| OBJECTIVE:To explore the clinical treatment effects of different surgical methods of microscopy and neuroendoscopic transsphenoidal approach for non-functional non-invasive pituitary adenomas,and the influence of the amount of transsphenoidal surgery on the clinical treatment effects.METHODS:All clinical datas of patients who were diagnosed with non-functional pituitary adenoma after transnasal-sphenoid approach Surgery in the neurosurgery ward of the First Affiliated Hospital of Guangxi Medical University from January 1,2016 to August 1,2020,were retrospectively collected.Patients with preoperative images that met the Handy-Wilson classification criteria I,II or 0,A,B,Knosp grade 0-2 and who were not found to have invaded the cavernous sinus and sella during the operation were enrolled in our study.By comparing the basic information,clinical symptoms,imaging datas,tumor information,the amount of transnasal sphenoid surgery of the surgeons,postoperative complications,improvement of pituitary hormones,lengths of hospital stay and hospitalization costs,extent of tumor resection,etc.the clinical efficacy of the two surgical methods and the influence of the amount of transnasal sphenoid surgery on it were evaluated.RESULTS:1.109 patients underwent microscopic transsphenoidal resection,and 37 patients underwent neuroendoscopic transsphenoidal resection.The amount of transnasal sphenoid surgery in the surgical group was 112±48 cases in the microscope group and 60±28 cases in the neuroendoscopy group,surgeons who performed the microscopic technique were more than the surgeons who performed the endoscopic technique in the number of transsphenoidal surgeries(P<0.001).2.Intracranial infection,sellar hemorrhage and cerebral hemorrhage,and acute hyponatremia/antidiuretic hormone inappropriate syndrome were similar between groups(P values were 0.730,0.680,0.633).Postoperative cerebrospinal fluid leakage requiring intervention was 5cases(4.6%)in the microscope group and 6 cases(16.2%)in the neuroendoscopy group,the incidence of cerebrospinal fluid rhinorrhea in the microscope group was lower than that in the neuroendoscopy group(P=0.031,OR 0.25,95%CI 0.07-0.87).In terms of short-term diabetes insipidus,there were 43 cases(39.4%)in the microscope group and 23cases(62.2%)in the neuroendoscopy group(P=0.016,OR 0.40,95% 0.18-0.85).The neuroendoscopy group(n=3)was more likely to occur than the microscope group(n=0)(P=0.015)in terms of epistaxis and other nasal conditions.After stratified chi-square analysis based on the amount of transnasal sphenoid surgery,postoperative cerebrospinal fluid rhinorrhea and short-term diabetes insipidus were homogeneous(P values were0.076,0.264),but there was both no statistical difference between groups.(P values were 0.819,0.741).The amount of transnasal sphenoid surgery is an independent influence factor of postoperative cerebrospinal fluid rhinorrhea,the risk of cerebrospinal fluid rhinorrhea in surgeons with transsphenoidal surgery(>100 cases)was 0.142 times that of transsphenoidal surgery(<100 cases)(P=0.021,95%CI 0.027-0.749).The operation style is not an independent influencing factor of postoperative cerebrospinal fluid rhinorrhea(P=0.129).Tumor texture is an independent factor in the occurrence of short-term diabetes insipidus,the risk of postoperative diabetes insipidus in patients with tough tumors is 3.000 times that of soft tissues(P=0.048,95%CI 1.01-8.92)。The operation method and the amount of transnasal sphenoid surgery are not independent factors of short-term diabetes insipidus(P values are 0.213,0.281,respectively).3.The improvement in headaches and vision were similar between the microscopy group and the neuroendoscopy group(P values were 0.173,0.187).There was no significant difference in the preoperative pituitary hormone deficiency axis,adrenal hormone axis,thyroid hormone axis,gonadal hormone axis,and hyperprolactin between groups(P values were0.665,0.061,0.273,0.584,0.453).4.The lengths of hospital stay in days in the microscope group was16.5(12.0-19.0)and the hospital payments was RMB 3,3746.9(27844.5-39353.5),LOS in days in the neuroendoscopy group was19.8(14.5-23.5),and the hospital payments was RMB 46920.8(40045.0-53042.0).LOS was longer and the cost of hospitalization was more expensive in endoscopic compared to microscopic surgeries(P =0.005,P<0.001respectively).The mean blood loss in the microscope group was 136(50-200)ml,and the mean operation time was 113(58.5-148.5)min,while the neuroendoscopy group was 154.6(100-200)ml,and the mean operation time was 317.2(220.0-401.0)min,there is a statistical difference between the tgroups(P values are 0.008,<0.001,respectively).The resection was assessed by MRI within 2 weeks after transsphenoidal operation,there were 14 cases(12.8%)of subtotal resection or confirmed residual in the microscope group and 2 cases(5.4%)in the neuroendoscopy group(P=0.360,OR 2.58,95%CI 0.56-11.9).Follow-up MRI 3-24 months after surgery: 23 cases(21.1%)were subtotal or confirmed residual in the microscope group,6 cases(10.8%)in the neuroendoscopy group(P=0.496,OR 1.41),95%CI 0.52-3.83).According to the stratified examination of the amount of surgery,there is no heterogeneity and statistical difference between groups for the MRI evaluation of the resection at 2 weeks after the operation and 3-24 months after the operation.Statistical difference((P=0.319,P=0.800,respectively;P=0.396,P=0.337,respectively).5.The mean surgical bleeding,mean surgical time,short-term diabetes insipidus incidence and transnasal sphenoid surgery volume are negatively correlated with statistical significance(r=-0.269,0.001;r=-0.709,P<0.001;r=-0.183,P=0.027).The postoperative cerebrospinal fluid rhinorrhea,subtotal resection and residual rate were negatively correlated with the amount of transnasal sphenoid surgery with no statistical difference(r value and P value-0.143,0.085;-0.126,0.129,respectively).The incidence of intracranial infection,sellar hemorrhage,acute hyponatremia/inappropriate antidiuretic hormone syndrome was positively correlated with the amount of transnasal sphenoid surgery(r value and P value were 0.017,0.840;0.093,0.266;0.021,0.801).CONCLUSION: 1.When the surgical experience of transnasal sphenoid surgery in the microscope group(>100 cases)is greater than that in the neuroendoscopy group(<100 cases)for the removal of nonfunctioning pituitary non-invasive pituitary adenomas,the neuroendoscopy group was higher than that of microscope group in terms of the rate of cerebrospinal fluid rhinorrhea,nasal cavity bleeding and other nasal conditions.But the neuroendoscopy group and the microscope group have similar effects in the improvement of pituitary hormones.2.In terms of tumor subtotal resection and residual rate,the microscope group was higher than the neuroendoscopy group,however,with no statistical difference. |
