The Evaluation Of Therapeutic Efficacy By Transsphenoidal Approach For Micro-resection Of Pituitary Adenoma

BACKGROUND:Pituitary adenoma is a kind of benign intracranial neoplasm, and it constitutes 10% of intracranial neoplasm. In recent years, the incidence rate is higher than before. Surgery is the most effective method for the treatment of pituitary adenoma. Since Hardy successfully used the transsphenoidal approach to treat the pituitary adenoma, this method has become the main approach. The transsphenoidal approach has many advantages: the rate of total resection is high, endocrine is easy to become normal, visual ability and visual field are greatly improved after successful surgery, patients have less complications and recover quickly. As a result, the transsphenoidal approach is an effective method.OBJECTIVE:The aim of this research is to evaluate the therapeutic efficacy of the resection for pituitary adenomas by microscopy transsphenoidal approach. And it is divided into three parts: 1. The relation between the size of tumor and therapeutic effect. 2. The relation between the endocrine type of tumor and therapeutic effect. 3. The relation between excision extent and therapeutic effect.PATIENTS:126 cases of pituitary adenomas by microscopy transsphenoidal approach since January of 2006 to January of 2008 in Qilu hospital of Shandong University.SURGERY METHOD:Before surgery, the hair of the nasal cavity was completely cleaned. In the surgery, we disinfect the nasal cavity completely after general anesthesia, and put microscope to expose the anterior of sphenoid sinus. The sphenoid sinus is opened with a micro-Kerrison punch to expose the sellar floor. Tumor is readily removed with various curettes and scoops. It is imperative that the integrity of the arachnoid is preserved to minimize the potential for a postoperative cerebrospinal fluid fistula. Then we reset nasal septum and hemostasis thoroughly. In the end we insert the inflating sponge into both nasal cavities.RESULTS:1. The relation between tumor size and therapeutic effectThe recovery rate of micro-adenoma is higher than macro-adenoma and giant adenoma, and the difference is significant (P<0.005). The recurrence rate of giant adenoma is significantly higher than micro-adenoma (P<0.05). Therapeutic effect of macro-adenoma is the same as giant adenoma.2. The relation between the endocrine type of tumor and therapeutic effectCompared with functional pituitary adenoma, the non-functional pituitaryadenoma has much smaller recovery and remission rate, and the difference is significant (P<0.05). There is no significant difference in endocrine pituitary adenoma according to our research (P>0.05).3. The relation between excision extent and therapeutic effectRecovery and remission rate is nearly 81.1% with total resection, 47.8% with subtotal resection, and 12.5% with hemisection. The difference has statistical significance (P<0.005).CONCLUSION:Micro-resection by transsphenoidal approach is very effective for most pituitary adenomas. After surgery, the endocrine is obviously improved, the main clinical manifestation is relieved significantly, and many complications disappear. In a word, the therapeutic efficacy of this approach is affirmed by our research.