Chatzidakis Stefanos, Anagiotos Andreas, Fotakopoulos George, Georgakopoulou Vasiliki Epameinondas, Tarantinos Kyriakos, Papalexis Petros, Aravantinou-Fatorou Aikaterini, Sklapani Pagona, Mathioudakis Nikolaos, Trakas Nikolaos, Spandidos Demetrios A, Faropoulos Konstantinos
Division of Neurocritical Care, Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA.
Department of Otorhinolaryngology, Nicosia General Hospital, 2029 Nicosia, Cyprus.
Med Int (Lond). 2023 Jan 4;3(1):6. doi: 10.3892/mi.2023.66. eCollection 2023 Jan-Feb.
For a number of years, the microscopic sublabial transsphenoidal (MST) approach was considered the gold standard approach for the treatment of pituitary macroadenomas. Nonetheless, the trend is currently shifting away from the MST to the endonasal transsphenoidal (EET) approach. The aim of the present study was to examine the post-operative outcomes of the first cases operated by a team of two young surgeons using the EET approach, compared to the cases operated by a team of senior neurosurgeons with extensive experience with the MST approach. For this purpose, data from 20 patients with pituitary adenoma were retrospectively collected from a single center who were operated by the current and previous pituitary-surgery teams. All the patients who presented with visual impairment in the EET group recovered completely (5/5), whereas 4/5 patients in the MST group recovered completely. Primary hospitalization duration was similar in the two groups. Gross tumor removal was achieved in 90% of patients in the EET group compared to 70% of the patients operated with the MST technique. Intraoperative complications were comparable between the two groups. The first cases operated at the center with EET proved to have better visual outcomes and a larger tumor removal when compared to the MST group. A greater experience in using this technique could exponentiate the differences in the post-operative outcomes, such as a lower hospitalization duration and fewer intraoperative complications. On the whole, colleagues who have yet to familiarize themselves with the EET approach could perhaps be encouraged to learn to utilize this technique, provided that their center is staffed with an experienced team of skull base surgeons to intervene in an intraoperative complication.
多年来，显微镜下经唇下经蝶窦（MST）入路一直被视为治疗垂体大腺瘤的金标准入路。尽管如此，目前的趋势正从MST入路转向鼻内镜下经蝶窦（EET）入路。本研究的目的是比较由两位年轻外科医生团队采用EET入路进行手术的首批病例与由一组具有丰富MST入路经验的资深神经外科医生团队进行手术的病例的术后结果。为此，从一个单一中心回顾性收集了20例垂体腺瘤患者的数据，这些患者分别由现任和前任垂体手术团队进行手术。EET组所有出现视力障碍的患者均完全恢复（5/5），而MST组5例患者中有4例完全恢复。两组的初次住院时间相似。EET组90%的患者实现了肿瘤全切，而采用MST技术手术的患者这一比例为70%。两组术中并发症相当。与MST组相比，该中心采用EET入路进行手术的首批病例显示出更好的视力结果和更大的肿瘤切除率。更多地使用该技术可能会扩大术后结果的差异，如缩短住院时间和减少术中并发症。总体而言，对于尚未熟悉EET入路的同行，或许可以鼓励他们学习使用该技术，前提是他们的中心配备有经验丰富的颅底外科医生团队以应对术中并发症。
