Application Of Sickle-shaped Incision In Endonasal Transsphenoidal Surgery For Pituitary Adenomas

Background: Pituitayr adenomas are common benign intracranial tumors,accounting for about 10% of intracranial tumors.The incidence of pituitary Adenoma was about 16.7% in the population.Endonasal transsphenoidal approach is the main approach for pituitary Adenoma resection at home and abroad.With the development of endoscopic technique,endonasal transsphenoidal pituitary adenoma resection has become the mainstream.At present,the endoscopic endonasal transsphenoidal approach consists of a longitudinal incision in the nasal septum or a mucosal flap placed in the posterior nasal meatus at the beginning of the operation.The incidence of postoperative epistaxis is 7%,and the incidence of dysosmia is 47%.The conclusion of clinical experience shows that sickle-shaped incision is effective in single nasal endoscopic endonasal transsphenoidal surgery for pituitary adenomas.Objective: To investigate the clinical effect of sickle-shaped incision in single-nasal endoscopic endonasal transsphenoidal pituitary adenoma resection.Methods:A retrospective clinical study was used.The sample cases were from the Department of Neurology,the Second Affiliated Hospital of Dalian Medical University.From January 2018 to June 2019,patients with pituitary tumors underwent neuroendoscopy through the single nasal sphenoid approach.Inclusion criteria include 1.Surgical methods for patients with pituitary tumors through neuroendoscopic single nasal sphenoid approach,postoperative pathological confirmation of pituitary tumors 2.Pituitary tumors are the first,no history of pituitary tumors 3.18 years of age 4.Patients who follow up regularly after surgery.Exclusion criteria include 1.Patients with recurrence of pituitary adenoma 2.Patients with radiotherapy and chemotherapybefore surgery 3.Combining with other neurosurgical diseases,such as meningioma,etc.4.Giant adenomas that invade the floor of the third ventricle,located in the saddle Tumors,tumors in the center of the skull base,and patients who need to make mucosal flaps after surgery.According to the above inclusion and exclusion criteria,a total of 68 patients were collected and divided into sickle-type incision groups and other incision groups(longitudinal incisions)according to the treatment methods received by the patients.Statistic general data,surgery related data,and follow-up postoperative complication data.Results: 1.The results of statistical analysis showed that there were no significant differences in age,sex,Hardy classification,visual field defect and headache between the two groups(p>0.05);2.The results of statistical analysis showed that there were no significant differences in operative time,postoperative hospital stay,tumor size and total resection rate between the two groups(p>0.05);3.Among the postoperative complications,1 case(3.57%) of arterial epistaxis occurred in sickle incision group,and 8 cases(20%)of arterial epistaxis occurred in Longitudinal Incision Group,the difference between the two groups was statistically significant(p<0.05).2 cases(7.14%) of the patients in the sickle incision group and 12 cases(30%)of the patients in the Longitudinal Incision Group had decreased olfaction 3 months after operation,the difference between the two groups was statistically significant(p<0.05);4.There was no significant difference in the incidence of perforation of Nasal Septum,cerebrospinal fluid rhinorrhea and intracranial infection(p<0.05).Conclusion:For Pituitary Microadenoma,macroadenoma,pituitary adenoma located in cavernous sinus and part of pituitary macroadenoma Convex Suprasellar,sickle-shaped incision has the characteristics of less damage to Nasal Mucosa,avoiding damage to sphenopalatine artery,protecting the blood supply of Nasal Mucosa and shortening the healing time of Nasal Mucosa after operation,the utility model can protect the olfactory function to the greatest extent,and at the same time,can fully expose the operation field and operating space.