Endoscopic Resection Of Knosp Grade Ⅲ Ⅳ Analysis Of The Effect Of Pituitary Adenoma

Objective: To explore the feasibility,safety,therapeutic effect and applications of endoscopic endonasal transsphenoidal approach in the treatment of Knosp-grading Ⅲ and Ⅳ invasive pituitary adenoma.Methods: 13 cases diagnosed with invasive pituitary adenoma and accepted endoscopic endonasal transsphenoidal approach were collected in the department of neurosurgery,the First Affiliated Hospital of Soochow University from July 2015 to November 2017.13 cases of pituitary adenoma examined with 3.0T pituitary dynamic contrast-enhanced MRI and confirmed by postoperative pathological examination.Adenomas were required to invade into the cavernous sinus and Knosp grading III-IV via imageological examination.Electrocardiogram,chest radiograph,visual field of vision,3D reconstruction of head CT saddle and pituitary dynamic contrast-enhanced MR examination were contained in preoperative examinations.Cardiac color ultrasound examinations were added in patients diagnosed with growth hormone-secreting pituitary adenoma and the elderly.Serological tests included: blood routine,blood clotting routine,biochemical complete,pituitary complete,testosterone determination(male patients),estradiol(female patients),etc..Hormone dilution tests were required in patients with pituitary hormone levels exceeding the upper limit.The surgical instrument hard neuroendoscopes were supplied by German STORZ company.The intraoperative nerve endoscope enters through the right nasal cavity,and the mucosa is cut openly at the opening of the sphenoid sinus.The frontal wall of the sphenoid sinus was exposed,the anterior wall of the sphenoid sinus and the saddle bottom were abraded,the dura was cut,and the aneurysm was resected using a multi-angle scraping circle under a nerve endoscope.After resection of the tumor,the saddle bottom can be reconstructed using artificial meninges,bioprotein gel,autogenous fat muscles,etc.,and bilateral nasal inflation sponges are used for filling.Observe the occurrence of headache,fervescence,changes in consciousness,changes in visual field and cerebrospinal fluid leakage.Monitor intake and out take,electrolyte,adjust the balance of water and salt metabolization.Pituitary dynamic contrast-enhanced MRI tests were reviewed within 3 days postoperatively to evaluate the removal of tumors.Long term follow-up were applied to evaluate the recurrence of tumors.Conclusion: All the cases were confirmed as pituitary adenoma by postoperative pathological examinations.7 cases underwent total removal and 6 cases received subtotal resection.: Follow up ranged from 6 to 28 months,no recurrence were found in total removal cases.The volume of adenoma of 1 subtotal-resection patient enlarged,whom treated with gamma knife radiotherapy.Only 1 of 13 was found no significant visual acuity and visual field changes and there existed different degrees of visual acuity and visual field improvement in other cases.Most patients had transient dysuria and electrolyte disturbances.Pituitary dysfunction occurred in 3 patients postoperatively and gradually rescued after intravenous infusion of hydrocortisone.Cerebrospinal fluid rhinorrhea occurred in 2 cases after surgery and recovered after continuous drainage of the subarachnoid space.There was no secondary operation and no intracranial infection.The average hospitalization day was 16 days and average cost was 39.7 thousand yuan.