Comparison of endonasal endoscopic surgery and sublabial microsurgery for prolactinomas.
BACKGROUND
Endonasal endoscopy is a promising minimally invasive surgery for the treatment of pituitary adenomas; it is also a good alternative to traditional sublabial microsurgery. In this study, we compared endoscopic surgery with microsurgery and evaluated both for their safety and effectiveness. We chose prolactinomas for study because their hormone and symptomatic changes facilitated the comparison.


METHODS
During the past five years, 44 randomized prolactinoma patients underwent pituitary adenomectomy. Group A (22 patients) underwent endonasal endoscopic surgery for prolactinomas. Group B (22 patients) underwent sublabial transsphenoidal microsurgery for prolactinomas.


RESULTS
In groups A and B, patients with prolactinoma exhibited significantly reduced postoperative prolactin levels, return of menstrual cycle, and relief of galactorrhea, (Wilcoxon signed rank test) (p < 0.001). But there were no statistically significant differences in the effectiveness of the procedures used in group A and group B. Visual improvement in cases of macroadenoma was satisfactory in both groups. Hospital stay in group A ranged from 2-5 days, with a mean of 3.2 days. Hospital stay in group B ranged from 4-8 days with a mean of 5.3 days. The hospital stay for group A patients was shorter (2.1 days) than for group B (Student t test, p < 0.05). The operative time was shorter by 1 hour in Group A (mean: 1.7 hours vs. mean: 2.7 hours, p < 0.05). There were fewer complications in group A (4.5%) than in group B (27%), p < 0.05.


CONCLUSIONS
The endoscopic era of pituitary surgery may be coming. Endonasal endoscopic surgery may have the same effectiveness as traditional microsurgery. However, endoscopic surgery may shorten hospital stay and operative time, and lead to fewer complications. It seems to be a good minimally invasive surgical technique for prolactinomas.
Cho
Der-Yang
DY
Department of Neurosurgery, China Medical College Hospital, Taichung, Taiwan, Republic of China.
Liau
Wen-Rei
WR
D000293:Adolescent; D000328:Adult; D004724:Endoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007742:Labial Frenum / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008866:Microsurgery / Q000009:adverse effects*; D008875:Middle Aged; D009666:Nose / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D010911:Pituitary Neoplasms / Q000097:blood / Q000601:surgery*; D011183:Postoperative Complications; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma / Q000097:blood / Q000601:surgery*
D011388:Prolactin