The Anatomy Study Of Tuberculum Sellae Area And Its Clinical Application Study In Endoscopic Transsphenoidal Approach For Treatment Of Suprasellar Pituitary Adenomas

Part Ⅰ Microscopic anatomical study of the tuberculum sellae areaObjective:To understand the anatomy of the tuberculum sellae and the surrounding dura mater by dissecting cadaveric head specimens,observe and measure the relevant anatomical data,and provide anatomical basis for the endoscopic transsphenoidal treatment of suprasellar pituitary adenomas.Methods:Two dry skull specimens,The shape of saddle tubercles was observed under microscope.Two fresh frozen cadaver heads,the calvaria and brain tissue were removed.The shape of sellar tubercle and dura were observed under microscope,The thickness of dura mater of tuberculum sellae,anterior part of diaphragma sellae and anterior wall of sellar floor were measured.Results:(1)The morphology of tuberculum sellae was variable in 4 specimens,In 2 cases,an acute Angle between the tuberculum and the anterior wall of the sellar floor was convex posteriorly,One case was at a right Angle,and the other case was smooth.(2)In the two fresh frozen cadaveric head specimens,the dura mater of the anterior skull base was separated at the tuberculum sellae and ran on the upper surface of the pituitary gland and the sellar floor,respectively.The dura mater thickness of tuberculum sellae was 0.3585±0.0037 mm,and the dura mater thickness of the anterior wall of the sellar floor was 0.2030±0.0079 mm,the difference was statistically significant(P=0.031).Conclusion:Neuroendoscopic transsellar nodule approach has been gradually carried out in clinical practice.Understanding the anatomy of this area is very important for the selection of surgical methods and surgical results.The tuberculum sellae and the dura mater of the tuberculum sellae are important anatomical landmarks for localization.Part Ⅱ Clinical study of neuroendoscopic transsphenoidal surgery for suprasellar pituitary adenomasObjective:To investigate the effect of removal of tuberculum sellae in endoscopic transsphenoidal resection of suprasellar pituitary adenomas on the degree of tumor resection,symptom improvement,endocrine remission and postoperative complications.Methods:A retrospective analysis was conducted on patients admitted to the Department of Neurosurgery,the Second Affiliated Hospital of Nanchang University from December 2020 to March 2023.The clinical data of 52 patients with suprasellar pituitary adenomas treated by neuroendoscopic transsphenoidal approach were analyzed.According to the resection method,the patients were divided into two groups: tuberculum sellae removal group(19 cases)and conventional surgery group(33 cases).The total tumor resection rate,symptom improvement rate,endocrine remission rate and complications were compared between the two groups.Results:The total resection rate of tumor was 89.5%(17/19)in the tuberculum sellae removal group and 63.6%(21/33)in the conventional surgery group.The total resection rate of tumor in the tuberculum sellae removal group was higher,and the difference was statistically significant(P=0.043).There were no significant differences in symptom remission rate,endocrine remission rate and postoperative complication rate between the two groups(P﹥0.05).Conclusion:Removal of the tuberculum sellae during endoscopic transsphenoidal surgery can improve the total resection rate of suprasellar pituitary adenomas without increasing the incidence of postoperative complications.