Relationship On Saddle Diaphragmatic Morphological Between Residual Tumor And Complications During Endonasal Transsphenoidal Resection Of Pituitary Adenoma

Objective:Correlation analysis on diaphragma Sellae(DS) descending shape among residual tumor, diabetes insipidus(DI) and intraoperative cerebrospinal fluid(CSF) leak during endoscopic endonasal transsphenoidal resection of pituitary macroadenoma. Methods:Collecting treated80cases of patients with pituitary macroadenoma confirmed by pathology from February2012to March2013.all cases were operated through nasal endoscopic resection of pituitary adenoma. We classified patterns of descent of the DS into four types:Type A:Uniform descent with the pituitary stalk remaining at the center of the sella turcica. Type B:Asymmetrical descent caused by lateral displacement of the pituitary stalk. Type C:Symmetrical descent on the sella turcica with dorsal displacement of the pituitary stalk.Type D:Minimal or no descent with the pituitary stalk of indistinct location. Results:the incidence of residual tumor,DI and intraoperative CSF leak were not all the same In four type A, B, C, D DS (χ2=11.069, P=0.011;χ2=11.483, P=0.009; χ2=8.890, P=0.029).The possibility of residual tumor was more elevated in types B and D which are statistical significant,Compared with type A and C.(Z=-2.409, P=0.016; Z=-2.062,P=0.039; Z=-2.477, P=0.013; Z=-2.245, P=0.025). residual Tumor rate was not statistical difference between types B and D (Z=-0.791, P=0.429). DI and CSF leak were more elevated in types A and C,which were not statistical significant,Compared with type B and D (P<0.05).DI and CSF leak was not statistical difference between types A and type C (Z=-0.195, P=0.846; Z=-0.362, P=0.717). Conclusion:Pattern of descent of the DS may serve as a reference to determine the risk of leaving residual tumor,CSF leak,as well as the possibility of developing postoperative DI to guide clinical.