내시경하 경비적 경접형동 접근법을 통한 뇌하수체 선종 치료결과: 후향적, 단일기관, 20년 연구

Treatment outcome of endoscopic endonasal transsphenoidal approach for the pituitary adenomas: A retrospective, single-institutional 20-year experience

Background: Pituitary adenomas (PAs) are the second most common benign intracranial tumors. The endoscopic endonasal transsphenoidal approach (EETSA) has been a treatment choice for such tumors. This study provides a 20-year experience of EETSA in a single institution as well as a subgroup analysis of the visual outcome after incomplete resection. Materials and Methods: Electronic medical records of 120 patients, who underwent EETSA at our institution between January 2003 and August 2022, were retrospectively analyzed. The ophthalmologic outcome was analyzed with the surgical outcome as well as clinical factors. An analysis was conducted on surgical morbidities, including cerebrospinal fluid leakage, meningitis, and diabetes insipidus, categorizing, and assessing their incidence over distinct decades. Results: Patients were followed for a median period of 41.3 months, with a median tumor size observed at 2.5 cm. Nonfunctioning PAs are 91 patients, and visual field defect was identified in 58 patients (48.3%). Gross total resection (GTR) was achieved in 53 patients (44.2%). Smaller tumor size and younger age were associated with GTR, whereas cavernous sinus (CS) invasion, suprasellar extension, and optic nerve compression were related to non-GTR. Forty-six patients were available for postoperative ophthalmologic evaluation. Thirty-six patients (78.3%) improved, 7 patients (15.2%) were stable, and 3 patients (6.5%) worsened. Conclusions: The long-term outcomes following EETSA are favorable, with relatively low morbidity rates. Tumor size, age, suprasellar extension, and CS invasion were related to GTR. In subgroup analysis, the suprasellar residual tumor is not related to visual outcomes or tumor recurrence rate.