Résumé :
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The transsphenoidal approach is the “Gold standard” in the treatment of pituitary adenomas. The endoscopic variation of this approach has slowly come to be viewed as a favored alternative in the treatment of pituitary adenomas as a result of its advantages of improved visualization and its insignificant obtrusiveness. The questions that guided the study were 1) What would be the anatomical, endocrine and visual results of the management of pituitary adenomas via the transsphenoidal route? 2) What would the comparison between the results obtained in the series of patients by means of microsurgical and endoscopic techniques reveal? 3) What is the rhinological comorbidity caused by these two techniques? For that 85 patients (44: microsurgery, 41: endoscopy) with a pituitary adenoma and who have previously received neither a surgical nor a radiotherapeutic treatments at the HMRU of Constantine (49 patients) and EHS Cherchell, Tipaza (36 patients) were retrospectively studied. Patients benefited from a prospective follow-up after three and six months with an evaluation of the results: Surgical excision, endocrine control, the evolution of visual deficits, and a postoperative clinical and nasoscopic rhinological examination. Data analysis revealed: 1) Satisfactory tumor resection in 69.51% after three and six months, with no statistically significant difference between the groups operated through microsurgery and endoscopy (p = 0.53, p = 0.9). 2) Controlled endocrine hypersecretion in 70% and 55% at three and six months without statistically significant difference (p = 0.7, p = 0.7). 3) 74.55% of visual improvement at three and six months without statistically significant difference (p=0.8, p = 0.68). 4) No per- or postoperative mortality is noted. The transsphenoidal route remains the surgical treatment of choice for pituitary adenomas, allowing satisfactory results to be obtained in terms of the quality of surgical excision, endocrine control and the recovery of visual disorders without serious ENT comorbidity but biggest series are mandatory to determine if there is a difference when using the endoscopic technique.
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