Analysis Of Influences And Prevention For Diabetes Insipidus After Transnasal Transsphenoidal Approach For Pituitary Adenoma

Objective By discussing the related factors for diabetes insipidus(DI)after transnasal transsphenoidal approach for pituitary adenoma,and providing a certain prevention strategy and theoretical basis for purpose of reducing the incidence of postoperative DI.Methods This is a systematically retrospective study conducted at the General Hospital of Ningxia Medical University,210 patients who underwent transnasal transsphenoidal surgery and were diagnosed as Pituitary Adenoma by postoperative pathology at the Surgical Ward of Neurology Center from March 2012 to March 2017 were included.The relation between postoperative diabetes insipidus and possible influences that contain gender,age,tumor size,invasive Knosp grades,tumor resection,with or without pituitary apoplexy and cerebrospinal fluid leak,pathological type,operation method,serum Na and percent change before and after surgery were evaluated with univariate and multivariate binary logistic regression analysis,thus the risk factors are identified.Results In this study,50 patients occurred postoperative DI with an incidence of 23.81%.Gender(P = 0.553),age(P = 0.145),invasive Knosp grades(P = 0.627),tumor resection(P =0.735),with or without cerebrospinal fluid leak(P = 0.452),pathological type(P = 0.464),operation method(P = 0.192),preoperative serum Na(P = 0.747),postoperative serum Na(P =0.073)and serum Na percent change before and after surgery(P = 0.064)were not associated with postoperative DI.Pituitary adenoma diameter less than 3cm(odds ratio [95% confidence interval]: 3.456[1.538-7.765],P = 0.003),tumor growth towards suprasellar(odds ratio [95% confidence interval]: 4.298 [1.410-13.098],P = 0.010)and tumor with pituitary apoplexy(odds ratio[95% confidence interval]: 2.713 [1.140-6.459],P = 0.024)were independently associatedwith postoperative DI after multivariate binary logistic regression analysis.About the incidence of postoperative DI,pituitary adenoma diameter less than 3cm is 3.456 times higher than that greater than 3cm,tumor growth towards suprasellar is 4.298 times higher than growth in the saddle,pituitary adenoma with pituitary apoplexy is 2.713 times higher than without pituitary apoplexy.Conclusion 1.Pituitary adenoma diameter less than 3cm,tumor growth towards suprasellar and tumor with pituitary apoplexy are independently risk factors for postoperative DI.2.It is necessary to carefully evaluate tumor size,the relation between tumor and saddle diaphragm and tumor with pituitary apoplexy before surgery,recognize and protect pituitary stalk neuraxis during surgery,which can reduce the incidence of postoperative DI.