Is endoscopic diving technique effective in surgical management of functioning pituitary adenomas? A prospective randomized study.

Donata Sukyte-Raube, Davide Locatelli, Paolo Castelnuovo, Mustafa Haseeb Alali, Eugenijus Lesinskas
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Abstract

Purpose: This study aimed to evaluate the effectiveness of the Endoscopic Diving Technique (EDT) as an adjunct to endoscopic endonasal transsphenoidal surgery in improving remission rates in patients with functional pituitary adenomas. The primary research question was whether EDT enhances early endocrinological and radiological remission without increasing surgical complications.

Methods: A prospective randomized trial was conducted at Vilnius University Hospital Santaros Klinikos between 2021 and 2023, with 141 patients diagnosed with functional pituitary adenomas. Seventy-eight patients met inclusion criteria and were randomly assigned to either the EDT group (n = 43), which included an additional endoscopic hydroscopy step, or the non-EDT group (n = 35). Follow-up assessments were performed at 3, 12, and 24 months to evaluate endocrinological and radiological remission. Additional parameters analyzed included surgical complications, operative duration, and water volume used for EDT.

Results: The EDT group demonstrated significantly higher early endocrine remission rates (83.7% vs. 60.0%, p = 0.023) and fewer radiological relapses at 3 months (86.0% vs. 68.6%, p = 0.097), 12 months (81.4% vs. 62.9%, p = 0.078), and 24 months (69.8% vs. 42.9%, p = 0.022). Surgical complication rates were comparable between the groups (4.7% vs. 2.9%, p = 1.000).

Conclusion: The implementation of EDT as an adjunct to transsphenoidal surgery is associated with improved endocrinological and radiological remission rates in functional pituitary adenomas without increasing surgical risk. EDT enhances visualization of the sellar cavity, facilitates tumor removal, and reduces venous hemorrhage, making it a valuable addition to standard surgical practice.

内镜潜水技术在功能性垂体腺瘤的手术治疗中有效吗?一项前瞻性随机研究。
目的:本研究旨在评估内镜下潜水技术(EDT)作为内镜下经蝶窦手术的辅助手段在提高功能性垂体腺瘤患者缓解率方面的有效性。主要的研究问题是EDT是否能在不增加手术并发症的情况下增强早期内分泌和放射学缓解。方法:2021年至2023年,在维尔纽斯大学医院Santaros Klinikos进行了一项前瞻性随机试验,141例诊断为功能性垂体腺瘤的患者。78名患者符合纳入标准,随机分配到EDT组(n = 43)和非EDT组(n = 35), EDT组包括一个额外的内窥镜检查步骤。随访3个月、12个月和24个月评估内分泌和放射学缓解情况。分析的其他参数包括手术并发症、手术时间和用于EDT的水量。结果:EDT组在3个月(86.0%比68.6%,p = 0.097)、12个月(81.4%比62.9%,p = 0.078)和24个月(69.8%比42.9%,p = 0.022)的早期内分泌缓解率显著高于EDT组(83.7%比60.0%,p = 0.023),放射学复发较少。两组间手术并发症发生率具有可比性(4.7% vs. 2.9%, p = 1.000)。结论:EDT作为经蝶手术的辅助手段,可改善功能性垂体腺瘤的内分泌学和放射学缓解率,而不会增加手术风险。EDT增强鞍腔的可视化,促进肿瘤切除,减少静脉出血,使其成为标准手术实践的宝贵补充。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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