Comparative Analysis Of Neuroendoscopic And Microscopic Trans-Nasal-Sphenoidal Giant Pituitary Adenomas Resection

Objective:To comparatively analyze the efficacy and safety of trans-nasal-sphenoidal giant pituitary adenomas resection under neuroendoscope or microscope.Methods:69 patients who underwent neuroendoscopic endonasal transsphenoidal surgery and 47 patients who underwent microscopic surgery for giant pituitary adenomas were enrolled in this retrospective analysis. Both groups received endonasal transsphenoidal approach.The clinical data of two groups were compared,which included total tumor removal rate,operation time,bleeding volume during operation,the length of hospital stay and operative complications.Results:Total tumor removal rate in the endoscope group was significantly higher than that in the microscope group(47.8% vs 25.5%,χ2=4.877,P=0.027). The endoscope group showed significantly longer operation time [(123.5±30.5min) vs (99.8±25.7min), t=4.373, P=0.000], higher bleeding volume during operation[(l93.5±45.7ml) vs (144.5±57.8ml),t=5.086,P=0.000], shorter length of hospital stay[(8.7±2.9d) vs (10.4±2.3d), t=-3.419, P=0.001], higher rate of CSF leaks(18.8% vs 4.3%, x2=4.066, P=0.044), lower rate of cranial nerve injuries(2.9% vs 17%, χ2=5.399, P=0.020) than these in the microscope group. There were no statistical differences in the postoperative anterior pituitary deficiency, postoperative diabetes insipidus, hyposmia and postoperative epistaxis(x2 values were 1.174,1.763,0.026 and 0.306 respectively,and all P values of them were over 0.05).Conclusion:Endoscopic endonasal transsphenoidal surgery can effectively improve the total resection rate for giant pituitary adenomas, reduce some complications and get a shorter hospital stay compared to endoscopic endonasal microscopic surgery.