Single-nostril Transsphenoidal Endoscopic Surgery And Microsurgery In The Treatment Of Invasive Pituitary Adenomas: Comparision Of Operation Method And Curative Effect

Objective:Compare advantages and disadvantages of microscope with single-nostril endoscopic transsphenoidal surgery for invasive pituitary adenomas by analysis of Clinical cases,summarized the experience of pituitary adenoma surgery.Methods:Xiangya Hospital of Central South University neurosurgery pituitary adenoma study group from January 2007 to October 2008 a complete hospital information and follow-up more than half of 44 cases of patients with invasive pituitary adenomas were retrospectively analyzed.15 cases in which the use of microscopic single-nostril transsphenoidal surgical resection(A),29 cases of the use of single-nostril endoscopic transsphenoidal surgical resection(B group).Of the two groups in age,tumor size,tumor resection effective rate, operative time,bleeding volume,postoperative hospital stay, postoperative symptoms,the postoperative complications,postoperative follow-up retrospective analysis of the situation and the control study.Results: A(microscopic surgery group) the average age was 41.2(range 19 to 69) years old,The average size of tumor was(measurement by largest diameter of MRI) 3.6(range 2.5 to 5.5)cm,tumor resection(removal of the tumor 100%) in 3 cases(20.00%),Subtotal tumor resection(removal of the tumor more than 90%) in 3 cases(20.00%),Most of resection (removal of the tumor from 70%to 90%) in 5 cases(33.30%),Partial resection(removal of the tumor is less than 70%) in 4 cases(26.67%), Effectively removed(subtotal plus full cut) in 6 cases(40.00%),The average operative time(time from the use of epinephrine to shrink the nasal mucosa of nasal packing foam expansion ) was 138(range 118 to 155) minutes,The average bleeding volume was 185(range150 to 300)ml, the average time of stay in hospital was 9(range 6 to 12)days,the number of symptoms Alleviated after operation wasll cases,No significant changes in four cases,no cases of deterioration and death,all Patients Require a review after six months,three cases of relapse(reviewed MRI show that the tumor volume increased and treat with gamma knife )B(Neuroendoscopic surgery group) the average age was 41.6(range 21 to 70) years old,The average size of tumor was 3.4(range 2.0 to 6.5)cm,tumor resection in 7 cases(24.14%),Subtotal tumor resection in 10 cases(34.48%),Most of resection in 7 cases(24.14%),Partial resection in 5 cases(17.24%),Effectively removed in 17 cases(58.62%), The average operative time was 101(range 83 to 120) minutes,The average bleeding volume was 147(range50 to 1000)ml,the average time of stay in hospital was 8(range 3 to 15)days,the number of symptoms Alleviated aider operation was 19 cases,No significant changes in 10 cases,no cases of deterioration and death,all Patients Require a review after six months,6 cases of relapse(reviewed MRI show that the tumor volume increased and treat with gamma knife).Conclusion:Transsphenoidal surgery of pituitary adenoma can make use of endoscopic can also under the microscope;Two surgical techniques in surgery time,postoperative hospitalization time were significantly different,Endoscopic surgery is superior to operation under the microscope.In bleeding volume,the effective rate of resection, postoperative complications,symptoms;and other aspects of tumor recurrence in both groups no significant differences;the effective rate of resection of the two operative group Implied endoscopic surgery is superior to prompt surgical microscope.