| Part I: Postoperative magnetic resonance imaging feature of the Sphenoid sinus mucosa following ranssphenoidal pituitary adenomas surgeryObject: To investigate the changes of MRI performance and related influencing factors in the sphenoid sinus mucosa after transsphenoidal pituitary adenoma resection.Method:(1)We collected clinical,imaging(MRI and CT)and pathological data of 79 patients with pituitary adenoma who following ranssphenoidal pituitary adenomas surgery from January 2012 to August 2016 in Department of Neurosurgery,Fuzhou General Hospital.(2)The imaging data was divided into four periods: preoperative(<2W),early postoperative period(<1W),mid-postoperative period(4?8M),and late postoperative period(>1Y).(3)Pituitary adenomas were be classified radiologically,according to their size,as microadenomas(<1cm),macroadenomas(1?4cm),giant adenoma(>4cm))(4)The postoperative sphenoid MRI findings were observed,such as thickening of the sphenoid sinus mucosa,including Sphenoid sinus mucinous cyst,etc.(5)The effects of gender,age,and surgical factors on inflammation after sphenoid sinus surgery were compared.Results:(1)79 patients with early postoperative MRI could be observed in varying degrees of hematocele and effusion,We considered early postoperative sphenoid sinus changes as postoperative responses.(2)There were 24 cases(30.38%)with inflammatory reaction in the middle postoperative period,including 8 cases(10.13)% of mucinous cysts,and 16 cases(20.25%)of mucosal thickening or effusions.(3)In 79 patients,there were 4 cases of thickened sphenoid sinus mucosa before surgery(all cases were acute stroke).The postoperative sphenoid sinus mucosa were significantly better than before surgery.(4)Among these 79 patients,there were 37 males,of whom 11 had sphenoid sinus inflammation.There were 42 females,of whom 13 had sphenoid sinus inflammation.And 54 cases were over 40 years old,among which there were 8 cases of sphenoid sinusitis and 25 cases below the age of 40,of which 12 cases had sphenoid sinus inflammation.The postoperative sphenoid sinusitis reaction was not statistically different from the age or gender(P>0.05).(5)Among 79 patients,according to the clinical endocrine type,there were 55 cases with no function,11 cases with PRL,10 cases with GH,and 3 cases with ACTH.There was no statistical difference in endocrine type and sphenoid sinus inflammation(P>0.05).(6)There were 76 cases with a clear Ki67 index,including 69 cases with a Ki67 index ? 3 and 21 cases with sphenoid sinus inflammation.There were 7 cases with Ki67>3,among which 3 cases had sphenoid sinus inflammation.There was no statistical difference between sphenoid sinus inflammation and Ki67 index(P>0.05).(7)Among 79 patients,there were 12 cases of preoperative sphenoid sinus cavity,among which 3 cases had postoperative sphenoid sinusitis.38 cases were double-lumenincluding postoperative sphenoid sinusitis in 10 cases;23 cases were three-chambered,including sphenoid sinusitis in 5 cases;there were 6 cases with four-chambered,including sphenoid sinusitis in 4 cases.Preoperative MRI coronal sinus cavity number and postoperative sphenoid sinusitis were statistically different(P<0.05).Conclusions: Transsphenoidal pituitary adenoma surgery had an impact on the normal physiology of the sphenoid sinus.The surgery should pay attention to the protection of the sphenoid sinus mucosa and strengthen the perioperative care.Part two: Postoperative magnetic resonance imaging feature of the Pituitary stalk following ranssphenoidal pituitary adenomas surgeryObjective: To investigate the MRI appearances of the pituitary stalk and the morphological changes after transsphenoidal pituitary adenoma resection.Methods:The imaging and clinical data of 92 patients with pituitary adenomas were collected,which were operated at the department of Fuzhou General Hospital from January 2012 to August 2016.The diameters,lengths,and coronal deviations of the pituitary stalk were measured preoperatively,early postoperatively,and mid-postoperatively,and morphologically observed.Results:(1)There were 46 cases pituitary stalks that were identifiable preoperative of the 92 cases.The preoperative pituitary stalk was roughly centered in 9 cases,the pituitary stalk was left in 19 cases,and the right side was in 18 cases.(2)The preoperative pituitary stalk diameter of the pituitary was 1.08 ? 3.89mm(average 2.38mm),and the pituitary stalk diameter was 1.29 ? 3.43mm(average 2.30mm).(3)The pituitary stalk length was 1.41 ? 11.74mm(average 6.12mm)of 32 cases in preoperation,there were 38 cases of early postoperative pituitary stalk length of 3.61 ? 11.63mm(average 6.93mm),In the postoperative mid-term measurement of 38 cases of pituitary stalk length of 5.37 ? 7.57mm(average 8.83mm).(4)There were 50 cases of posterior pituitary bright spots(54.34%)in the early postoperative period.Conclusion: We found that the diameter of the pituitary stalk returned to normal in mid-postoperative period.The position of the pituitary stalk recovered gradually after surgery.The length of the pituitary stalk gradually increased.The early postoperative pituitary bright spot showed no significant correlation with postoperative diabetes insipidus.Part three: Postoperative magnetic resonance imaging appearance of the normal residual pituitary gland following adenoma resectionObjective: To investigate the re-expansion of the pituitary gland after transsphenoidal pituitary adenoma and to make a correlation analysis.Methods:(1)The imaging and clinical data of 92 patients with pituitary adenomas were collected,which were operated at the department of Fuzhou General Hospital from January 2012 to August 2016.(2)The resection of the pituitary tumor were obseverd.(3)The preoperative position and postoperative changes of the pituitary gland was observed.(4)The re-expansion of the gland was obseverd and to make a correlation analysis.Results:(1)In 96 patients with pituitary adenoma,64 cases(66.67%)were completely removed by imaging and 32 cases(33.33%)were residual after surgery.The primary cause of tumor recurrence was cavernous sinus invasion,followed by suprasellar distension.(2)In 89 patients,except for pituitary microadenomas,including 30 cases of superior type,27 cases of lateral type,31 cases of lateral type,and 1 case of inferior type.(3)In the mid-postoperative period,the volume of pituitary was basically recovered(G1)in 4 cases,most of which recovered(G2)in 23 cases,partially recovered(G3)in 43 cases,and almost no recovery(G4)in 26 cases.(4)The maximum diameter of pituitary tumors was significantly different from that of pituitary adenoma after remodeling(r=0.442,P<0.01).(5)There was no significant difference in the age of patients with remodeling after pituitary adenoma surgery(P>0.05).Conclusion:(1)The MRI from 4?8 months after surgery could accurately determine the residual or recurrence of tumors.(2)Pituitary gland remodeling occursed after pituitary adenoma.When the tumor diameter was larger,the more difficult it was to re-expansion after tumor resection. |
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