Neuroendoscopic and microscopic transsphenoidal approach for resection of nonfunctional pituitary adenomas

Abstract

BACKGROUND Nonfunctional pituitary adenoma is a common type of pituitary adenoma, which can lead to headache, visual field disturbance, and cranial nerve damage due to increased tumor volume. Neuroendoscopic and microscopic transsphenoidal approaches have been widely used in the resection of nonfunctional pituitary adenomas. However, the clinical efficacy in neuroendoscopic and microscopic surgery is still controversial. AIM To explore the clinical efficacy of neuroendoscopic and microscopic transsphenoidal approach for resection of nonfunctional pituitary adenomas. METHODS We retrospectively analyzed 251 patients with nonfunctional pituitary adenomas; 138 underwent neuroendoscopic surgery via transsphenoidal approach, and 113 underwent microscopic surgery via transsphenoidal approach between July 2010 and September 2015. All patients were followed up for > 6 mo. Gender, age, course of disease, tumor diameter, tumor location, and percentage of patients with headache, visual impairment, sexual dysfunction, and menstrual disorders were contrasted between the two groups to compare the difference of preoperative data. Cure rate, symptom improvement rate, recurrence rate, the postoperative hospital stay, operating time, intraoperative blood loss, and the incidence of postoperative complications were compared in order to evaluate the advantages and disadvantages of neuroendoscopic and microscopic surgery. RESULTS There was no significant difference in cure rate, symptom improvement rate, and recurrence rate between neuroendoscopy group and microscopy group (82.6% vs 85.8%, P > 0.05; 90.6% vs 93.8%, P > 0.05; 5.1% vs 9.7%, P > 0.05). In the neuroendoscopy group, the postoperative hospital stay was 8.4 ± 0.6 d; operating time was 167.2 ± 9.6 min; intraoperative blood loss was 83.4 ± 9.3 mL, and the rates of diabetes insipidus and electrolyte imbalance were 4.3% and 8.0%, respectively. The corresponding results in the microscopic group were 11.2 ± 0.6 d, 199.7 ± 9.3 min, 138.8 ± 13.6 mL, and 32.7% and 20.4%, respectively. There were significant differences in postoperative hospital stay, operating time, intraoperative blood loss, and the rates of diabetes insipidus and electrolyte imbalance between the two groups ( P < 0.05). CONCLUSION Neuroendoscopic and microscopic transsphenoidal approaches have similar clinical efficacy for the resection of nonfunctional pituitary adenomas. Neuroendoscopic surgery reduces operating time, intraoperative bleeding, postoperative recovery, and complications.

Intraoperative lumbar drainage can prevent cerebrospinal fluid leakage during transsphenoidal surgery for pituitary adenomas: a systematic review and meta-analysis

“…Thus, the aim of this meta-analysis was to definite whether intraoperative LD can prevent CSF leakage during the perioperative period of pituitary adenomas transsphenoidal surgery. The estimated pooled results showed that intraoperative LD was an effective measure [19]. Intraoperative LD can reduce strain on the arachnoid, making it less susceptible to puncture [11,13,20].…”

“…The force during tumor resection enhanced tension on the arachnoid, which might tear the arachnoid. A tear of arachnoid increased the risk of CSF leakage [ 19 ]. Intraoperative LD can reduce strain on the arachnoid, making it less susceptible to puncture [ 11 , 13 , 20 ].…”

Comparison of outcomes between intracapsular resection and pseudocapsule-based extracapsular resection for pituitary adenoma: a systematic review and meta-analysis

“…ER required more aggressive resection of the pseudocapsule which was attached directly to the surface of arachnoid. As a result, the extra process to remove the pseudocapsule from the thin layer of arachnoid enhanced tension on the arachnoid, inducing tearing of arachnoid and CSF leakage [ 7 , 18 ]. In contrast, some studies have suggested that the advantages of ER for anatomical orientation, and removal of a security margin could reduce the risk of opening arachnoid layer with subsequent CSF flow [ 16 ].…”

Utilizing a Novel Pituitary Retractor for Early Descent of the Diaphragma Sellae during Endoscopic Transsphenoidal Pituitary Surgery

“…During pituitary surgery, descent of the diaphragm sellae (DS) is occasionally encountered. This can block access for remnant tumor or cause cerebrospinal fluid (CSF) leak due to uneventful rupture of the DS 9) . To prevent early descent of the DS, resection of pituitary tumors is generally performed in a sequential manner from the inferior part to the lateral part and finishing with the superior part 15) .…”