Extended endoscopic endonasal approach in resection of suprasellar invasive pituitary adenoma

Abstract

Objective To analyze the clinical efficacy and safety of the extended endoscopic endonasal approach (EEEA) in the resection of suprasellar invasive pituitary adenoma. Methods and Results A total of 68 patients with suprasellar invasive pituitary adenoma admitted to The Second Hospital of Hebei Medical University from June 2019 to June 2022 were treated with EEEA for tumor resection, of whom 73.53% (50/68) achieved gross total resection (GTR), 17.65% (12/68) achieved subtotal resection, and 8.82% (6/68) achieved partial resection. The GTR rate of giant adenoma was 37.40% (10/27). The average follow⁃up was (12 ± 6) months, 75.81% (47/62) improved visual acuity, 19.35% (12/62) had no change after surgery, 4.84% (3/62) deteriorated visual acuity. The improvement rate of visual field defect was 74.14% (43/58), no change was 15.52% (9/58), and symptom aggravation was 10.34% (6/58). The symptoms of diplopia disappeared completely in the patients with oculomotor nerve palsy at the last follow ⁃ up (3 cases). Postoperative complications included cerebrospinal fluid leakage [1.47% (1/68)], central diabetes insipidus [16.18% (1/68)], intraoperative hematoma [4.41% (3/68)], delayed nasal hemorrhage [4.41% (3/68)] and intracranial infection [7.35% (5/68)], with no death. Conclusions EEEA for large or giant pituitary adenomas invading the anterior skull base, suprasellar region and the third ventricle has a high GTR rate, less trauma and fewer complications, and is worthy of clinical promotion.

DOI: 10.3969/j.issn.1672⁃6731.2023.07.004