Clinical Comparison Of Transsphenoidal Neuroendoscopy And Microscopy For Resection Of Pituitary Adenomas

Objective:Compare the efficacy and safety of endoscopic and microscopic surgery in the treatment of pituitary adenomas, to analyze the advantages and disadvantages between them, gain the experience of mini-invasive surgical treatment of pituitary adenomas.Method:Retrospectively review of 555 patients who were diagnosed as pituitary adenomas and underwent transsphenoidal surgery with microscopic (n=279)and endoscopic technique (n=276) at Qilu Hospital from January 2011 to January 2014. Compare and analysis of the operating time, length of postoperative hospital stay, rat tumor total-resection rates, postoperative complications and endocrinologic cure rates between the two groups. The operating time and length of post-operative hospital stay also noted among every years in endoscopic surgery group respectively. Respectively, to analyze 36 cases of the recurrent or regrowing pituitary adenomas repeated resection by the two manners, tumor total-resection rates, endocrinologic cure rates, length of postoperative hospital stay and postoperative complications also were compared.Result:The total resection rate of microscopic group and endoscopic group were 95.34%(266/276) and 97.10%(268/276) respectively, but with no significant differences(P=0.277).The mortality rate were 0.72% in the microscopic group, while which were 0% in the endoscopic group, the difference also was no significant (P=0.159). Although significant differences were found in the total time the surgeon was operating by microscopy and endoscopy(100.85 minutes vs.132.77minutes;P< 0.01), the length of operating time lesser by years. The endoscopic group had a statistically significant reduction in length of postoperative stay (5.97 vs. 7.73days).The study showed the comparable complication rates between the two groups for both nasal symptoms and incidence of diabetes insipidus, with a trend toward lesser nasal symptoms and diabetes insipidus in the endoscopic group. The remission rate of functional adenomas was better in endoscopic group than microscopic group, but with no statistically significant. In regard to the recurrent or regrowing pituitary adenomas, the total removal rate in the endoscopic group was 16/21(76.19%) obvious higher than the microscopic group,which the rate was 6/15 (40.00%), the length of post-operative hospital stay and postoperative complications also were less than the latter.Conclusion:Microscopic and endoscopic techniques have similar outcomes when just compare of totality of tumor resection and postoperative remission of hormone levels. However, contacts to the traditional microscopic surgery, the transnasal endoscopic surgery decrease the complications and length of postoperative stay. The endoscopic operating time also decreases after skill training. The neuroendoscopy has more advantages in the treatment of recurrent or regrowing pituitary adenomas. The endoscopic technique may be a more safe and less invasive way for pituitary adenomas resection.