Comparison And Analysis Of Transsphenoidal Endoscopic Submucosal Approach And Traditional Approach For The Excision Of Pituitary Adenoma

Background:Pituitary adenoma is one of the most common central nervous system tumors.Epidemiologic studies have documented the incidence of pituitary adenomas was as high as 16.7%among the general population.During our work,we found that patients experienced significant postoperative sinonasal symptoms,olfactory disorders or epistaxis for the first few months after transsphenoidal endoscopic traditional approach(TSE-TA)surgery.We describea a modification of transsphenoidal endoscopic surgery:transsphenoidal endoscopic submucosal approach(TSE-SA).This study was designed to analysis whether TSE-SA can decrease postoperative complication morbidity for patients with pituitary adenomas.Objective:To compare the clinical therapeutic effect of TSE-SA and TSE-TA for pituitary adenoma surgery.Methods:From July 2015 to June 2016,62 patients underwent TSE-SA surgery,as TSE-SA group.From July 2016 to June 2017,84 patients underwent TSE-TA surgery,as TSE-TA group.The hospital history data(basic data,tumor characteristics,intraoperative cerebrospinal fluid(CSF)leak,operation time,postoperative hospital stay,intraoperative blood loss,complete tumor resection rate,endocrine function remission rate)and postoperative complications(CSF rhinorrhea,epistaxis,nasal septal perforation,intracranial infection,severe olfactory disturbance,temporary diabetes insipidus(Dl))were analyzed.Results:A total of 62 patients in TSE-SA group,55(88.7%)cases underwent total resection,and the GTR rate of those cases that invasion of cavernous sinus was 53.3%.And a total of 84 patients in TSE-TA group,75(89.3%)cases underwent total resection,and the gross total resection(GTR)rate of those cases that invasion of cavernous sinus was 77.5%.The postoperative hospital stay in the TSE-SA group were shorter than those in the TSE-TA group,and the difference has statistically significant(P<0.001).The operation time of two groups without statistical difference(P=0.092).The effective rates of growth hormone(GH)and prolactin(PRL)in the TSE-SA group were 81.8%and 82.6%,respectively.The effective rates of GH and PRL in the TSE-TA group were 95%and 100%,respectively.And the differences in endocrine function remission rate of two groups have no statistical difference.The incidence of postoperative total complications,epistaxis,and nasal septal perforation in the TSE-SA group was lower than in the TSE-TA group,and the differences have statistically significant(P=0.007,P=0.044,P＝0.033).There was no significant difference in the incidence of postoperative CSF leak,severe olfactory disturbance,intracranial infection,and temporary DI(P>0.05).There was a significant difference in olfactory function of the conventional TSE-TA group between preoperative and 3 months after surgery(P<0.001).while there was no difference in olfactory function of the TSE-SA group between preoperative and the 3 months after surgery(P=0.174).Conclusions:The TSE-SA can provide a clear operation field and preserve the intact nasal mucosa,including the septum turbinates.In addition,the TSE-SA causes less damage,and there are better outcomes in terms of the early postoperative olfactory function recovered,postoperative epistaxis and nasal septum perforation.