The New Classification Method Is Used To Evaluate The Efficacy Of Pituitary Growth Hormone Adenoma Combined With Vacuolar Sella Surgery

Objective To investigate outcomes and identified risk factors affecting cure and intraoperative cerebrospinal fluid leak after transsphenoidal surgery using a new classification for growth hormone-secreting pituitary adenoma associated with empty sella.Methods In this retrospective cohort study,51 patients enrolled from January 2010 to June 2016 were categorized into 3 groups using a new classification scheme:grade A,whole tumor occupation area beneath a horizontal line drawn along the lowest level of empty sella;grade B,tumor occupation area that crossed the horizontal line on 1 side;and grade C,tumor occupation area that crossed the horizontal line on 2 sides.Clinical data were collected and analyzed.Results The incidence of co-occurring GH-secreting pituitary adenoma and ES was 6.54%(51 of 780)of the acromegalic patients in the present study.Cure rate for grade A patients(88.24%;15/17)was significantly higher than cure rate for grade B(55.00%;11/20)and grade C(50.00%;7/14)patients.Occurrence of cerebrospinal fluid leaks in grade C patients(35.71%;5/14)was higher than in grade A patients(5.88%;1/17).Logistic regression analysis indicated that risk factors affecting cure included maximum tumor diameter(P = 0.009,odds ratio[OR]= 1.222),preoperative fasting growth hormone level(P =0.031,OR = 1.088),and grade C of new classification scheme(P = 0.017,OR = 4.485).Risk factor affecting intraoperative cerebrospinal fluid leak was grade C(P = 0.039,OR = 3.580).Conclusions Transsphenoidal surgery is the current optimal treatment strategy.Empty sella increases the difficulty of surgery with a higher incidence of complications.The new classification scheme was better for predicting the surgical outcome for this disease.