Clinical Application Of Multimodal Navigation Operation Technique Assisted Neuroendoscopic Resection Of Invasive Pituitary Adenoma

Purpose: The invasive pituitary adenomas could invade and destruct to peripheral neurovascular structures,and the intraoperative injury and bleeding of cavernous sinus or adhesive arteries were the main cause of the high incidence of complications after neuroendoscopic resection.To this end,we explore the application and effect of multimodal navigation surgery technique in the neuroendoscopic resection of invasive pituitary tumors.Methods: We conducted a retrospective analysis of clinical data of patients who underwent neuroendoscopic invasive pituitary adenoma resection at the First Affiliated Hospital of China Medical University from January 1,2016 to January 1,2019.The patients were divided into multimodal group and control group according to the guidance of multimodal neuronavigation technology during the operation.In this study,we compared the differences between the multimodal group and the control group in terms of gender,age,tumor size,Knosp classification,degree of surgical resection,postoperative complications and tumor recurrence.Results: We retrieved 69 patients in this study,including 35 patients in the multimodal group and 34 patients in the control group.Postoperative pathological examination confirmed that all resected tumors were pituitary adenomas.There were no statistical differences between the two groups in terms of gender,age,tumor size and Knosp classification.In the multimodal group,33 cases(94%)were completely resected,and 24 cases(71%)were completely resected in the control group.The total resection rates were statistically different between the two groups(p=0.009).Thirteen patients(5 in the multimodal group and 8 in the control group)had newly diagnosed hypopituitarism,which were improved by using appropriate hormone therapy.During the follow-up period,4 cases of recurrence occurred in the multimodal group,and 7 cases of recurrence occurred in the control group.The remaining 58 patients recovered well after operation,and there was no obvious sign of recurrence.Conclusion: Multimodal navigation surgery technique showed the positional relationship of anatomical landmarks,tumor and their surrounding neurovascular structures before surgery through image fusion and three-dimensional reconstruction,which effectively improved the total resection rate of invasive pituitary adenomas,and reduced the complications.It provides an effective adjunct to neuroendoscopic resection of invasive pituitary adenomas.