Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN.
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2021 Aug;96(8):2043-2057. doi: 10.1016/j.mayocp.2021.03.028. Epub 2021 Jun 10.
To understand the transition from microscopic surgery (MS) to endoscopic surgery (ES) on the pituitary across the United States, we assessed a single institution practicing both procedures to discern advantages and disadvantages for each.
Retrospective institutional chart review of 534 patients in a large practice over a 6-year period (January 1, 2014, to December 31, 2019) comparing a single MS neurosurgeon with a single ES neurosurgeon operating on the same days.
In this series, 14% (n=75) of patients had a prior operation, there were no carotid artery injuries, the overall risk for a postoperative infection was 0.4% (n=2), and risk for a postoperative cerebrospinal fluid leak requiring treatment was 2.0% (n=11). Mean ± SD hospital stay was 1.3±0.04 days; readmission for any reason within 30 days occurred in 3.4% (n=18) of patients. The mean volumetric resection for MS was 86.9%±1.7% and for ES was 91.7%±1.3% (P=.03). There was a higher rate of notable events (P=.015) with MS, but MS had 16% lower cost and operative times were 48 minutes shorter than for ES (83±7 vs 131±6 minutes). The ES required substantially fewer postoperative secondary treatments such as radiation therapy (P=.003).
Pituitary surgery is a very safe and effective procedure regardless of technique. The MS has shorter operative times and overall lower cost. The ES results in increased volumetric resection and fewer secondary treatments. Both techniques can be valuable to a large practice, and understanding these niches is important when selecting optimal approaches to pituitary surgery for a given patient.
了解美国垂体瘤从显微镜手术（MS）向内镜手术（ES）的转变，我们评估了一家同时开展这两种手术的机构，以辨别每种手术的优势和劣势。
对一家大型医疗机构在 6 年期间（2014 年 1 月 1 日至 2019 年 12 月 31 日）的 534 例患者的回顾性机构图表进行评估，比较了一位从事 MS 神经外科的医生和一位从事 ES 神经外科的医生在同一天进行的手术。
在本系列中，14%（n=75）的患者有过既往手术史，无颈动脉损伤，术后感染的总体风险为 0.4%（n=2），需要治疗的术后脑脊液漏的风险为 2.0%（n=11）。平均±SD 住院时间为 1.3±0.04 天；30 天内因任何原因再次入院的患者占 3.4%（n=18）。MS 的平均体积切除率为 86.9%±1.7%，ES 为 91.7%±1.3%（P=.03）。MS 的显著事件发生率较高（P=.015），但 MS 的成本降低 16%，手术时间比 ES 缩短 48 分钟（83±7 分钟 vs 131±6 分钟）。ES 术后需要的二次治疗，如放疗，明显减少（P=.003）。
无论采用何种技术，垂体瘤手术都是一种非常安全有效的手术。MS 的手术时间更短，总费用更低。ES 可增加肿瘤切除体积，并减少二次治疗。这两种技术都对大型医疗机构有价值，了解这些差异对于为特定患者选择最佳的垂体瘤手术方法非常重要。
