassa, Dadra and Nagar Haveli India.
Indian J Otolaryngol Head Neck Surg. 2020 Mar;72(1):36-43. doi: 10.1007/s12070-019-01725-8. Epub 2019 Aug 19.
The surgical approach for hypophysectomy has undergone sweeping revolution in the past three decades. With the advent of endoscopes, better instrumentation, better illumination and viewing cameras, endoscopic endo-nasal trans-sphenoidal approach to sella has now largely become the norm. The aim of this study is to present our experience, analysing the surgical outcomes of this approach in patients with pituitary adenoma, pertaining to entirety of tumor removal, alleviation of symptoms and rate of complications. This prospective study was conducted at our tertiary health care centre from June 2012 to June 2015. A total of 14 patients, meeting the inclusion criteria, underwent endoscopic trans-sphenoidal hypophysectomy for pituitary adenoma. Age of presentation ranged from 19 to 73 years (mean 43.6 years). 9 patients were female and 5 were male. The most common presenting symptom was headache, followed by visual disturbances. Amongst those with hormonal imbalance, most common were prolactinomas and growth hormone secreting adenomas. Preoperative MRI brain showed macroadenomas in all 14 patients. 7 (50%) patients had suprasellar extension, while 5 (36%) patients had intracavernous extension too. CT paranasal sinuses provided the roadmap for surgery by identifying anatomical variations. Alleviation of headache occurred in all cases. Normalization of altered hormonal profile was seen in all cases. 83.3% of our patients with visual field defects on perimetry showed improvement post-surgery. Recidivism was directly related to the size and extent of adenoma. Transient diabetes insipidus was seen in 4 (28%) cases. Persistent diabetes insipidus occurred in 1 (7%) patient. CSF leak was seen in 2 (14%) patients, 1 (7%) patient developed postoperative meningitis. Most common nasal complication was excessive crusting. There was no incidence of any vascular complications, focal neurological deficit or hypopituitarism in our study. The pure endoscopic approach is a safe, efficacious, and minimally invasive technique for the removal of pituitary adenomas. The results have been encouraging in our prospective study. However, the importance of learning curve in endoscopic skull base surgery and use of a multi-disciplinary collaboration cannot be overemphasized.
在过去三十年中，垂体切除术的手术方法经历了彻底的变革。随着内窥镜、更好的器械、更好的照明和观察摄像头的出现，内窥镜经鼻蝶窦入路至蝶鞍目前已在很大程度上成为标准术式。本研究的目的是介绍我们的经验，分析该手术方法在垂体腺瘤患者中的手术结果，包括肿瘤的完全切除、症状缓解和并发症发生率。这项前瞻性研究于2012年6月至2015年6月在我们的三级医疗保健中心进行。共有14例符合纳入标准的患者接受了内窥镜经蝶窦垂体腺瘤切除术。患者年龄在19岁至73岁之间（平均43.6岁）。9例为女性，5例为男性。最常见的症状是头痛，其次是视力障碍。在激素失衡的患者中，最常见的是泌乳素瘤和生长激素分泌腺瘤。术前脑部MRI显示所有14例患者均为大腺瘤。7例（50%）患者有鞍上扩展，5例（36%）患者同时有海绵窦内扩展。鼻窦CT通过识别解剖变异为手术提供了路线图。所有病例的头痛均得到缓解。所有病例中激素水平改变均恢复正常。我们视野缺损的患者中83.3%在手术后视野得到改善。复发与腺瘤的大小和范围直接相关。4例（28%）出现短暂性尿崩症。1例（7%）患者发生持续性尿崩症。2例（14%）患者出现脑脊液漏，1例（7%）患者发生术后脑膜炎。最常见的鼻腔并发症是结痂过多。我们的研究中未发生任何血管并发症、局灶性神经功能缺损或垂体功能减退。单纯内窥镜手术方法是一种安全、有效且微创的垂体腺瘤切除技术。我们的前瞻性研究结果令人鼓舞。然而，在内窥镜颅底手术中学习曲线的重要性以及多学科协作的应用再怎么强调都不为过。
