Analysis Of Complications After Endoscopic Transnasal Pituitary Tumor Resection

Objective:To investigate the postoperative complications of 120 patients undergoing neuroendoscopic transnasal pituitary adenoma resection.Methods:A total of 120 patients were selected for the first time from June 2019 to December 2020,who were diagnosed as pituitary Adenomas in a subspecialty treatment group of Kunming Medical University and underwent neuroendoscopic resection of pituitary ADENOMAS.The morbidity and recovery of postoperative complications were analyzed retrospectively.Results:There were 4 cases(3.3%)with postoperative epistaxis in 120 patients,including 1 case with epistaxis on the same day and 2 cases with epistaxis after pulling out the nasal gauze.One patient suffered from massive hemorrhage of nasal cavity after operation,and the effect of compression hemostasis was poor.All of the 4 patients achieved the therapeutic effect before discharge,and no nasal bleeding occurred during follow-up.79 patients(65.8%)had electrolyte disorder after operation,and 56 patients(46.7%)had diabetes insipidus,in 55 cases,the symptoms of Polyuria improved during the period of hospitalization and recovered to normal before discharge.One case was a 32-year-old male.He was discharged from hospital for 2 weeks and went to the outpatient clinic.He complained of excessive urine,and the daily urine volume was about 3000-4000ml.He brought along deaminopressin tablets to control the urine volume,one month after discharge from hospital,the symptoms of diabetes insipidus were improved by telephone follow-up,1 case(0.8%)had decreased vision after operation,there was no bleeding in the operation area after reexamination,and excessive hemostatic material and biofilm decompression were taken out in emergency second operation,the postoperative visual acuity was better than that before operation.The postoperative visual acuity was improved significantly at 3 months follow-up.A 56-year-old male patient with pituitary macroadenomas developed diplopia after operation.Preoperative imaging showed lesions surrounding the cavernous Sinus,with the possibility of scratching the nerves that control eye movements.The patients were followed up for 3 months,and the diplopia symptoms were improved at 6 months.19 cases(15.8%)of cerebrospinal fluid leakage were repaired by Sandwich method,and the head of bed was tilted 30° after operation.About one week after operation,the healing of sellar bottom repair was observed under neuroendoscope.One patient,a 22-year-old female,was still in bed with clear brain crest fluid(CCF).The patient was not in good condition after operation.One case was a 75-year-old woman who underwent "Sandwich" method to repair the leak of cerebrospinal fluid during the operation,the patient’s family asked for Conservative treatment and refused to repair the leak again,which eventually led to intracranial infection.The family asked for automatic discharge.After operation,12 patients(10%)had hypopituitarism and were given oral hormone supplement.The hormone level was rechecked before discharge.Conclusion:Complications such as epistaxis,cerebrospinal fluid leakage,intracranial infection,transient diabetes insipidus,Electrolyte Disturbance,postoperative visual loss and hypopituitarism can occur after endoscopic endonasal pituitary tumor resection,the vast majority of complications can be improved by post-operative symptomatic treatment,a few can also be discharged after a period of time to recover slowly.