Abstract：Objective To present the Results of a consecutive series of patients with prolactinomas underwent a fully endoscopic endonasal trans-sphenoidal approach, and to assess the efficacy and safety of this procedure.Methods From July 2000 to June 2011, clinical data of 132 patients with prolactinoma to underwnet anendoscopic transsphenoidal surgery in Beijing Tiantan Hospital were analyzed. The patients were divided into microadenomas(≤1 cm, 34 cases),macroadenomas without cavernous sinus invasiveness(＞1 cm, 70 cases) and macroadenomas with cavernous sinus involvement(28 cases). The gross total removal (GTR), normalization rate of prolactin(PRL), average length of hospital stay, vision and visual field, operative complications, death and recurrence were followed up and analyzed. All measurement data were statistically analyzed by Wilcoxon Signed Ranks and the p-value is less than 0.05, which was statistically significant statistical significance.Results Follow-up ranged from 11 months to 12 years with a mean of 5 years and 7 months. The GTR rate for microadenomas was 97.1% (33/34); normalization rate of PRL levels for microadenomas was also 97.1% (33/34). As for macroadenomas without cavernous sinus invasiveness,GTR was achieved in 95.7% (67/70); normalization rate of PRL levels for the tumors was 72.9% (51/70). The GTR rate for 28 macroadenomas with cavernous sinus involvement was 3.6% (1/ 28);normalization rate of PRL levels for the tumors was 0.Among the 48 patients with visual deficit before surgery, 18 patients (37.5%) had complete normalization of their visual disturbance, 12 patients (25.0%) had moderate improvement, and 18 patients (37.5%) had no improvement. No patients experienced visual worsening after the surgery.There were no cases of persistent diabetes insipidus in the study. There were 4 transient diabetes insipidus. Twelve patients(9.1%) had postoperative cerebrospinal flud leakage.Two patients developed delayed post-operative epistaxis.There was no postoperative pituitary insufficiency and syndrome of inappropriate antidiuretic hormone secretion. There were no cases of postoperative mortality and carotid artery injury.The average length of hospital stay was short (5-7days).Conclusions The use of a fully trans-sphenoidal endoscopic procedure to treat prolactinomas is a safe and effective option.
Rosseau G, Bailes J, del Maestro R, et al. The development of a virtual simulator for training neurosurgeons to perform and perfect endoscopic endonasal transsphenoidal surgery[J]. Neurosurgery, 2013, 73 Suppl 1: 85-93.
[2]
Knosp E, Steiner E, Kitz K, et al. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings[J]. Neurosurgery, 1993, 33(4): 610-618.
[3]
Gillam MP, Molitch ME, Lombardi G, et al. Advances in the treatment of prolactinomas[J]. Endocr Rev, 2006, 27(5): 485-534.
[4]
王忠诚. 王忠诚神经外科学[M]. 2005: 414-415.
[5]
Liu JK, Das K, Weiss MH, et al. The history and evolution of transsphenoidal surgery[J]. J Neurosurg, 2001, 95(6): 1083-1096.
[6]
Guiot J, Rougerie J, Fourestier M, et al. Intracranial endoscopic explorations[J]. Presse Med, 1963, 71: 1225-1228.
[7]
Hardy J. Surgery of the pituitary gland, using the trans-sphenoidal approach. Comparative study of 2 technical methods[J]. Union Med Can, 1967, 96(6): 702-712.
[8]
Gamea A, Fathi M, el-Guindy A. The use of the rigid endoscope in trans-sphenoidal pituitary surgery[J]. J Laryngol Otol, 1994, 108(1): 19-22.
Bodhinayake I, Ottenhausen M, Mooney MA, et al. Results and risk factors for recurrence following endoscopic endonasal transsphenoidal surgery for pituitary adenoma[J]. Clin Neurol Neurosurg,2014,119:75-79.
[11]
Kumar S, Darr A, Hobbs CG, et al. Endoscopic, endonasal, trans-sphenoidal hypophysectomy: retrospective analysis of 171 procedures[J]. J Laryngol Otol, 2012, 126(10): 1033-1040.
[12]
Dehdashti AR, Ganna A, Karabatsou K, et al. Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series[J]. Neurosurgery, 2008, 62(5): 1006-1017.
[13]
Hofstetter CP, Shin BJ, Mubita L, et al. Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas[J]. Neurosurg Focus, 2011, 30(4): E10.
[14]
Frank G, Pasquini E, Farneti G, et al. The endoscopic versus the traditional approach in pituitary surgery[J]. Neuroendocrinology, 2006, 83(3-4): 240-248.
[15]
Gondim JA, Schops M, de Almeida JP, et al. Endoscopic endonasal transsphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center[J]. Pituitary, 2010, 13(1): 68-77.
[16]
D′Haens J, Van Rompaey K, Stadnik T, et al. Fully endoscopic transsphenoidal surgery for functioning pituitary adenomas: a retrospective comparison with traditional transsphenoidal microsurgery in the same institution[J]. Surg Neurol, 2009, 72(4): 336-340.
De Witte O, Carlot S, Devuyst E, et al. Minimally invasive endoscopic unilateral transsphenoidal surgery for pituitary adenomas[J]. B-ENT, 2011, 7 Suppl 17: 27-32.
2015, Vol. 20 
