The Study Of Resecting Pituitary Adenoma By Microsurgery Through Pterional And Frontal Approach.

Objective: The pituitary adenomas is a familiar nature tumour occurred at the front of pituitary.It is one of the best familiar tumour of encephalic. The incidence of a diseaseof it is about 10%-15% in all encephalic tumour.Its cure means include medication,excision and radiotherapy.And the excision is the first cure means.Now the Surgical approaches were trans pterional sinus approach, transinferior frontal approach, transsphenoidal sinus approach and subfrontal transsphenoidal sinus approach. There were literation report on microsurgical technique of pituitary adenomas treated through transinferior frontal approach at present,and there are short of clinical study about its curative effect of after operation and correlative complications thoroughly and systemically.With selecting the proper Surgical approaches and microsurgical technique can increase the inpatient's curative effect of after operation ,decrease complications after operation. The pituitary microadenoma was treated transsphenoidal sinus approach. The pituitary macroadenoma were treated transinferior frontal approach, transsphenoidal sinus approach and subfrontal transsphenoidal sinus approach . curative effect of after operation and correlative complications stressly so that theory are offered for guiding clinic and increasing curative effect.Methods: This data have 60 cases, 21 cases of male and 39 cases of female.This study's seclecting standard include:1 age;2 There are integrated paper of image before operation;3 There are integrated index of endocrinology; 4. All patients have been cured by the microsurgical technique of pituitary adenomas treated diffrient surgical approaches.5.The same cure means are adopted both before and after operation.These patients were divided into three groups by their tumour diameter. Group A(10 cases) was pituitary microadenoma with tumour diameter within 1 cm; Group B(35 cases) was pituitary macroadenoma with tumour diameter within 1-3 cm; Group C(15 cases) was pituitary macroadenoma with tumour diameter across 3 cm; Microsurgecal technique,curative effect and complications of all these pituitary adenomas were assessed statistically. All these pituitary adenomas have been treated microsurgically by diffrient surgical approaches.All these pituitary adenomas were assessed statistically by their excision rate of vary tumour diameter, estimating the influence of vary tumour diameter to excision rate. And the clinical effect were observed by incretion of all these pituitary adenomas of operation. All complications of vary Group after operation were statistically investigated . It was assessed by the statistical software of SPSS11.5.The data were expressed by x|-±s .The equal count of multi-sample were compared by F test. Averages of two group were compared by t test, and the result were considered with notability difference by p<0.05.Results: 1 Totally removal rate The data show that the totally removal rate had decreased sharply with the increasing of tumour diameter. Totally removal rate was 100% in tiny pituitary adenomas, 82% in large pituitary adenomas , 77% in giant pituitary adenomas. The totally removal rate of Group A were sharply higher than Group B and Group C (p<0.05) , Group B and Group C hadn't statistics means (p>0.05) .2 Endocrinol results PRL measure range: 40 - 1250ng/ml , average 372±101ng/ml, among them PRL>200ng/ml 28 cases,It was found by statistics analyse that the level of PRL of Group B and Group C had notability difference than Group A before operation (p<0.01) .The PRL of male and female patient were 810.9±235.7ng/ml and 471.5±144.5ng/ml before operation .There were statistics means (p<0.01) between them.The results show that the level of PRL at Group A ,B,C all had been decreased sharply after operation microsurgically by frontal approach3 Complication rate The complications of pituitary adenomas after operation always included urine collapse, electrolyte turbulence, nerve centre fever, pituitary low-function and alimentary canal bleeding ect. The higher complications rate after operation is urine collapse, always to 68%.There were 40% 74% and 73 % in Group A ,B and C partly. And electrolyte turbulence rate were 50% 80% and 73% in Group A ,B and C partly. This results show that the urine collapse and electrolyte turbulence rate in Group A were sharply under than them in Group B and C (p<0.05) .Conclusion: 1. The pituitary macroadenoma always with transplating were treated transinferior frontal approach.2. The large pituitary adenomas were resected trans pterional approach.3. The pituitary microadenoma were resected transsphenoidal sinus approach.4. Curative effect of pituitary microadenoma was better than pituitary macroadenoma.