Endoscopic Transsphenoidal Approach For Pituitary Adenomas:Clinical Efficacy And Prevention Of Complications

Objectives To explore the clinical efficacy and prevention of complications of endoscopic transsphenoidal approach for pituitary adenomas.Methods We collected and retrospectively analyzed the clinical data of210patients with pituitary adenomas undergoing endoscopic transsphenoidal approach via single nostril in the neurosurgery department of Qilu Hospital of Shandong University:male106, female104, including150cases of nonsecreting adenomas,60cases of endocrine-active adenomas:34cases of growth hormone adenomas,18cases of adrenocorticotropic adenomas,8cases of prolactinomas(diameters of the tumors:<lcm in14cases,1-3cm in118cases,>3cm in78cases; involving cavernous in45cases). All patients underwent purely endoscopic endonasal surgery via single nostril. Follow-up period ranged3-32months, including: if there is residual tumor tissue or tumor recurrence, urine output, hormone levels, vision recovery and so on.Result Total removal was achieved in170cases(81%), subtotal removal in5cases(2.4%), and partial removal in35cases(16.6%).After the operation,63cases (30%) were found with DI,25cases(11.9%) with hormone deficiency,4cases(1.9%) with cerebrospinal fluid leakage,4cases(1.9%) with infection,2cases(0.9%) with epistasis,1case(0.9%) with vision deterioration,1case(0.9%) with death. By the end of the follow-up period:18cases(8.5%) with hypopituitarism,2cases(0.9%) with permanent DI. No case relapsed.Conclusions1.Pituitary adenomas under Knosp II level can be removed with high total removal rate via endoscopic transsphenoidal approach,.2.Mastering the anatomical structure of the nasal cavity and the skull base and recognition of various anatomical landmarks are prerequisites for surgery.3.The correct positioning of the midline, effective hemostasis and gentle surgical operation during nasal phase, sphenoid phase and saddle phase can increase efficiency and reduce postoperative complications.4.Sufficient perioperative preparation, careful and correct intraoperative operation as well as timely and correct conduction during postoperative time are key factors for prevention and cure of postoperative complications. To reach these rigorous requirements and standards, neurosurgery doctors must strengthen exchanges and cooperation with ENT, endocrine and other disciplines except for rich clinical experience and skilled operation.