The effect of different surgical approaches under neuroendoscopy for the treatment of pituitary adenomas
GU Xuanmin
YANG Jinsheng
JIA Yunling
YANG Yanhui
Abstract：Objective To explore the therapeutic effects of different endoscopic approaches for patients with pituitary adenoma based on stress response,changes in olfactory function and visual function.Methods The research subjects were selected from 102 patients with pituitary adenoma who received treatment at the First Affiliated Hospital of Henan University of Science and Technology from January 2021 to September 2023,and their clinical data were retrospectively analyzed.According to treatment methods,102 patients were divided into group A(53 cases)and group B(49 cases).The group A was treated with neuroendoscopic transnasal-sphenoid sinus approach,and the group B was treated with neuroendoscopic transnasal submucous sphenoid sinus approach.The postoperative follow-up time was 6 months.The surgical indexes,including olfactory function,visual function,stress response and matrix metalloproteinase 9(MMP-9),insulin-like growth factor 1(IGF-1),silent information regulator1(SIRT1),hypoxia inducible factor-1(HIF-1α),and complications during follow-up were compared.Results Compared with the group A,the amount of intraoperative blood loss and proportion of turbinate fracture/resection in the group B were lower,the times of surgery and postoperative hospital stay were shorter(P＜0.05),while there was no difference of the proportion of total resection of tumors in group A and group B(P＞0.05).6 months after surgery.The scores in the five flavor odor test of both groups at 6 months after surgery were higher than 3 months after surgery(P＜0.05),while group A had lowers cores at 6 months after surgery than before surgery(P＜0.05).At 3 months after surgery,the scores of the five flavor odor test in both groups were lower than before surgery,and group B at 3 and 6 months after surgery was higher than group A(P＜0.05).Compared with the preoperative results,at 1 month after surgery,the standard deviation of visual field pattern(PSD)were decreased,the visual field index(VFI)and mean visual field defect(MD)were increased in both groups(P＜0.05),but there was no difference between the two groups(P＞0.05).Compared with before surgery,the levels of stress indicators at 1 d after surgery were all increased in two groups,but compared with the group A,those in group B were lower(P＜0.05).Compared with before surgery,the levels of serum MMP-9,IGF-1,SIRT1,and HIF-1α at 1 d after surgery were decreased in both groups(P＜0.05),but there was no significant difference between the two groups(P＞0.05).There was no difference of the incidence of complications during the follow-up period between the group A and the group B(P＞0.05).Conclusion Both approaches for treating pituitary adenoma could achieve good tumor resection results and regulate the levels of serum MMP-9,IGF-1,SIRT1,and HIF-1α in patients.The impact on patients'visual function was not significantly different,and the safety was good.However,the submucosal sphenoid sinus approach through the nasal septum had advantages in reducing intraoperative bleeding,nasal nail breakage/resection,shortening surgery and hospitalization time,and affecting patients'olfactory function and stress response.
Keywords：Pituitary adenomaNeuroendoscopyNasal transsphenoidal approachNasal septum submucosal transsphenoidal approachStress responseOlfactory function
Publication Date：2025-02-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 167-172 )