LAUSR

OBJECTIVE Improving the gross total resection (GTR) rate of suprasellar pituitary macroadenomas (SPMAs) using the pure endoscopic endonasal transsphenoidal approach (EETA) has been a long-standing focus of neurosurgeons. This study was aimed at evaluating the influences of the removal of the tuberculum sellae bone (TSB) without opening the dura of the tuberculum sellae (TS) on the GTR rate of SPMAs via the EETA. METHODS We retrospectively analyzed medical reports of patients with SPMAs who underwent the EETA between February 2015 and November 2020. Data on clinical manifestations, endocrinological types, imaging features (Hardy classification, morphology, and texture), clinical outcomes, and TSB removal status were collected. All patients were followed up for six months postoperatively. RESULTS Seventy-eight patients were enrolled in our study. The GTR rates of the TSB removal group (45/78, 57.7%) and non-removal group (33/78, 42.3%) were 80.0% (36/45) and 57.6% (19/33), respectively. Univariate logistic regression analysis (LRA) found that the removal of TSB, rounded morphology, and low Hardy classification were correlated with higher GTR rates. Multiple LRA indicated that even after adjusting for tumor types and imaging features, the removal of TSB had an independent effect on the GTR rate (OR: 7.6, 95% CI: 1.8-31.6, P = 0.005). The incidence rates of postoperative cerebrospinal fluid (CSF) leakage and diabetes insipidus (DI) were not significantly different between the TSB removal group and TSB non-removal group. CONCLUSIONS TSB removal using the EETA without opening the TS dura improves the GTR rate of SPMAs without increasing the incidence of postoperative complications.