학습곡선 상승기 중 비내시경하 경비강 경접형동 뇌하수체 종양 절제술의 임상적 결과
Clinical Results of Endoscopic Endonasal Transsphenoidal Hypophysectomy during an Acceleration Phase of Learning Curve
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background and Objectives The aim of this study was to compare endoscopic endonasal transsphenoidal hypophysectomy (EETSA) with microscopic transseptal transsphenoidal hypophysectomy (MTTSA) in terms of clinical results during an acceleration of learning curve. Subjects and Method A retrospective chart review was performed of the first 14 cases of EETSA and previous 14 cases of MTTSA. Resection results, endocrinologic outcomes, complication rates, operating time, and duration of hospital stay were investigated. A non-parametric analysis was performed to determine the significance of differences between groups. Results EETSA was performed, achieving gross total removal, based on postoperative MRI, for 12 of the 14 patients (86%) and hormonal remission for 4 of the 5 patients (80%); on the other hand, MTTSA was performed, achieving gross total removal for 9 of the 14 patients (64%) and hormonal remission for 1 of the 5 patients (20%). We found better resection results in patients who underwent EETSA than in those who did MTTSA with respect to tumors extending into suprasellar area (p＜0.05). Visual improvement was achieved in all the cases with visual defect (n=5) after EETSA, whereas 4 of 6 cases (66%) were improved after MTTSA. Significant differences in complication rates, operating time and hospital stay could not be determined. All cases with CSF leakage in EETSA were successfully managed by using the nasoseptal flap. Conclusion EETSA provided better resection results than MTTSA did, especially in cases extending into the suprasellar area, showing good hormonal cure and visual improvement rates. Two approaches were comparable with respect to complications during the learning curve.
Abstract
Background and Objectives The aim of this study was to compare endoscopic endonasal transsphenoidal hypophysectomy (EETSA) with microscopic transseptal transsphenoidal hypophysectomy (MTTSA) in terms of clinical results during an acceleration of learning curve. Subjects and Method A retrospective chart review was performed of the first 14 cases of EETSA and previous 14 cases of MTTSA. Resection results, endocrinologic outcomes, complication rates, operating time, and duration of hospital stay were investigated. A non-parametric analysis was performed to determine the significance of differences between groups. Results EETSA was performed, achieving gross total removal, based on postoperative MRI, for 12 of the 14 patients (86%) and hormonal remission for 4 of the 5 patients (80%); on the other hand, MTTSA was performed, achieving gross total removal for 9 of the 14 patients (64%) and hormonal remission for 1 of the 5 patients (20%). We found better resection results in patients who underwent EETSA than in those who did MTTSA with respect to tumors extending into suprasellar area (p＜0.05). Visual improvement was achieved in all the cases with visual defect (n=5) after EETSA, whereas 4 of 6 cases (66%) were improved after MTTSA. Significant differences in complication rates, operating time and hospital stay could not be determined. All cases with CSF leakage in EETSA were successfully managed by using the nasoseptal flap. Conclusion EETSA provided better resection results than MTTSA did, especially in cases extending into the suprasellar area, showing good hormonal cure and visual improvement rates. Two approaches were comparable with respect to complications during the learning curve.
참고문헌 (22)
- Senior BA, "Minimally invasive pituitary surgery", Laryngoscope, 118(10), pp.1842~1855 (2008)
- Sethi DS, "Endoscopic management of lesions of the sella turcica", J Laryngol Otol, 109(10), pp.956~962 (1995)
- Gamea A, "The use of the rigid endoscope in trans-sphenoidal pituitary surgery", J Laryngol Otol, 108(1), pp.19~22 (1994)
- Sonnenburg RE, "The learning curve in minimally invasive pituitary surgery", Am J Rhinol, 18(4), pp.259~263 (2004)
- Hadad G, "A novel reconstructive technique after endoscopic expanded endonasal approaches:vascular pedicle nasoseptal flap", Laryngoscope, 116(10), pp.1882~1886 (2006)
- Kabil MS, "Fully endoscopic transnasal versus transseptal transsphenoidal pituitary surgery", Neurosurg, 48(6), pp.348~354 (2005)
- Dehdashti AR, "Pure endoscopic endonasal approach for pituitary adenomas:early surgical results in 200 patients and comparison with previous microsurgical series", Neurosurgery,62(5),pp.1006-15; discussion, 101, pp.5~7 (2008)
- Tabaee A, "Predictors of short-term outcomes following endoscopic pitu itary surgery", Clin Neurol Neurosurg, 111(2), pp.119~122 (2009)
- Zhang Y, "Endoscopic transsphenoidal treatment of pituitary adenomas", Neurol Res, 30(6), pp.581~586 (2008)
- Sheehan MT, "Preliminary comparison of the endoscopic transnasal vs the sublabial transseptal approach for clinically nonfunctioning pituitary macroadenomas", Mayo Clin Proc, 74(7), pp.661~670 (1999)
- Ogawa T, "Hypophysis surgery with or without endoscopy", Auris Nasus Larynx, 28(2), pp.143~149 (2001)
- Nasseri SS, "A combined,minimally invasive transnasal approach to the sella turcica", Am J Rhinol, 12(6), pp.409~416 (1998)
- 조진희, "비내시경을 이용한 경비강 경접협동 전두개저 수술", 대한이비인후과학회지 두경부외과학, 53(3), pp.135~142 (2010), 대한이비인후과학회
- Helal MZ, "Combined micro-endoscopic trans-sphenoid excisions of pituitary macroadenomas", Eur Arch Otorhinolaryngol, 252(3), pp.186~189 (1995)
- Jarrahy R, "Assessment of the efficacy of endoscopy in pituitary adenoma resection", Arch Otolaryngol Head Neck Surg, 126(12), pp.1487~1490 (2000)
- Kassam AB, "Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap", Neurosurgery, 63(1 Suppl 1), pp.ONS44~ONS52 (2008)
- Zanation AM, "Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery", Am J Rhinol Allergy, 23(5), pp.518~521 (2009)
- Snyderman CH, "What are the limits of endoscopic sinus surgery?:the expanded endonasal approach to the skull base", Keio J Med, 58(3), pp.152~160 (2009)
- Willians PL, "Functional neuroanatomy of Man. 1st ed", pp.1089~ (1975), WB Saunders
- Lanza DC, "Anatomy of human nasal passages. In Handbook of Olfaction and Gustation. 1st ed", pp.69~71 (1995), Marcel Decker, Inx
- Say P, "Resection of the inferior superior turbinate:does it affect olfactory ability or contain olfactory neuronal tissue", Am J Rhinol, 18(3), pp.157~160 (2004)
- Biedlingmaier JF, "Analysis for olfactory epithelium using olfactory marker protein on endoscopically harvested middle turbinates", Am J Rhinol, 10, pp.221~224 (1996)