Study On Postoperative Complications After Endoscopic Endonasal Transsphenoidal Surgery

After modification and refining of endoscopic endonasal transsphenoidal approach since 1960’s,it has been widely employed in the treatment of pituitary adenomas and other parasellers tumors due to its safety and effectivity.In particular,this approach offers a better choice for some special anterior skull base lesions such as suprasellar and clival tumors.In contrast with microscopic transsphenoidal and open transcranial approaches,endoscopic endonasal transsphenoidal approach pemits aggressive resection and superior outcomes via a narrow access corridor with the minimal trauma to surrounding tissue.Major concerns with an endoscopic endonasal transsphenoidal surgery,however,are the risks of cerebrospinal fluid(CSF)rhinorrhea and intracranial infection etc.As endoscopic skull base surgery damaging to the skull,the cranial cavity is easy to transport with the outside and the lack of protection of the skull,dura and blood-brain barrier and other factors,which increase the risk of intracranial infection.Therefore,after tumor removal,a series of measures should be taken to repair the surgical defects to avoid postoperative cerebrospinal fluid(CSF)leak,intracranial infection and pneumocephalus.Postoperative intracranial infection rate has not yet been clearly established,according to previous literature reports cerebrospinal fluid rhinorrhea and intracranial infection rate ranging from0.7% to 10%.The aim of this study was to evaluate potential preoperative,intraoperative and postoperative risk factors for intracranial infection.The surgical operation meticulous on the details of improvement can decrease the occurrence of complications.In order to decrease the suffering of patients,essential operative procedures should be taken or be careful to reduce the incidence of postoperative intracranial infection in patients with nasal endoscopic surgery.Part 1 Incidence and rick factors of postoperative meningitis after endoscopic endonasal transsphenoidal surgeryObjective To identify the incidence,bacteriological characteristics and risk factors for intracranial infection after endoscopic endonasal transsphenoidal surgery.Methods We reviewed 311 consecutive endoscopic endonasal transsphenoidal surgeries performed from 2012–2016 and analyzed preoperative comorbidities,intraoperative techniques,and postoperative care.In this retrospective study,the data are expressed as mean values±standard deviations(SDs)for the continuous variables and as numbers and percentages for the categorical variables.The χ2 test and Fisher’s exact test were used for comparisons when appropriate.A multivariate logistic regression model was used to select factors significantly associated with intracranial infection.All variables were used to compare two groups of patients,including patients with or without postoperative intracranial infection.Analyses were performed using SPSS software v.19(SPSS,Inc.,Chicago,IL),and all P values of 0.05 or less were considered statistically significant.Results In our retrospective study,there were 19 CSF leaks(6.11%)and 18 central nervous system(CNS)infections(5.79%),and culture results were positive in 14 cases and negative in 4 cases.Large diaphragmatic defects(intraoperative CSF leak Kelly grade 3),intraventricular pneumocephalus,huge pneumocephalus(≥1 cm of air)and postoperative CSF leak were risk factors for postoperative central nervous system infections.Conclusion In endoscopic endonasal transsphenoidal approach,intraoperative surgical procedure may occupy a more important role in patients with postoperative intracranial infections.Large diaphragmatic defects(intraoperative CSF leak Kelly grade 3),intraventricular pneumocephalus,huge pneumocephalus(≥1 cm of air)and postoperative CSF leak were risk factors for postoperative intracranial infection.To decrease the suffering of patients,essential operative procedures should be taken or be careful to avoid the large diaphragmatic or dural defects and reduce the opportunity to communicate with the outside.Part 2 Study on the olfactory dysfunction after endoscopic endonasal transsphenoidal surgeryObjective To investigate the incidence of olfactory dysfunction after transsphenoidal surgery and the related influencing factors.Methods 1.1 Standard set reagent In this study,all the olfactory recognition thresholds were quantitatively measured using the T & T olfactory meter to identify the concentration of the odor as the olfactory recognition threshold.The olfactory instrument in the study can simultaneously detect the olfactory perception threshold and the olfactory recognition threshold.1.2 Odor selection criteria:(1)each smell must be able to distinguish with other scents;(2)smell easy to identify,easy for most people feel;(3)the intensity and nature of the smell is more stable;(4)olfactory component of a single,easy processing.1.3 Method of operation: ⑴ test the use of 0.7cm X15 cm filter paper front dip about 1cm length of the olfactory liquid placed in the nostrils below the nose 1 ~ 2 cm,smell 2-3 times,smell the order of the low concentration to high concentrations of detection The In addition,the first threshold test,and then identify the threshold test.When a test of the recognition threshold is performed,the subject is required to identify the taste of the smell,or the like.The sum of the scores obtained by adding the scores of the five olfactory recognition thresholds divided by 5 is the mean value of the olfactory identification valve,and the average is used to determine the degree of olfactory damage.The evaluation criteria are evaluated according to the kit instructions.⑵ postoperative olfactory function determination grading The main evaluation of olfactory disorder in this study: olfactory dysfunction in accordance with the degree can be divided into olfactory recession and loss of smell.The assessment of olfactory disorder in this study is mainly carried out from three aspects: olfactory threshold;olfactory discrimination and odor memory ability.⑶ observation and follow-upIn addition to the preoperative and postoperative 1-week survey,the patients were followed up for 1 month,3 months and 6 months after the time point,the first call to recall all patients to the hospital for endoscopic and sinus CT examination of the assessment,As well as the T & T olfactory meter test.The method of postoperative investigation should be carried out on a face-to-face basis and,if necessary,by telephone.The date of the investigation of the patient’s surgery is controlled within 2 weeks before and after the appointment control time.Use the same inspection room as the survey site.Follow the answer to keep the room quiet,try to avoid the patient’s family to answer and induction.All survey data are unified,each of the two were entered and checked.Results There were 112 patients in this group,of which,there were 5 patients who were lost to follow-up.The patients were followed up for a total of 106 cases.All patients were followed up by T&T.In addition,5 patients were found to have impaired olfactory function,of which,4 cases had slight attenuation of olfactory function,and the second one was moderate attenuation of olfactory function in 1 patients.In this study,the T & T olfactory function level was measured at different time points of follow-up.The time points were selected as preoperative,1 week after operation and 3 months after operation.This study found that about 84.9% of the patients There are varying degrees of olfactory dysfunction.And about 54.78% of patients with severe olfactory dysfunction or loss of olfactory function,the results reported with the previous literature,the incidence of olfactory dysfunction is more consistent.In addition,comparedwith the performance of olfactory function recovery in 1 week after surgery,the olfactory function of 3 months after operation showed a more obvious recovery,and the difference was statistically significant(P <0.05).But compared with the preoperative olfactory situation,the overall postoperative olfactory function of patients did not get completely restored.In addition,the recovery of postoperative olfactory function showed no significant difference in sex,age,and other groups(P> 0.05).Conclusion In this study found that postoperative olfactory loss or loss of patients,nasal olfactory function can be more than 3 months after the nose after the nose to get a better recovery.And those who were completely lost or damaged after the nasal sense of nasal surgery,the recovery of olfactory function was slower,and the level of operation was not reached at 4 months after operation,and it was not possible to determine No get a better olfactory function recovery.Although the incidence of postoperative olfactory dysfunction is low,but with the medical level and the improvement of postoperative quality of life requirements,nasal transsphenoidal surgery postoperative olfactory dysfunction more and more attention by clinicians and patients The It is hoped that through the fine intraoperative operation and postoperative active recovery and prevention,as soon as possible to reduce the incidence of postoperative complications,after the occurrence of positive and effective recovery and treatment.