Clinical Analysis Of Frequent Problems After Transsphenoidal Resection Of Pituitary Adenomas

Background: transsphenoidal resection of pituitary adenomas initiated from 1907(Schloffer).At that time, because of poor lighting, deep operative site, poor unfolding, difficult hemostasis, and hard controlling intracranial infection, for a long time, the approach had not been used widely. Till 1960's, Hardy used operating microscope for transsphenoida1 resection of pituitary adenomas. By dint of its magnification and lighting advantages, operating unfolding took on a new look. Accompanying the improvement of operating microscope microinstrument and X-ray registration device, transsphenoidal pituitary adenomectomy developed unprecedentedly. The approach possesses the advantages of tiny damage, good operative effect, safety, time saving, low complication and low fatality. Now it is accepted by more and more neurosurgeons. But up to now Diabetes insipidus and other operative problems Still occur frequentlyObjective: To discuss the feature, reason and treatment of frequently problems after transsphenoida1 resection of pituitary adenomas.Methods: To retro-analysis the clinical manifestation and postope- erative treatment of eight 145 cases transsphenoidal resection of pituitary adenomas.Results: 33(22.8%) cases had temporary diabetes insipidus; 22 (15.2%) cases had suffered postoperative hyponatremia, 9(6.2%) cases occurred postoperative insufficiency of pituitarium anterius function; 4(2.7%) cases had leakage of cerebrospinal fluid. residual tumor were fou- nd in 13 (9.0%)cases. The incidence of postoperative DI: microadenomas(38.7%)>macroadenomas(20.3%)and giant adenomas(14.3%), there was statistical significance. The incidence of postoperative DI in different cell types and different age groups of the pituitary adenoma were no significant difference. Over the age of 60 group had the highest incidence of hyponatremia. The incidence of hyponatremia in different sizes and cell types of pituitary adenoma were no significant difference. 4 cases of cerebrospinal fluid leakage were all cured by bed rest, the method of reducing intracranial pressure. Pituitary function gradually returned to normal in 5 cases of patients with insufficiency of pituitarium anterius function after using hormone replacement therapy for 6 months. The remain 4 cases which were not restored to normal have to continue long-term hormone replacement therapy. 5 cases of patients with residual tumor in 13 cases chose subfrontal approach surgical treatment again after 3 months to 2 years. The remaining 8 cases used of radiotherapy.Conclusion:The incidence of postoperative DI in microadenomas was highest than macroadenomas and giant adenomas. the reasons for the result were correlated with microadenoma's characteristics and the resection form of the operation.The incidence of hyponatremia was related to the age. The incidence in group of over the age of 60 was the highest.Postoperative insufficiency of pituitary function was prone to occur in macroadenomas and giant adenomas. Before the operative Pituitary function was lower, which was difficult to return to normal.Application of gelfoam repair small and medium-sized cerebrospinal fluid leakage was a safe and effective way, which can effectively prevent the occurrence of postoperative cerebrospinal fluid leakage.The main reasons of residual for pituitary adenoma after transsphenoid operation was tumor invo1ving cavernous sinus.The experience of surgeon to reduce the residual tumor played an important role.