An Analysis Of Risk Factors For Postoperative Complications In Endoscopic Endonasal Pituitary Surgery

Objective:Pituitary adenoma is one of the most common intracranial tumors,and as the main treatment,surgical resection has got great improvement in the aspects of safety,total resection rate and decreased complications for nearly 100 years.At present,endoscopic endonasal approach has been approved by most neurosurgeons for pituitary surgery.But the postoperative complications remain significant.And this study analyzed the different characteristics of patients who diagnosed with pituitary adenoma and underwent this surgery to evaluate the postoperative complications,and try to provide a reference for clinical prevention and treatment.Methods:A retrospective review of 270 first-episode pituitary adenoma patients undergoing endoscopic endonasal approach pituitary surgery in Qilu hospital of Shandong University was performed.Five complications were collected,including postoperative intracranial infection,postoperative CSF leak,postoperative hypopituitarism,diabetes insipidus and postoperative hyponatremia.The patients' age,gender,BMI,smoking history,drinking history,hypertension,diabetes mellites,preoperative hypopituitarism,tumor size,operation time,tumor texture,CSF leak during operation etc.were collected as the risk factors.Complications above underwent univariate analyzes were performed first respectively with a statistical approach of chi-square test and independent-samples T test,which test standard(a)defined as 0.05,P value less than 0.05 that regarded as statistical significance,then picked up the significant factor(s)to run the logistic regression analysis to evaluate the relationship between the independent risk factors.Exp(B)estimated OR value,then came to the conclusion of independence risk factor(s).Results:1.The univariate analysis showed that postoperative intracranial infection were associated with operation time,postoperative CSF leak,postoperative lumbar drainage(P<0.05).And the logistic regression showed that the onset of postoperative CSF leak(OR=10.311)was the independent risk factor exclusively.2.Postoperative hypopituitarism were connected with age,preoperative hypopituitarism,tumor size,tumor texture in the univariate analysis(P<0.05).The multivariate logistic regression showed that older age(OR=1.021),preoperative hypopituitarism(OR=2.801),tough texture(OR=2.344)may lead to postoperative hypopituitarism.3.Postoperative CSF leak related to gender,operation time,tumor size and CSF leak during operation(P<0.05).The logistic regression showed that female(OR=0.334),intraoperative CSF leak(OR=0.626)were the independent risk factors.4.The endocrine function status of tumor,intraoperative CSF leak,postoperative hypopituitarism had statistical significance to the postoperative diabetes insipidus(P<0.05).Patients with unfunctional adenoma(OR=0.972),onset of intraoperative CSF leak(OR=2.146)and postoperative hypopituitarism(OR=2.145)may more vulnerable to diabetes insipidus.5.The phenomenon of hyponatremia associated with endocrine function status of tumor,postoperative hypopituitarism(P<0.05).And adenoma with endocrine function(OR=8.782),onset of postoperative hypopituitarism(OR=2.775)may have a higher rate of postoperative hyponatremia.Conclusions:Many factors that could lead to postoperative of intracranial infection,CSF leak,hypopituitarism,diabetes insipidus and hyponatremia,which regard as the complications after endoscopic endonasal pituitary surgery.And the onset of postoperative CSF leak threw a threat on postoperative intracranial infection.While older age,exposure to preoperative hypopituitarism,tough texture of tumor may lead to postoperative hypopituitarism.And female,intraoperative CSF leak may lead to patients vulnerable to postoperative CSF leak.Patients with unfunctional adenoma,the appearance of intraoperative CSF leak and postoperative hypopituitarism were likely to develop diabetes insipidus.At last,but not least,adenoma with endocrine function,the presentation of postoperative hypopituitarism may experience a process of postoperative hyponatremia.