Explore Neuro-endoscopic Endonasal Transsphenoidal Approach To Pituitary Tumors

Objective:To explore the characteristics and clinical efficacy of neuro-endoscopic Endonasal transsphenoidal approach to pituitary adenomas by comparing with traditional microscopic transsphenoidal pituitary adenoma operation.To summarize the advantages and disadvantages of the surgical method and some related factors and the treatment of postoperative complications,that aims to improve the surgical skills.Methods:The16cases clinical data of neuro-endoscopic transsphenoidal approach to pituitary adenomas and29cases by traditional microscopic method in the Second Hospital of Shanxi Medical University from September2009to September2011were analyzed retrospectively. All the patients were under general anesthesia and all the pituitary adenomas were confirmed by postoperative pathology.All the clinical manifestation, various hormone levels, imaging manifestations, the situation of operations, the consumed time of operations, treatment of postoperative complications, the postoperative length of staying in hospital and the postoperative follow-up situation were recorded and analysed. The two groups of clinical data were compared from the above aspects.Results:1、16cases of pituitary adenomas surgery by neuro-endoscopic transsphenoidal approach were successfully completed.13cases were resected totally (81.25%),2cases were resected subtotally (12.5%),1case was resected partly (6%).transient diabetes insipidus appeared in3cases(18.75%), cerebrospinal fluid rhinorrhea appeared in1case(6.25%).8cases lower than preoperative hormone level in11patients with the pituitary hormone abnormalities3days after surgery.5cases improved significantly and2cases improved mild improvement in7patients with visual field and vision disorders6months after surgery.The pituitary hormones in nine cases return to normal. The mean postoperative hospital stay are4.31days,the shortest of3days,the longest8days.2、In29patients with traditional microscopic transsphenoidal pituitary adenoma operation,total tumor resection in22cases (81.25%), the subtotal tumor resection in4cases (13.79%), the part tumor resection in3case (10.34%), transient diabetes insipidus in8cases (27.59%), cerebrospinal fluid rhinorrhea in2case (6.89%). After3-day review of the pituitary hormone abnormalities in20patients,14patients hormone decline more than50%comparing with the preoperative. In13patients with visual field and vision disorders,9cases improved significantly,4cases improved slightly,1case had no change. The mean postoperative hospital stay are6.6days,the shortest of4days,the longest9days.Conclusions:Comparing with traditional microscopic surgical method, neuro-endoscopic Endonasal transsphenoidal approach to pituitary adenomas has the following characteristics:more simple operation under direct vision,clearer and broader operative field, easier identification and removal of the tumors and peritumoral structure,fewer complications, shorter postoperative hospital stay.It is a minimally invasive and safe surgical method.