| ObjectPituitary Adenoma(PA) is the second of the incidence of intracranial primary benign tumors. Surgical resection is the first choice to most of them. Endoscopic endonasal transsphenoidal surgery(EETS) has been recognized as the most preferred way of surgical approach. EETS can provide good short-distance lighting, panoramic and angled view, muti-angled observation, detailed intrasellar and suprasellar structure and less trauma. However, there are some unsolved problems with EETS: lower total resection rate and more intraoperative and postoperative complication, especially, cerebral spinal fluid(CSF) leakage. To reduce and prevent the incident of introoperative CSF leakage, neurosurgeons have universally accepted lumbar CSF drainage intraoperatively and regarded it as a beneficial means. Nevertheless, the influence of lumbar CSF drainage to pituitary adenoma to gross total resection(GTR) rate and intraoperative postoperative complication has not been reported up to now. 176 patients who received EETS with pituitary macroadenomas were recruited in this study. All the cases received lumbar CSF drainage preoperatively and CSF release intraoperatively to reduce the tension of diaphragm sellae. The PA GTR rate and complication intraoperatively and postoperatively was analyzed. The effect of lumbar CSF drainage in EETS was discussed. MethodBetween January 2013 and October 2014, there were 176 cases of PA who received EETS in 6th Neurosurgery Ward, TangDu Hospital, the Forth Military Medical University. Finished the preoperative examination, all patients were informed consent. After the completion of the general anesthesia, lumbar CSF drainage was done and shut. All the surgery was operated by a same sole experienced doctors. The surgery was done by conventional programme, CSF was been released and recorded according to the extent of diaphragm sellae collapse, intraoperative CSF leakage and PA total resection was been observed. Routine therapy and long-term follow-up was afforded to all the cases, and postoperative complication was observed. The data of hospitalization and follow-up was recorded and sorted. Comparing with literature and previous data of our department and analyzing by SPSS 22.0 statistical software, with a P value of < 0.05 was considered statistically significant. ResultA total of 176 PAs were treated by EETS, with males 90 cases(51.1%) and females 86 cases(48.9%).The mean age was 45.5±17.5yrs. The follow-up period is between 1 and 21 months. 176 cases received lumbar CSF drainage and then diaphragm sellae went up, the volume of CSF was released in 20 ml in 16 cases, 40 ml in 80 cases, 60 ml in 70 cases, 80 ml in 10 cases,respectively, with a average volume of 48.4ml. On GTR rate in the study, macroadenoma was 148cases(96.1%), giant adenoma was 20cases(90.9%), and the GTR rate was higher than the data from our department prior 2013 and other researches in recent years(P<0.05). The GTR rate in endoscopic and magnetic resonance imaging(MRI) was 96.6% and 95.5%, respectively, and was obviously higher than the data from our department prior 2013(P<0.001). Intraoperative CSF leakage was observed in 27cases(15.3%), and it was lower than the data from our department prior 2013 and other researchers in recent days(P<0.05). Postoperative complication was observed in 26cases(14.8%), CSF leakage 4 cases(2.3%). There was no obvious difference on the occurrence of overall and single complication(P>0.05). There were no significant catheter-related complications. ConclusionIntra-operative lumbar CSF drainage can reduce the incidence of intraoperative CSF leakage, increase the GTR rate. It can not reduce the incidence of postoperative complication(such as diabetes insipidus, hypopituitarism, internal carotid artery injury, hemorrhage, subarachnoid hemorrhage). There is no drainage tube related complications was observed. This study has a certain clinical application value. |
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