Clinical Research Of Neuroendoscopic And Microscopic Transsphenoidal Approach For The Resection Of Nonfunctional Pituitary Adenomas

OBJECTIVE:In this study,we compared the clinical data of patients with nonfunctional pituitary adenomas treated by neuroendoscopic and microscopic transsphenoidal approach to explore the clinical effica2y of neuroendoscopic and microscopic transsphenoidal approach for the resection of nonfunctional pituitary adenomas,which provided the basis for selecting which surgical method should be better to patients with nonfunctional pituitary adenomas in the clinical work so as to improve the therapeusis efficacy of patients.METHODS:We collected the clinical data of 251 patients with nonfunctional pituitary adenomas underwent transsphenoidal surgery from July 2010 to September 2015 by electronic medical records,including 138 patients undergoing neuroendoscopic transsphenoidal surgery and 113 patients underwent microscopic transsphenoidal surgery.The sex difference,age composition,duration of disease,clinical symptoms,tumor diameter and tumor grade were contrasted between the two groups to compare the difference of preoperative data.The curative rate,the improvement rate of symptoms,the recurrence rate,the mortality rate,the average length of postoperative hospital stay,the duration of operation,the amount of bleeding during operation and the incidence of postoperative complications were compared in order to compare the advantages and disadvantages of surgical methods.RESULTS:There were no significant differences in age composition,sex difference,duration of disease,clinical symptoms,tumor diameter and tumor grade between the two groups(p>0.05).In the neuroendoscopy group,the curative rate was 82.6%,the symptom improvement rate was 90.6%,the recurrence rate was 5.1%,and the mortality rate was 0.7%.In the microscope group,the curative rate was 85.8%,the symptom improvement rate was 93.8%,the recurrence rate was 9.7%,the mortality rate was 0.8%.There were no significant differences in cure rate,clinical symptom improvement rate,recurrence rate and mortality rate between the two groups.The postoperative hospital stay in the neuroendoscopy group was(8.4±0.6)days,and the postoperative hospital stay in the microscope group was(11.2±0.6)days.There was significant difference between the two groups(P<0.05),and we may consider that patients with nonfunctional pituitary adenomas have shorter hospital stays after neuroendoscopic surgery than microscopic surgery.The operation duration of the neuroendoscopy group was(167.2±9.6)mins,and that of the microscope group was(199.7±9.3)mins.The data of the two groups were statistically significant(p<0.05),we consider that neuroendoscopic surgery for nonfunctional pituitary adenomas can reduce operation duration better than microscopic surgery.The amount of intraoperative bleeding was(83.4±9.3)ml in the neuroendoscopy group and(138.8±13.6)ml in the microscope group.There was a significant difference between the two groups(p<0.05),neuroendoscopic surgery for nonfunctional pituitary adenomas can be considered to reduce intraoperative bleeding better than microscopic surgery.The incidence of postoperative diabetes insipidus was 4.3%in the neuroendoscopy group and 32.7%in the microscope group.And between the two groups,the incidence of postoperative cerebrospinal fluid leakage was 7.2%and 10.6%,respectively the incidence of electrolyte disorder was 8.0%and 20.4%,the incidence of hypopituitarism was 23.2%and 30.9%,and the incidence of intracranial infection was 6.5%and 9.7%.There was no significant difference in the incidence of postoperative cerebrospinal fluid leakage,hypopituitarism and intracranial infection(p=0.347>0.05,p=0.165>0.05,p=0.350>0.05)between the two groups.However,the incidence of diabetes insipidus and electrolyte disorder were significantly different(p=0.000<0.05,p＝0.004<0.05)between the two groups.CONCLUSIONS:The clinical efficacy of neuroendoscopic and microscopic transsphenoidal approach for the resection of nonfunctional pituitary adenomas is similar,but neuroendoscopic surgery for nonfunctional pituitary adenomas is more effective in reducing the operation time and the amount of intraoperative bleeding,shortening the recovery time and reducing the occurrence of complications.For the patients with nonfunctional pituitary adenomas,neuroendoscopic surgery should be a choice with the faster recovery,fewer complications and more safety.