The Causes Analysis And Treatment Of Main Complications After Transsphenoidal Surgery For Pituitary Adenoma

Objective: To investigate the causes of complications after transsphenoidal surgery for pituitary adenoma and summarize the experience of treatment.Methods: The clinical data of 120 patients with pituitary adenoma who were treated in Guizhou Provincial People's Hospital from January 2015 to June 2017 were retrospectively analyzed.The patients were followed up for six months to 2 years.The main symptoms,signs,imaging finding and endocrine data,surgical procedures and pathological diagnosis were specially analyzed,and the postoperative complications and therapeutic effects were summarized.Only diabetes insipidus,hypopituitarism and cerebrospinal fluid leakage were analyzed statistically in this paper.The patients were divided into 2 groups: giant adenoma and micro-large adenoma and the incidence of complications was compared.The incidence of complications was compared according to whether high flow cerebrospinal fluid leakage and the pituitary and pituitary stalk damaged during operation.The data were processed with SPSS 22 and P value less than 0.05 was statistically significant.Results:1.The overall postoperative complications:The 54 cases of complications were from 120 patients with pituitary adenoma underwent surgery.There were diabetes insipidus in 47 cases,hypophysis dysfunction or preoperative hypopituitarism aggravated in 17 cases,postoperative cerebrospinal fluid rhinorrhea in 3 cases,intracranial infection in2 cases who were secondary to cerebrospinal fluid rhinorrhea,visual dysfunction in 2 cases,subarachnoid hemorrhage in 2 cases,nasal bleeding in 3 cases,delirium in 1 cases,death in 1 cases(the incidence of complications was 45.0%).The patients with these complications were followed up for six months to 2 years after active treatment.36 cases were cured.18 cases including 17 cases of hypopituitarism(2 cases with permanent diabetes insipidus)and 1 cases of mild cognitive impairment were improved.2.The postoperative complications occurred in 25 of 26 patients with giant adenomas.The postoperative complications occurred in 29 of 94 patients of micro adenomas and large adenomas.The incidence of postoperative complications in the giant tumor group was higher than that of the micro adenoma and large adenoma group(P < 0.001).3.All patients had diabetes insipidus after operation and 17 cases had hypopituitarism in21 patients of the pituitary or pituitary stalk injured.The postoperative diabetes insipidus occurred in 26 patients without obvious pituitary and pituitary stalk injuries in other 99 patients.The incidence of diabetes insipidus and hypopituitarism was higher than that of those without pituitary or pituitary stalk injury(P < 0.001).4.The cerebrospinal fluid(CSF)rhinorrhea occurred in 3 cases among 21 patients with high flow cerebrospinal fluid leakage during operation.No postoperative CSF rhinorrhea occurred in other 99 patients without high flow cerebrospinal fluid leakage during operation.The incidence of CSF rhinorrhea increased significantly in patients with high flow cerebrospinal fluid leakage during operation(P < 0.005).Conclusion: 1.The main causes of the complications were the huge tumor,the pituitarium and pituitary stalk intraoperatively damaged,the high flow cerebrospinal fluidleakage during operation and unsatisfied reparation of sella base.2.The maximum protection of the pituitarium,pituitary stalk and nerve vessels around the tumor should be stressed during the operation for prevention of complications.The complete reconstruction of the sella base also can effectively reduce cerebrospinal fluid rhinorrhea and the incidence of complications.3.It is very important to observe the changes of the condition of patient closely after operation and to find and treat the complications as soon as possible.