Imagine Evaluation About Location And Fenestration Of Sellar Floor In Pituitary Adenoma Patients With Endonasal Transsphenoidal Surgery

Objective: To explore the application value of three dimensional reconstruction of the sphenoid sinus separation by CT in sellar floor location in endonasal transsphenoidal surgery and the relationship between the extent and location of operation window of sellar floor and the extent of tumor resection,intraoperative and postoperative main complications and to evaluate the influence factors of individualized sellar floor fenestration scheme and the effect of sellar floor fenestration before and after operation.Methods: 65 cases of pituitary adenoma patients(later histologically verified) who undergone microscopic endonasal transsphenoidal surgery between March 2014 and March 2015 in our department were included in this retrospective analysis.14 cases with incomplete data and previous history of transsphenoidal surgery were excluded.51 cases were accepted for this study.Preoperative paranasal sinus CT and pituitary MRI scan were done for each patient before operation.CT image was transferred to a computer,Mimics15.0 software was applied to reconstruct the sphenoid sinus separation,its number, shape and direction was observed and recorded and contrast them with the intraoperative findings,to locate sellar floor under the guide of them;To develop individualized sellar floor window scheme by observating and measuring the sphenoid sinus and its adjacent structure and anatomical variation,tumor and sella characteristics,the minimum distance between bilateral cavernous segment of the internal carotid artery and their deviated distance from the middle line.To observe and record the internal carotid artery damage,cerebrospinal fluid leakage and tumor texture in the operation;Postoperative complications were observed and recorded, postoperative paranasal sinus CT and pituitary MRI scan were done again, using Mimics15.0 software to reconstruct the sellar floor fenestration and measure the maximum horizontal and longitudinal diameter of the fenestration, the distance from the highest point of fenestration to planum sphenoidale. Take the maximum horizontal and longitudinal diameter of the fenestration as the diameter of sellar floor fenestration, using the ellipse area formula to calculate the area of the sellar floor fenestration.To observe the size and position of the residual tumor by postoperative MRI.For patients with postoperative suprasellar residual tumor,to evaluate the effect of sellar floor fenestration by two above the level of the attending neurosurgeon(including the operation doctor)through observating the relative position of the bone window and the residual tumor in the image fusion of paranasal sinus CT and pituitary MRI,combined with tumor texture and shap.The correlation between the data was analyzed by SPSS17.0 statistical.The results were analyzed by chi square test(including Fisher’s exact test),two independent sample T test,non parameter Mann-Whitney two independent samples U test,Pearson correlation analysis and Logistic regression model, P<0.05,with statistical significance.Results: The positioning of sellar floor of all cases was achieved quickly and accurately under the guide of sphenoid sinus separation,the preoperative reconstruction results were consistent with intraoperative findings.There were 11 cases of cerebrospinal fluid leakage in operation.The tumor removal was total in 35 cases, subtotal and partial in 16 cases.The location of residual tumor was suprasellar region in 5 cases,cavernous sinus in 7 cases, suprasellar region and anterior cranial fossa in 2 cases, cavernous sinus and posterior cranial fossa in 2 cases.Postoperative transient diabetes insipidus in 17 cases, pituitary function subnomorlity in 13 cases(excluding preoperative hypopituitarism in 15 cases,36 cases included in the evaluation of pituitary function after surgery).Most cases of sellar floor fenestration were suitable,only 2 cases were too small. The area of sellar floor fenestration in the pituitary microadenoma and macroadenoma group and the giant pituitary adenomas group were statistically significant(P<0.05).The area of sellar floor fenestration in the total removal group and the incomplete resection group were statistically significant(P<0.05). The ratio of sellar floor fenestration area to the largest tumor area in the total removal group and the incomplete resection group were statistically significant(P<0.05).Logistic regression analysis was carried out by the relevant factors of the extent of tumor resection in 51 patients with pituitary adenomas, the ratio of sellar floor fenestration area to the largest tumor area and the tumor invasion were independent predictive factors of the extent of tumor resection(P<0.05).The distance from the highest point of fenestration to planum sphenoidale in intraoperative cerebrospinal fluid leakage group and without intraoperative cerebrospinal fluid leakage group were statistically significant(P<0.05). The area of sellar floor fenestration in the diabetes insipidus group and without diabetes insipidus group,in the postoperative hypopituitarism group and without postoperative hypopituitarism group were no statistically significant(P>0.05).Conclusions: Three dimensional reconstruction of sphenoid sinus separation by preoperative CT is helpful for locating the sellar floor quickly and accurately;The observation and measurement about sphenoid sinus and its adjacent structures, and its anatomical variation,related characteristics of tumor and sella turcica in pituitary MRI and paranasal sinus CT can help develop suitable individualized sellar floor fenestration scheme;The relative insufficient of the sellar floor fenestration is one of the reasons for residual tumor.The position of the sellar floor fenestration was higher, closer to planum sphenoidale,the leakage of cerebrospinal fluid would be more inclined to occur;The diabetes insipidus and postoperative hypopituitarism were not associated with the size of sellar floor fenestration.