Hamideh Akbari1, Mojtaba Malek2, Mohammad Ghorbani3, Seyed Mahmoud Ramak Hashemi3, Mohammad Ebrahim Khamseh1, Ali Zare Mehrjardi4, Zahra Emami1, Ameneh Ebrahim Valojerdi1. 1. a Endocrine Research Center , Institute of Endocrinology and Metabolism, Iran University of Medical Sciences , Tehran , Iran. 2. b Research Center for Prevention of Cardiovascular Disease , Institute of Endocrinology and Metabolism, Iran University of Medical Sciences , Tehran , Iran. 3. c Department of Neurosurgery and Neuro-Intervention , Firouzgar Hospital, Iran University of Medical Sciences , Tehran , Iran. 4. d Department of Pathology, Firouzgar Hospital, Iran University of Medical Sciences , Tehran , Iran.
Abstract
OBJECTIVE: To compare clinical outcomes of large pituitary adenomas (≥3 cm in maximum diameter), operated on by Endoscopic Transsphenoidal Surgery (ETS), versus Microscopic Transsphenoidal Surgery (MTS). METHODS: Medical records and MRI Scans of patients with a diagnosis of pituitary adenoma for whom transphenoidal surgery was done were reviewed. Complete pre and post-operative data were available for 121 patients. Thirty five patients had large pituitary adenoma and were enrolled in this study. ETS was done in 16 patients, and 19 underwent MTS. All patients were followed for at least six months. Clinical and imaging characteristics were reported in details. Post-operative clinical outcomes were defined as clinical outcomes persisted 6 months after surgery. RESULTS: The average tumor size was 36.3 ± 4.4 mm in ETS group, and 34.0 ± 4.6 mm in MTS group, (p = .46). Six months after surgery, tumor size was 4.6 ± 6.6 mm in ETS and 17.7 ± 12.2 mm in MTS group, (p = .002). Gross total resection (GTR) was observed in the 81.2% of the patient in the ETS group. In the MTS group, GTR was observed in 15.8%. Post-operative clinical outcomes including new onset hypopituitarism, visual impairment, and permanent diabetes insipidus (DI) were comparable between the two groups. CONCLUSION: ETS is superior to MTS in treatment of large pituitary adenomas with comparable post-operative complications.
OBJECTIVE: To compare clinical outcomes of large pituitary adenomas (≥3 cm in maximum diameter), operated on by Endoscopic Transsphenoidal Surgery (ETS), versus Microscopic Transsphenoidal Surgery (MTS). METHODS: Medical records and MRI Scans of patients with a diagnosis of pituitary adenoma for whom transphenoidal surgery was done were reviewed. Complete pre and post-operative data were available for 121 patients. Thirty five patients had large pituitary adenoma and were enrolled in this study. ETS was done in 16 patients, and 19 underwent MTS. All patients were followed for at least six months. Clinical and imaging characteristics were reported in details. Post-operative clinical outcomes were defined as clinical outcomes persisted 6 months after surgery. RESULTS: The average tumor size was 36.3 ± 4.4 mm in ETS group, and 34.0 ± 4.6 mm in MTS group, (p = .46). Six months after surgery, tumor size was 4.6 ± 6.6 mm in ETS and 17.7 ± 12.2 mm in MTS group, (p = .002). Gross total resection (GTR) was observed in the 81.2% of the patient in the ETS group. In the MTS group, GTR was observed in 15.8%. Post-operative clinical outcomes including new onset hypopituitarism, visual impairment, and permanent diabetes insipidus (DI) were comparable between the two groups. CONCLUSION:ETS is superior to MTS in treatment of large pituitary adenomas with comparable post-operative complications.
Entities:
Keywords:
Trans-sphenoidal surgery; large pituitary adenoma
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