Clinical Characteristics,treatment And Management Of Postoperative Complications Of Giant Pituitary Adenomas Complicated With Obstructive Hydrocephalus

Objective To investigate the clinical features,treatment,postoperative efficacy and postoperative complications of giant pituitary adenoma complicated with obstructive hydrocephalus,With a view to helping with clinical work.Methods A total of 42 cases of giant pituitary adenomas with obstructive hydrocephalus treated with neurosurgery and diagnosed by pathology and imaging data from March 2012 to May 2015 were selected as the research subjects;Retrospective analyzed its clinical datas,Summarized,analyzed and collated their datas;I has used SPSS17.0 statistical software to analyze the differences between the different group s(P < 0.05 was statistical-ly significant).In the surgical methods,through the nose-sphenoid sinus surgical approach 9 cases;33 cases of craniotomy surgery,including 25 cases of operation via the inferior frontal approach,via the inferior frontal approach combined middle frontal fistula 4 cases,pterional approach surgery in 4 cases.Results Male 28 cases(67.0%)、female 14 cases(33.0%);30 cases of typical pituitary adenoma,Male 21 cases(70.0%)、female 9 cases(30.0%);Atypical pituitary adenoma in 12 cases,Male 7 cases(58.3%)、female 5 cases(41.7%);The number of male and female patients with typical and atypical pituitary adenomas were examined by the chis-quare test;χ2=0.525,P>0.05;so this difference was not statistically significant。 Age 18-75 years old,average age was 51.33±15.46 years old;The independent sample T test was performed on patients with typical and atypical pituitary adenomas,getting the average age of the two was 49.75 ± 3.145 and 54.50 ± 3.405 years respectively,P was 0.354>0.05,there was no statistically significant difference.Course of 1 month-7 years,made independent samples T test for the course of the patients with typical and atypical pituitary adenomas,the average course of the two was 21.63±4.94 and 11.17±4.11 months,P was 0.214>0.05,there was no statistically significant difference.Preoperative serum endocrine examination confirmed that 18 cases of endocrine active tumors(14 cases of PRL adenoma,1 case of GH adenoma,1 case of ACTH adenoma,1 case of TSH adenoma),24 cases were nonfunctional tumors(24/42).Including 12 cases of atypical pituitary adenoma(28.6%),typical pituitary adenoma in 30 cases(71.4%).42 cases of giant pituitary adenomas,with a diameter of 4.0cm-7.0cm,an average of 5.1±0.842cm;All of the imaging MR were aggressive,at the same time below the sella turcica、 suprasellar and bilateral cavernous sinus invasion in 8 cases(19%),to the suprasellar invasion in 13 cases(31%),at the same time below the sella turcica and suprasellar in 4 cases(10%),to the suprasellar and bilateral cavernous sinus invasion in 15 cases(36%),to the suprasellar and right cavernous sinus invasion in 1 cases(2%),to the suprasellar and left cavernous sinus invasion in 1 cases(2%).Among them,12 atypical pituitary adenomas and 16 cases of functional adenoma(16/18)were at least invasive the bottom of the sella、the top of the salla and next to the salla in the two.The total resection rate was 59.5%(25/42),through the nose-sphenoid sinus surgical approach 22%(2/9),craniotomy surgery 69.7%(23/33),including via the inferior frontal approach 72.0%(18/25),4 cases of frontal pterional approach in1 cases of total resection and subtotal resection in 3 cases,via the inferior frontal approach combined middle frontal fistula 4 cases were resected completely.The total resection rate of craniotomy and transsphenoidal surgery were analyzed by chi-square test,χ2=4.791,P<0.05,For the difference was statistically significant.Decreased visual acuity and visual field defect after surgery significantly improved 20 cases(20/38);Headache and dizziness significantly improved after surgery in 19 cases(19/25);Nausea,vomiting significantly improved after surgery in 8 cases(8/9);Hydrocephalus significantly improved in 24 cases after surgery.Chisquare test was used to determine the number of cases of visual acuity disorder,headache,dizziness and hydrocephalus after craniotomy and transsphenoidal surgery;For visual field disordersχ2=0.985 、 P>0.05,the difference was not statistically significant;For headache dizziness was χ2=5.376,P<0.05,the difference was statistically significant;For hydrocephalus improvement was χ2=7.663、P<0.05,the difference was statistically significant.Postoperative transient diabetes insipidus in 19 cases,treated with minirin tablets quickly recovered after symptomatic treatment;Electrolyte imbalance in 16 cases(10 cases of low sodium,6 cases of low potassium,combined with 6 cases),after the positive to be added to correct the same time to remind patients with dietary supplement recovery;Headache and dizziness in 2 cases,1 case of intracranial infection,postoperative tumor cavity bleeding two cases were Improved after symptomatic treatment.Intraoperative cerebrospinal fluid leakage occurred in 2 cases(transsphenoidal surgery in 1 cases and craniotomy in 1 cases).No early deaths.Postoperative hydrocephalus was significantly improved in 24 cases;Postoperative ventriculoperitoneal shunt in 4 cases,One of the cases underwent ventriculoperitoneal shunt as postoperative hydrocephalus was not obvious and the patient consciousness gradually deepened;3 cases underwent ventriculoperitoneal shunt as hydrocephalus does not relieve and symptoms were not significantly improved.Five cases were relapsed during follow-up.Conclusions 1.About giant pituitary adenoma combined obstructive hydrocephalus patients mostly are middle-aged and nonfunctional pituitary adenomas.The largest proportion of functional adenoma was the prolactin cell adenoma.The patient has a long course,severe symptoms and complex clinical features;Tumor lesions are all difficult to cut and easy to relapse.The improvement of some symptoms,the total resection rate and the improvement of hydrocephalus after craniotomy are better than transsphenoidal approach.2.We should choose a personalized approach to surgery according to the characteristics of tumor growth and physiological characteristics of patients.We do not recommend ventricle drainage or ventriculoperitoneal shunt before surgery,while we can make a decision according to the improvement of the symptoms and the severity of the complications after surgery.3.Preoperative preparation to be adequate,intraoperative operation to be gentle to minimize the occurrence of postoperative complications.Once complications occur,we must actively symptomatic treatment.