The Analysis And Research Of Treatment On Invasive Pituitary Adenoma With Endoscope-Assisted Single Nostril Transsphenoidal Approach

Objective: Combined with the review and summary of related literature,to raise the awareness of the features of invasive pituitary adenoma,retrospective investigation and analysis were conducted in the clinical data of 38 cases with endoscope-assisted transsphenoidal approach.Withstudying the type of pituitary adenoma,its aggregated degree prior to the operation,postoperative complications,and follow-up visits of the patients,summarizing the feature of the pituitary adenoma,exploring the clinical experience for tumor resection by endoscope-assisted transsphenoidal approach,including the method,technique,postoperative,complications,treatment,the total and near total removal rate of the tumor would be expected to enhance,which enables the patients have a relief or delay of symptoms as well as no recurrence.Method: The clinical records and medical images of 38 cases have been collected and analyzed through review,in which the patients were diagnosed of IPA in conformity with standard clinicaldiagnosis and had received transsphenoidal surgical removal throughneuroendoscope in our hospital from Jan,2010 to May 2015.Before the tumors being removed through transsphenoidal surgery,all the 38 patients had been treated with hormone level test,overall clinicalexamination and complete imaging study.At the same time,the features of IPA,the method and skills of transsphenoidal surgery through neuroendoscope,and the experience of treating the postoperative complication analyzed and summarized through reviewing the clinical literature.Result: Among the 38 IPA cases of transsphenoidal surgery throughneuroendoscope,there are 33 cases(86.84%)in which the patients are recovered on the basis of imaging study,and 4 cases(10.52%)in whichthey need to take hormone medicine for a long-term treatment because their growth hormone and prolactin appear higher above the standard after internal secretion test.There are 3 cases(7.89%)in which all the index ofinternal secretion of postoperative examination were normal but became abnormal again in the process of supervision,and one case(2.63%)in which postoperative hormone levelappeared lower than normal.Cases of operative complication are as follows: one case(2.63%)of impaired vision;one case(2.63%)of anosmia;3 cases of cerebrospinal fluid rhinorrhea;2 cases of recovery after lumbar cistern drainage and anti-infective therapy;one case of recovery after a make-up transsphenoidal surgery through neuroendoscope because of intracranial infection and after lumbar cistern drainage and anti-infective therapy;4 cases(10.52%)of diabetes insipidus;3 cases(7.89%)of recovery fromtemporary diabetes insipidus hypopituitarismafter medicine therapy;one case(2.63%)of eternal diabetes insipidus along with,necessary to take hormone medicine for a long-term treatment;one case(2.63%)of eternal diabetes insipidus along with hypopituitarism,necessary to take hormone medicine for a long-term treatment;3 cases(78.94%)of recovery from temporary diabetes insipidus after medicine therapy;one case(2.63%)ofhypopituitarism,necessary to take hormone medicine for a long-term treatment;30 cases(78.94%)of improvement in clinical symptoms to different extent before surgery operation;3cases(7.89%)of relapse;tumor internal carotid artery circumvented above 50%;28 cases of C level of Wilson-Hardy;26 cases(92.85%)of complete removal;2 cases of remaining part of tumor;one case(3.57%)of relapse;2 cases of D level of Wilson-Hardy,with remaining part of tumor after operation;one case(50%)of relapse;one caseof E level of Wilson-Hardy,with remaining part of tumor,and with postoperative relapse(100%),having to take an operation again to remove the relapsed tumor.During the following visits,there has not been any case of death.Logistic regression analyzed that only two factors-size were statistically significant,with corresponding value P is 0.0113 and 0.0433 respec tively,as well as the corresponding OR value is 7.732 and 4.778 on th e level of a=0.05.The 4.4778 OR value of hardy showed that “the high er grade tumors” are 4.4778 times as difficult as “the lower grade tumor s”,which means the higher grade tumors were hard to be removed com pletely.The 7.732 OR value of size showed that “the bigger grade tumo rs” are 7.732 times as difficult as “the smaller grade tumors”.Conclusion: Single-nostril transsphenodial surgery through neuroendoscope to remove invasive pituitary adenoma,the success rate by one operation has been enhanced as the surgery through neuroendoscope has the advantages of quicker recovery,less trauma and less complications,clearer operation field,and less hurting mucosa of nasal cavity so as to remove the tumor thoroughly without any of its remnant.Most of the invasive pituitary adenoma could be removed by transsphenoidal surgery through neuroendoscope meanwhile we could find that the curative effect is closely related to the proficiency as well as the anatomy knowledge of the operator.transsphenoidal surgery through neuroendoscope to remove invasive pituitary adenoma,the success rate by one operation has been enhanced as the surgery through neuroendoscope has the advantages of quicker recovery,less trauma and less complications,clearer operation field,and less hurting mucosa of nasal cavity,and the advantage that the tumor can be seen clearly from every direction by using neuroendoscope so as to remove the tumor thoroughly without any of its remnant.According to the logistic regression analysis,the higher grades of hardy tumors are difficult to be excised totally.As a result,it is necessary for operator to master strictly the operation indication of the invasive pituitary adenoma with higher grade,improve the knowledge learning of the neuroanatony,grasp expertly the operation skill of the transsphenodial surgery through neuroendoscope and gather more operation experience so that perfect the transsphenodial surgery through neuroendoscope to remove invasive pituitary adenoma.At the same time,the postoperative treatment should tend to be individual and comprehensive so as to to meet the standards satisfactorily which will biologically cure or control the invasive pituitary adenoma.