A Clinical Study Of Pituitary Adenoma Resection By Trans-single Nostril Transsphenoidal Sinus Approach

Objectives: To summarize the experiences and techniques of trans-single nostril transsphenoidal sinus approach on pituitary adenoma resection by discussing the methods and complications of single nostril transsphenoidal microscopic pituitary adenoma resection.Methods: To select 32 pituitary adenoma patients who are suitable to be operated by trans-single nostril transsphenoidal approach in the First Affiliated Hospital of Dalian Medical University from January 2006 to February 2007. There are 16 males and 16 females among the patients whose ages vary from 18 to 75. There are 4 microadenomas , 19 macroadenomas and 9 gigaadenomas. They were treated with the right single nostril transsphenoidal microscopic pituitary adenoma surgery.Eighteen patients were adopted posterior part incision of nasal septum, we cut the right mucous membrane of posterior part of nasal septum whose distance to anterior sphenoidal wall is 1～1.5cm. Push osteoseptum to the opposite side, expose anterior sphenoidal wall and open sphenoidal sinus to sella turcica. Open the bottom of sella turcica and remove the tumor. Fourteen patients were adopted middle part incision of nasal septum, we cut and free mucous membrane of middle part nasal septum, push cartilaginous nasal septum to the opposite side between cartilaginous nasal septum and osteoseptum. Insert ecarteur and resect parts of osteoseptum to expose anterior sphenoidal wall. Open sphenoid sinus to reach sella turcica after recognizing gap of sphenoid sinus. Open the bottom of sella turcica and remove the tumor.Results: None of patients was dead, the shortest operation time is 30 minutes, the longest operation time 150 minutes, the average time 65minutes. Total resection of the tumor were performed on 27 patients , and subtotal resection of tumor were performed on 5 patients. None of the patients suffered from intracranial infection, no injury of internal carotid artery and optic nerve , no uncontrolled hemorrhoea. Two patients had a delayed cerebrospinal fluid leakage, ten patients had temporary diabetes insipidus. All of those patients were cured after treatment. Eleven patients paid a follow-up visit between 3～6 months after the operation, no recurrence occurred after being rechecked MRI.Conclusion: The pituitary adenoma resection by trans-single nostril transsphenoidal sinus approach, which is used to completely rescet with less trauma and fewer complications,is a reliable and effective method, easy to perform.Objective: To design a simple direction chisel of sellar bottom by studying the clinical significance of individual measure on angle of nasal-sella ,which can help to locate the position of bottom of sella quickly and accurately during pituitary adenomas resection by transsingle-nostril transsphenoidal sinus approach.Methods: ( 1) Select 20 MRI films of head who have pituitary adenomas,mesure the angle of nasal-sella, distance of nasal-sphenoid and nasal-sella through center anteroposterior axes, calculate the distribution range and the average value. (2)Use chopsticks and other materials to make a model of simple direction chisel of sella bottom and demonstrate the principle and method of the operation.Results: The angles of nasal-sella of 20 patients: average value is 35.2°(minimum is 31.0°,maximum is 39.0°); The distance of nasal-sphenoid : average value is 62.6mm(minimum is 54.0 mm,maximum is 72.0 mm); The distance of nasal-sella: average value is 73.6mm(minimum is 64.0 mm,maximum is 86.0 mm).Conclusions: ( 1 ) The angle of nasal-sella should be measured individually. (2)The simple direction chisel of sellar bottom can help to locate the position of bottom of sella quickly and accurately, it is worth applying to clinical practice.