Clinical Use Of Transsphenoidal Transtuberculum Sellae Approach In The Resection Of Gigantic Pituitary Adenomas

Pituitary adenomas is a kind of benign tumors which has a incidence from 1/100000 to 7/100000. The tumors are often found among people aged from 20 to 50 which have a little difference between male and female. But in autopsy the the incidence of subclinical pituitary adenomas is 20% .The pituitary adenomas cases have increased year by year because the development of the endocrinous diagnosis techniques, neuroradiology, and microsurgery.Transsphenoidal approach has little injury to patients, low mortality rate and few complications. It is the first choice in the process of the resection of pituitary adenomas and other sellae tumors. But it is difficult to ablate the tumors which extended to supradiaphragm or cavernous sinus, for example, gigantic pituitary adenomas, cranio-pharyngioma, meningomas, chordoma and so on. In order to solve these problems, many neurosurgeons explore some modified transsphenoidal approach: extended trnssphenoidal approach, such as trnassphenoidal-transtuberculum sellae approach or transmaxillary-transsphenoidal approach.With the development of endoscope, neuronavigation and operative MRI use in transsphenoidal operations, the approach is becoming a safe and mini-injury operation method. Extended transsphenoidal approach will be used more widely in the future. The thesis is to research on the correlated anatomy and operation techniques and clinical use of the transsphenoidal- transtuberculum sellae approach.Objective: To discuss the correlated anatomy, operative techniques and clinical use of the transsphenoidal-transtuberculum sellae approach. Method: We collect 15 patients from the neurosurgery department of Qilu Hospital from September 2002 to December 2004, aged from 19 to 50, with a average of 35.5, including 6 males and 9 females. Nine cases are prolactinomas (PRL), four cases are growth hormone (GH) secreting tumors, and two cases are non-functional adenomas. They have a course of diseases from 1 to 12 years. All the patients are operated by transsphenoidal -transtuberculum sellae approach, before operation; they are all examed by MRI and CT, endocrine examinations. And the same items are examed again after operations to evaluate the effect.Result: Among 15 patients, 4 cases were completely resected and 9 subtoally resected, 2 are resected in greater part. One case has cerebrospinal rhinorrhea, two cases have diabetes insipidus, and one case has with hyponatremia. Endocrinous test prove that the hormone level descend in different degree. With a postoperative follow-up from 2 months to 2 years, no patient recrudesce.Conclusion: Transsphenoidal-transtuberculum sellae approach can provided enough view in the operation and have a satisfied ablation of the tumors which extended to supradiagragm . It is the important supplement to the classical transsphenoidal approach, and enlarge the indication of the transsphenoidal approach.