Operative Efficacy And Complications Of Microscope Or Endoscope For 60 Patients With Pituitary Macroadenoma

Introduction:Pituitary macroadenoma is traditionally thought with a diameter more than 3 cm.Given the different risks and benefits relative to approaches,and background including morphological features and functioning pattern,neurosurgeons always differ in choosing operative strategy.Objective:The authors attempted to compare and analyze the efficacy and surgical risks of endoscopic and microscopic approaches when dealing with pituitary microadenoma.Materials and methods:This research enrolled 60 patients(36 endoscopic surgeries and 24 microscopic surgeries)with pituitary adenoma larger than 3 cm in the Second Affiliated Hospital of Zhejiang University from 2016/01/01 to 2017/4/30.We gathered relevant statistics of all patients and compared the surgical efficacy of individual approaches inclusive of gross-total and subtotal resection,remission of visual acuity declination and visual field defection,biochemical remission rate,and compared the surgical complications including CSF leakage,intracranial infection,hypopituitarism,diabetes insipidus and severe arterial injury.All the statistical works were done through SPSS 20.0,with the significance of 0.05.Results:As for pituitary macroadenoma,resection rate of microscope group(66.0�31.7)%is lower than the endoscope group(87.9�15.1)%(p=0.012).Hierachical comparison show that of endoscope group achieved 36.1%GTR rate,22.2%NTR rate,27.8%STR rate and 13.9%PR rate,significantly different from the 20.8%GTR rate,20.8%NTR rate,8.3%STR rate and 50.0%PR rate of microscope group(p=0.015).Biochemical remission of microscope group(2/6)is not significantly different from the endoscope group in aspect of functional adenoma(6/10).There is no statistical discrepancy between microscope group(18/18)and endoscope group(16/19)in remission of visual acuity impairment.Statistical discrepancy is not found in the remission of visual field deficit between microscope(10/10)and endoscope(10/11).In terms of surgical complications,the occurrence of CSF leakage in endoscope group(1/24)is statistically higher than microscope group(11/36)(p=0.019);and number of central diabetes insipidus in endoscope group(14/36)is significantly more than the other group(1/24).There is no statistical discrepancy between the incidences of intracranial infection(p=0.143),hypopituitarism(p=0.229)and severe arterial injury(p=0.512)of two groups.Conclusion:The overall efficacy of endoscopic surgery for large pituitary adenoma is better than microscopic surgery,but on the contrary endoscopic approach bears higher risk of surgical complications than microscopic approach.