Clinical Analysis Of 42 Cases Of Neuroendoscopic Nostril-transsphenoidal Surgery Of Pituitary Adenomas

Objective: Explore the technique and observe the clinical effect of neuroendoscopic nostril-transsphenoidal surgery for pituitary adenomas.Methods: Summarize 42 cases of pituitary adenomas from June 2015 to December 2016 which under the treatment of endoscopic surgery from same surgeon,all of the patients completed MRI,CT and related hormone test.Patients were treated under general anesthesia neuroendoscopic nostril-transsphenoidal surgery and enforced reliable sellar floor reconstruction.No cerebrospinal fluid leakage occurred in the operation,extract the nasal gauze after three days.Oppressing with catheter balloon for a week when cerebrospinal fluid leakage occurred in the operation,and extract the nasal gauze after 2weeks.The routine use of antibiotics for a week,if cerebrospinal fluid leakage occurred in the operation,prevent infection with third generation cephalosporins for 12 days.Follow-Up for 6-12 months and review MRI and pituitary hormone.Results: 37 cases were gross total resection,1 case of mixed pituitary adenoma and 2 cases of hard texture adenoma were small amount of residue,and a little portion of residue of 2invasive pituitary adenomas.The hormone levels of 19 cases of functional pituitary adenoma recovered to normal,the diabetes insipidus were occurred in 11 cases,9 cases were cured,and 2 cases were improved significantly.No cases occurred postoperative pituitary hypofunction who preoperative pituitary function were normal,4 cases of preoperative hypopituitarism were given alternative medicine,and discontinued the alternative medicine when function of pituitary recovered after 2 months.One giant pituitary adenoma with noncommunicating hydrocephaly occurred bled after surgery and aggravated the hydrocephaly,so completed diaphragma ventriculorum lateralium stoma by neuroendoscope and recovered well.2 cases of sphenoid sinusitis,no olfactory disorder and nasal discomfort.4 cases of cerebrospinal fluid leakage occurred after operation,and cured by raised head position and lumbar cisterna drainage for 7-14 days.Conclusion:The effect of pituitary tumor exposure is satisfied in neuroendoscope nostril-transsphenoidal surgery,it is safe and effective to protect the normal pituitary and pituitary stalk,the surgery can maximum range and more safely to resect pituitary adenoma with less postoperative complications.