Arnaout Mohamed M, Makia Mansour A, Bessar Ahmed A, Elnashar Ismail, ElSheikh Magdy O
Department of Neurosurgery, Zagazig University, Zagazig, Sharqia, Egypt.
Department of Radiodiagnosis, Zagazig University, Zagazig, Sharqia, Egypt.
Surg Neurol Int. 2025 May 23;16:192. doi: 10.25259/SNI_726_2024. eCollection 2025.
The endoscopic endonasal transsphenoidal approach has become standard for the management of pituitary adenomas. This approach has been shown to facilitate early recovery and discharge from the hospital. The early recovery protocol has many advantages for both patients and the healthcare system in terms of patient satisfaction and cost-effectiveness.
Forty-seven patients with pituitary adenomas who underwent a trans-nasal endoscopic approach at our institution, operated by one neurosurgeon and one ENT surgeon, were retrospectively studied. Enhanced recovery protocols entailed preoperative, intraoperative, and postoperative protocols. The standard care included 1 day postoperative intensive care unit admission plus 1 or 2 days in the ward. Patient satisfaction was measured in terms of resolution of chief complaint, and a questionnaire survey was conducted at discharge and the 3-month follow-up.
There was a significant decrease in the length of hospital stay with a mean of 2.7 days (standard deviation = 0.74). Patient satisfaction was better at the 3-month follow-up than in the early postoperative period. Most of our patients improved in terms of biochemical cure (18 out of 25 functioning adenomas [72%]) and experienced resolution of the chief complaint. The death occurred in only one patient due to pulmonary embolism.
Our study supports the benefits of early recovery protocols for endoscopic endonasal surgery for pituitary adenoma resection. The procedure is both safe and efficacious and improves overall patient satisfaction. Cerebrospinal fluid leaks remain a challenge but may improve with the use of fat, fascia lata, or middle turbinate flaps for large defects.
鼻内镜经蝶窦入路已成为垂体腺瘤治疗的标准方法。该入路已被证明有助于患者早期康复并出院。早期康复方案在患者满意度和成本效益方面对患者和医疗系统都有诸多益处。
对我院47例经鼻内镜手术治疗垂体腺瘤的患者进行回顾性研究，手术由一名神经外科医生和一名耳鼻喉科医生操作。强化康复方案包括术前、术中和术后方案。标准护理包括术后1天入住重症监护病房，再加1或2天在病房。通过主诉缓解情况来衡量患者满意度，并在出院时和3个月随访时进行问卷调查。
住院时间显著缩短，平均为2.7天（标准差 = 0.74）。3个月随访时患者满意度高于术后早期。我们的大多数患者在生化治愈方面有所改善（25例功能性腺瘤中有18例[72%]），且主诉得到缓解。仅1例患者因肺栓塞死亡。
我们的研究支持垂体腺瘤切除鼻内镜手术早期康复方案的益处。该手术安全有效，可提高患者总体满意度。脑脊液漏仍是一个挑战，但使用脂肪、阔筋膜或中鼻甲瓣修复大的缺损可能会有所改善。
