Resumo

ENSENAT, J. et al. Prospective comparative study on 50 patients between microsurgical sublabial transsphenoidal approach and endoscopic endonasal transsphenoidal approach. Neurocirugía [online]. 2009, vol.20, n.4, pp.335-345. ISSN 1130-1473.

Objective. Compare the standard transsphenoidal sublabial microscopic approach with the endoscopic transsphenoidal approach concerning the tumoral invasiveness and resection, complications of the approaches and time of post operative hospitalisation. Material and methods. We realized a prospective, non randomised study with 50 patients. They were operated between 2002 and 2006. All the patients had sellar lesions with different grades of invasiveness of the cavernous sinus as classified by Knosp. The variables included in our study were tumoral invasiveness and operative resection (total, subtotal and partial), optic nerve lesion, postoperative panhypopituitarism, CSF fistula, cranial nerves deficits, epistaxis, meningitis, diabetes insipidus and carotid artery lesion. Our series included 27 males and 23 females ranging from 19 to 80 years old (48 mean). In 23 patients we used the standard sublabial microscopic approach (two patients were excluded) and for 25 patients we used the endoscopic approach. The mean follow up was of 12 months. Results. In our experience the endoscopic technique presents a higher percentage of total resection comparing to the sublabial microscopic approach (60% versus 34,8%) and higher percentage of subtotal resections (32% versus 26%) with a statistical significant difference (p=0,033). The time of hospitalisation was significant shorter for the endoscopic approach group (p=0,001), diminishing by half of the time (3 days) of the microscopic approach group. Concerning the tumoral invasiveness and complications we did not appreciate any significant dissimilarity. We appreciated that a higher grade of invasiveness augments by 3,59 the risk of an unsuccessful surgery. Discussion and conclusion. In our experience the endoscopic technique may favour a better tumoral resection and shorter time of hospitalisation. We did not appreciate differences concerning the complications.

Palavras-chave : Pituitary tumors; Transsphenoidal sublabial approach; Transsphenoidal endoscopic approach; Complications in pituitary surgery; Knosp grades.

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