To Explore The Strategies And Prevention Of Complications About The Pituitary Adenoma Excision Operation By Nasal Transsphenoidal Approach

Objective： To explore the strategies and prevention of complicationsabout the pituitary adenoma excision operation by nasal sphenoidalapproach.Methods： The clinical data of40cases of patients with pituitaryadenoma confirmed by postoperative pathology from Neurosurgery ward3of the first affiliated hospital Of Dalian medical university from January2012to January2012were analyzed retrospectively.22females,18males,the ratio of male to female was4:5, the minimum age is14years old, themaximum age was72years, the mean was43±3; The course of the diseasein patients with6months to4years, the average were1.5±0.5years.Imaging: All patients were made diagnosis of pituitary dynamic byenhanced MRI examination:14cases of micro pituitary adenomas(diameter<1cm)；20cases of large adenomas (diameter1-3cm);6cases ofmacroadenome(diameter>3cm). Laboratory tests: In40cases,28cases ofprolactin(PRL),7cases of growth hormone (GH),3cases of adrenocorticotropic hormone (ACTH),2cases of patients with non-functional pituitary adenomas.Clinical manifestations:18cases of headache,vomiting in5cases,18cases decreased vision, vision disorders15cases(including71/4quadrant anopia for example, accounted for46%, doublethe temporal abstract for8cases,53%),8cases of diplopia, polyuria in5cases,20patients with mammary,17cases of menstrual disorder, loss oflibido in3cases,3cases of skin purple lines. After surgery preparation, allpatients were made a operation that a single nostril sphenoidal surgicalresection. To explore the indications selection, of single nostril sphenoidalsurgery through retrospective analysis of tumor size, tumor resection rate,pathology and postoperative complications, prevention and treatment ofintraoperative methods of operation techniques and postoperativecomplications.7cases of postoperative electrolyte imbalance, expressed assodium, potassium hyperlipidemia, returned to normal after symptomatictreatment; To explore the pathological classification, operation skills andprevention of complications of the single nostril sphenoidal approachsurgery through making retrospectively analyzed to the tumor size, tumorresection and complications.Results：Subsequent visit in Postoperative six months: the whole set ofvision loss in18patients, all alleviate (100%); Vision disorder15cases,14cases alleviate (93%); Diplopia8cases,7cases of relief (87%).17cases ofMenstrual disorder,16cases alleviate(94%); Skin purple lines3cases,2 cases alleviate (66%). The rest of patients after surgery are back to normal.In28cases increased prolactin,2cases of postoperative did not return tonormal (the second review before leaving hospital hormone), but was backto normal after drug treatment of4weeks; The patients with Growthhormone and adrenocorticotropic hormone (ACTH) elevated were back tonormal postoperative one week.Postoperatively3-6months, all the patientswere made MRI, and the whole group of cases of36cases (90.0%), subtotalresection were3cases (7.5%), subtotal resection in most tumor resectionwas1case (2.5%).7cases of postoperative electrolyte disordercharacterized by low sodium, potassium, returned to normal aftersymptomatic treatment;6cases of Diabetes insipidus returned to normalafter treatment by application of acetic acid to glycine vasopressin andpituitrin; Cerebrospinal fluid leak in2cases, to stay in bed, half lyingposition healing after conservative treatment; Postoperative visualimpairment aggravating in1case (for postoperative hemorrhage secondary),emergency recovery after craniotomy hematoma removal; The hypothalamusdysfunction (3cases) and intracranial infection,1cases were cured bymedical treatment. This group of patients with no deaths.Conclusion:It is the preferred surgical procedure for treatment of pituitaryadenomas by single nostril sphenoidal approach of pituitary adenomaresection, as the body function of small trauma, rapid recovery, curativeeffect, fewer complications and low death probability. But there are some complications that jeopardizing the health of patients,and some of which isfatal complications. Therefore, we should grasp the operation indicationstrictly, and make preoperative check to fully understand the relevantcharacteristics and anatomical structure of the tumor, and takeintraoperative good surgical technique and fine operation as far as possible,and familiar with the occurrence of postoperative complications cause andtreatment strategy, to improve the patient’s quality of life and prolongsurvival time.