| Part Ⅰ Correlation between intrasellar pressure and imaging features of pituitary adenomaObjective:To investigate the relationship between sex,tumor volume,stroke,cystic degeneration,lateral growth,invasiveness and height of suprasellar expansion of patients with pituitary adenoma with ISP,and to analyze the related influencing factors of ISP.Methods:47 patients with pituitary adenomas who underwent transsphenoidal surgery from January 2018 to November 2019 in the Department of Neurusurgery of Dongfang Affiliated Hospital of Xiamen University were collected.Inclusion criteria:(1)patients with complete medical records;(2)all patients had complete imaging data and underwent pituitary thin layer MRI examination in our hospital;(3)patients with pituitary adenoma confirmed by immunohistopathology after surgery.Preoperative information was collected about patient sex,tumor volume,whether stroke,whether cystic degeneration,whether lateral growth,whether stroke and height of suprasellar expansion,and the tumor volume and aggressiveness were graded.ISP of patients were measured intraoperatively,and ISP of patients with different gender,tumor volume grading,whether they had stroke,whether they had cystic degeneration,whether they had unilateral growth,and whether they had invasive were analyzed postoperatively,as well as whether there was a correlation between ISP with the height of suprasellar expansion and patients’ age.Results:A total of 47 patients with pituitary adenoma were included in this study,including 26 males and 21 females.There were 11 cases of stroke and 36 cases of nonstroke.There were 17 cases with cystic degeneration and 30 cases without cystic degeneration.24 patients were invasive and 23 were non-invasive.ISP showed no significant difference between different genders,whether they had stroke,whether they had invasive,and whether they had cystic degeneration(P>0.05).There were 5 cases of unilateral growth and 42 cases of non-uni lateral growth,and the average ISP between unilateral growth and non-unilateral growth was statistically different(P<0.05).The average ISP of patients with unilateral growth of pituitary adenoma was lower than that of patients with non-unilateral growth.Among the 47 patients,8 had volume grade 0,15 had volume grade 1,and 24 had volume grade 2.There was a statistical difference in the average ISP between grade 0 and grade 2 of volume classification(P<0.05),and the average ISP of patients with volume grade2 was greater than grade 0.Age and the height of suprasellar expansion were not correlated with ISP.Conclusion:There are no significant correlation between the volume of ISP and age,gender,invasive,stroke,cystic degeneration,and the height of suprasellar expansion of pituitary adenoma patients.There is a significant difference in average ISP between pituitary adenomas with different volume classification.With the gradual growth of pituitary adenoma volume,ISP also shows a trend of gradual increase.The average ISP of pituitary adenomas with non-lateral growth is significantly higher than that with lateral growth.Part Ⅱ Study the effect of intrasellar pressure on anterior intercavernous sinus and its clinical significanceObjective:To determine the influence of ISP on different types of AICS would block AICS.Methods:34 patients with pituitary adenomas who underwent transsphenoidal surgery from May 2018 to June 2019 in the Department of Neurusurgery of Dongfang Affiliated Hospital of Xiamen University were collected.Inclusion criteria:(1)successful transsphenoidal surgery;(2)patients with pituitary adenoma whose intraoperative pressure was successfully measured;(3)those without congenital AICS deficiency;(4)no congenital AICS deformity(such as wide AICS deformity).Preoperative collection of patient age,the height of suprasellar extension and volume of tumor;ICP and ISP of patient was measured in operation,and the AICS were graded by three neurosurgeons,in operation.The effects of age,the height of suprasellar extension,volume,ICP and ISP on different AICS classification were analyzed.Results:A total of 34 patients with pituitary adenoma were included in this part of the study,including 13 patients with AICS grade 0,7 patients with grade 1,11 patients with grade 2,and 3 patients with grade 3.The four factors of tumor volume,age,the height of suprasellar extension and ICP did not pass the significance test(P>0.05),indicating that tumor volume,age,the height of suprasellar extension and ICP had no significant influence on AICS grading.ISP passed the significance test(P<0.05),indicating that ISP is an independent risk factor for AICS rating,and every 1 unit increase of ISP can increase the probability of reducing AICS rating by 0.919 times.Conclusion:According to the anatomic performance of AICS estimated by the surgeons in this study,the occurrence rate of AICS in pituitary adenoma patients is about 72%,the incidence of congenital deficiency is about 23%,and the incidence of congenital dysplasia is about 5%.The intraoperative anatomic grading of AICS is not correlated with ICP,tumor volume,suprasellar expansion height,or patient age.The grading of AICS is only related to ISP,and ISP rise caused by the gradual growth of tumor will further cause AICS to gradually block or even disappear.Part Ⅲ The role and mechanism of intrasellar pressure in the formation of the tissue structure of pituitary adenomaObjective:To Discuss the difference ISP,tumor volume and the height of suprasellar expansion between different tissue conformation of pituitary adenomas and explore the formation mechanism of different tissue conformation of pituitary adenomas.Methods:46 patients with pituitary adenomas who underwent transsphenoidal surgery from January 2018 to November 2019 in the Department of Neurusurgery of Dongfang Affiliated Hospital of Xiamen University were collected.Inclusion criteria:(1)patients with complete medical records;(2)all patients had complete imaging data and underwent pituitary thin layer MRI examination in our hospital;(3)patients with pituitary adenoma confirmed by immunohistopathology after surgery;(4)ISP was successfully measured during the operation.Preoperative MRI data of patients were carefully read,and pituitary adenoma was divided into four different tissue conformations:parenchymal group,cordage group,cystic group and spongy group.Meanwhile,tumor volume and the height of suprasellar expansion of patients were measured,and ISP value of patients was measured intraoperatively.Differences in tumor volume,the height of suprasellar expansion and ISP were analyzed among pituitary adenomas with different tissue conformations.Results:In this part of the study,a total of 46 patients with pituitary adenoma were included,including 21 patients with parenchymal type pituitary adenoma,16 patients with cystic type pituitary adenoma,7 patients with sponge type pituitary adenoma and 2 patients with cordage type pituitary adenoma.The average ISP between pituitary adenomas with different tissue conformations was parenchymal type>cordage type>cystic type>spongy type,and there was a statistical difference between the average ISP between the parenchymal type pituitary adenoma and the cystic type pituitary adenoma(P<0.05).There was a statistically significant difference between the average ISP between the parenchymal type pituitary adenoma and spongy type pituitary adenomas(P<0.05).There was no significant difference in average ISP pairwise comparison between other conformations.The average height of suprasellar expansion of pituitary adenoma in the 4 types of tissue conformation was the cordage type>cystic type>parenchymal type>spongy type,and there was a significant difference in the average height of suprasellar expansion between the parenchymal type and the cystic type pituitary adenoma(P<0.05).No significant difference was found in the pairwise comparison of the average height of suprasellar expansion between the other conformations.The average height of suprasellar expansion of pituitary adenomas with different tissue conformations was cordage type>cystic type>parenchymal type>spongy type,and there was a significant difference in the height of suprasellar expansion between parenchymal type and cystic type pituitary adenoma(P<0.05).Pairwise comparison of the average height of suprasellar expansion between other conformations showed no significant difference.Conclusion:In this study,the average ISP among the 46 patients with pituitary adenoma of different tissue conformations is parenchymal type>cordage type>cystic type>sponge type,and there is a significant difference between the average ISP of parenchymal group pituitary adenoma and cystic and spongy type pituitary adenoma.There is a significant difference in the average height of suprasellar expansion of coronal surface between the parenchymal type pituitary adenoma and the cystic type pituitary adenoma among the pituitary adenomas with different tissue conformations.The average height of suprasellar expansion of the pituitary adenoma among the four types tissue conformation is the cordage type>cystic type>parenchymal type>spongy type. |
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