title: Endoscopic endonasal pituitary adenomas surgery: the surgical experience of 178 consecutive patients and learning curve of two neurosurgeons.
abstract: BACKGROUND
  We aim to study surgical technique and analyze the related factors affecting tumor total removal and postoperative endocrinological remission for endoscopic endonasal pituitary adenomas surgery.
  
  
  METHODS
  We retrospectively analyzed 178 endoscopic endonasal pituitary adenomas surgery from March 2011 to May 2014. Endonasal approach included the routine transnasal-sphenoidal approach, transnasal- maxillary sinus approach in four cases and transnasal-clivus approach in one case.
  
  
  RESULTS
  According to postoperative imaging data and endocrine examination results, total removal was achieved in 129 patients (72.5%), and endocrinological remission was achieved in 38 patients with functional adenomas (44.1%). Statistical analysis of the clinical data showed that total removal rate was much closely related to tumor volume (P = 0.006), and tumor invasiveness (P < 0.001).
  
  
  CONCLUSIONS
  In this study, we found tumor sizes and invasion of cavernous sinus were related to total removal rate and endocrinological remission rate; the direction and degree of tumor invasion, and the surgeon's experience were the key influence factors of the endocrinological remission rate for invasive functional pituitary adenomas.
authors.affiliation: Department of Neurosurgery, Shanghai Pituitary Tumor Center, Hua Shan Hospital, Shanghai Medical College, FuDan University, Shanghai, China.
authors.forename: Xuefei
authors.initials: X
authors.lastname: Shou
authors.affiliation: Department of Neurosurgery, Shanghai Pituitary Tumor Center, Hua Shan Hospital, Shanghai Medical College, FuDan University, Shanghai, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Shen
authors.affiliation: Department of Neurosurgery, Shanghai Pituitary Tumor Center, Hua Shan Hospital, Shanghai Medical College, FuDan University, Shanghai, China.
authors.forename: Qilin
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Shanghai Pituitary Tumor Center, Hua Shan Hospital, Shanghai Medical College, FuDan University, Shanghai, China.
authors.forename: Yichao
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Shanghai Pituitary Tumor Center, Hua Shan Hospital, Shanghai Medical College, FuDan University, Shanghai, China.
authors.forename: Wenqiang
authors.initials: W
authors.lastname: He
authors.affiliation: Department of Neurosurgery, Shanghai Pituitary Tumor Center, Hua Shan Hospital, Shanghai Medical College, FuDan University, Shanghai, China.
authors.forename: Zengyi
authors.initials: Z
authors.lastname: Ma
authors.affiliation: Department of Neurosurgery, Shanghai Pituitary Tumor Center, Hua Shan Hospital, Shanghai Medical College, FuDan University, Shanghai, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Neurosurgery, Shanghai Pituitary Tumor Center, Hua Shan Hospital, Shanghai Medical College, FuDan University, Shanghai, China.
authors.forename: Shiqi
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Shanghai Pituitary Tumor Center, Hua Shan Hospital, Shanghai Medical College, FuDan University, Shanghai, China. endoscope_huashan@163.com.
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002426:Cavernous Sinus / Q000473:pathology; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D000069471:Neurosurgeons; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Endonasal approach; Endoscope; Pituitary adenoma