Centro Medico ABC, Mexico City, Mexico.
Hospital de Especialidades Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico.
Arch Med Res. 2023 Dec;54(8):102872. doi: 10.1016/j.arcmed.2023.102872. Epub 2023 Aug 24.
Transsphenoidal resection remains the standard treatment for most pituitary adenomas. However, the ideal surgical approach to safely access these lesions, either microsurgical or endoscopic, continues to be debated. Since the introduction of endoscopic transsphenoidal surgery, centers around the world have increasingly adopted this technique, experiencing a shift away from the conventional microsurgical approach. Large series reporting the efficacy and safety of endoscopic surgery have fueled a growing interest in comparing clinical outcomes between both approaches. Still, proving superiority of either surgical approach remains an elusive task due to the inherent drawbacks of surgical observational studies, as we are still faced with a growing body of evidence reporting conflicting results. Thus, a comprehensive discussion regarding the reach and limitations of both techniques becomes necessary. In this narrative review, we perform a critical appraisal of the literature and provide an expert opinion on the state-of-the-art in transsphenoidal surgery for pituitary adenomas. The advantages and limitations of each approach are assessed and compared from a technical standpoint, and their reported outcomes evaluated in the framework of this transition phase. Available evidence should be interpreted in light of individual patient characteristics and within the context of each medical center, taking into consideration the known impact that surgical expertise and multidisciplinary management hold on clinical outcomes.
经蝶窦切除术仍然是大多数垂体腺瘤的标准治疗方法。然而，对于这些病变，无论是采用显微外科手术还是内镜手术，安全进入的理想手术入路仍存在争议。自内镜经蝶窦手术引入以来，世界各地的中心越来越多地采用这种技术，传统的显微外科方法逐渐被摒弃。大量报道内镜手术疗效和安全性的大型系列研究激发了人们对两种方法临床结果进行比较的兴趣。然而，由于手术观察性研究固有的缺陷，证明任何一种手术方法的优越性仍然是一项艰巨的任务，因为我们仍面临着越来越多的证据报告相互矛盾的结果。因此，有必要对这两种技术的范围和局限性进行全面讨论。在这篇叙述性综述中，我们对文献进行了批判性评估，并就垂体腺瘤经蝶窦手术的最新技术提供了专家意见。从技术角度评估了每种方法的优缺点，并在这一过渡阶段的框架内评估了其报告的结果。应根据患者的个体特征并结合每个医疗中心的具体情况来解释现有证据，同时考虑到手术专业知识和多学科管理对临床结果的已知影响。
