Institute of Neuroscience, Geisinger Commonwealth School of Medicine, Danville, PA, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Eur J Surg Oncol. 2021 Jun;47(6):1352-1356. doi: 10.1016/j.ejso.2021.02.004. Epub 2021 Feb 14.
Pituitary surgery has shifted in recent years from microscopic surgery(MS) to endoscopic endonasal surgery (EES). However, the comparative long-term outcome of these surgical approaches, including the need for subsequent re-operation has never been reported. We present our experience in a high-volume referral center experienced in both endoscopic and microscopic approaches to compare the need for re-operation after initial resection of non-functioning pituitary macroadenomas using these surgical approaches.
684 patients (398 with NF adenomas) underwent trans-sphenoidal pituitary surgery in our institution between 2006 and 2017. Complete follow-up (mean 72 months, minimum two years) was available in 87 newly diagnosed patients with non-functioning pituitary macroadenomas (NFPMA; 48-microscopic and 39-endoscopic). The EES approach has been used almost exclusively since 2012. The need for repeat operation for tumor resection during the follow-up period was assessed as the primary end-point of the study. Extracted data included various demographic and clinical parameters, radiographic findings as well as the extent of resection (EOR).
The EOR was similar for both groups, with a trend towards better EOR in the EES group. The rate of surgical complications was also similar for both groups. There was a strong trend towards lower need for re-operation in the EES group compared to the MS group (12.8% vs. 29.2%, p = 0.056). In a multivariate analysis, only EOR and Knosp grade were independently associated with the need for re-operation surgery.
Our data indicate that EES in NFPMA tends to be associated with a lower need for re-operation compared to the MS approach, with a similar rate of EOR and complications.
近年来，垂体手术已从显微镜手术（MS）转变为内镜经鼻蝶入路手术（EES）。然而，这些手术方法的长期比较结果，包括后续再次手术的需求，从未有报道过。我们在一家内镜和显微镜技术经验丰富的高容量转诊中心介绍我们的经验，比较使用这些手术方法切除无功能垂体大腺瘤后再次手术的需求。
2006 年至 2017 年，我院 684 例患者（398 例为 NF 腺瘤患者）接受了经蝶窦垂体手术。87 例新诊断的无功能垂体大腺瘤（NFPMA；48 例显微镜和 39 例内镜）患者获得完整随访（平均随访 72 个月，最短 2 年）。自 2012 年以来，EES 方法几乎全部用于治疗。在随访期间，评估因肿瘤切除而再次手术的需求作为本研究的主要终点。提取的数据包括各种人口统计学和临床参数、影像学发现以及切除程度（EOR）。
两组的 EOR 相似，EES 组的 EOR 趋势更好。两组的手术并发症发生率也相似。EES 组再次手术的需求明显低于 MS 组（12.8%比 29.2%，p=0.056）。多变量分析显示，只有 EOR 和 Knosp 分级与再次手术需求独立相关。
我们的数据表明，与 MS 方法相比，EES 治疗 NFPMA 时再次手术的需求较低，EOR 和并发症发生率相似。
