| Objective: In this study,we set out to define our institutional criteria for patient eligibility for endoscopic extended transnasal approach resection of complex pituitary adenoma and suprasellar pituitary adenoma,and to report our experience with extended transnasal approaches for these lesions.We aimed to discuss the important considerations of patient selection and risk stratification to optimize outcomes for patients with these difficult lesions,and also include considerations that should be reviewed during surgical approach selection.Methods: Medical records from the First Affiliated Hospital of China medical university neurosurgery department were retrospectively reviewed for all patients who underwent endoscopic extended transnasal treament for complex pituitary adenoma and suprasellar pituitary adenoma from September 2012 to April 2018(77 procedures).Patients undergoing surgery for complex pituitary adenoma were identified and patient data were collected,including general information,clinical symptoms,imaging data,surgical video,pathological data,hormone examination and other data.According to the growth direction of the suprasellar part of the tumors and Hardy classification system,77 cases of tumors were classified and graded.Chi-square test and other statistical methods were used to analyze the related factors of age,sex,tumor size,tumor texture,and different classification and grading of tumors with the degree of tumor resection,so as to clarify the correlation between the clinical characteristics of such tumors and the degree of resection.Results: 77 patients(37 females and 40 males)underwent extended endoscopic transnasal resection of tumors during the study period(71 primary tumors and 6 recurrent tumors).The average age of the patients was 46 years(range: 17-71 years).The median length of follow-up was 17 months(range: 5-72 months).The median diameter of the largest tumors in 77 patients was 2.1 cm(range 1.4-4.2 cm).54 patients initially presented with visual field deficits and visual impairment,17 patients presented with headache,3 patients presented with facial changes and acromegaly,and 3 patients presented with hydrocephalus.26 cases of hard and tough tumors,38 cases of soft tumors and 13 cases of mixed tumors were identified during the operative process,respectively.Pathological examination confirmed that all patients were pituitary adenomas,including 73 non-functional pituitary adenomas and 4 functional pituitary adenomas(3 growth hormone adenomas and 1 thyroid stimulating hormone adenoma).Previous interventions included craniotomy in two cases,transnasal surgery in three cases,gamma knife radiotherapy in one case,and Sandostatin LAR(Octreotide Acetate Microspheres for injection)in one case.Complications included three readmissions(one on the third day after discharge for fever,two on 48 hours after discharge for epistaxis),diabetes insipidus in 10 cases,hyponatremia in 7 cases,and the development of cerebrospinal fluid rhinorrhea in 4 cases.One patient died of intraventricular hemorrhage and hydrocephalus after operation.Statistical analysis showed that the maximum tumor diameter,tumor texture,classification according to the growth direction of suprasellar tumors and Hardy classification system had statistical significance on the degree of resection(P values were 0.028,< 0.001,0.005,0.031,respectively).Conclusion: Considering the factors such as selection of surgical patients,tumor size,tumor consistency,tumor location and surgeon's preference for surgical approaches,extended endoscopic transnasal surgery can be used to resect or debulk complex pituitary adenoma and suprasellar pituitary adenoma safely and with favorable outcomes... |
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