75 Preoperative Diagnose Of Invasiveness Of Knosp ?-? Pituitary Macroadenoma And Endoscopic Surgery Experience

Object:An important prognostic factor for the surgical outcome and recurrence of a pituitary macroadenomas is its invasiveness into parasellar tissue,particularly into the space of the cavernous sinus(CS).The aims of this study is to analyze the reliability of MRI on invasiveness of pituitary macroadenomas through the comparison of MRI prior to surgeries and endoscopic findings of Knosp III-IV pituitary adenoma;and to dicuss the guiding significance of the man-made partition of Knosp III-IV pituitary macroadenomas.Methods:In this paper,the author investigates 75 pituitary macroadenomas,classified as Grade-?(44)or Grade-?(31),which were recorded from endoscopic surgeries in CMU1~STT hospital from 2015 to 2017.Measurements of the distances between midpoints of C4and C2 of ICA,and the vertical distances between the farthest points of tumors and the C2&C4 ligatures are taken.The calculation of the ratios(X)of those two kinds of distances is to be done in this paper,by combining the surgical findings with an endoscopic technique,to discuss the reliability of MRI on invasiveness of pituitary macroadenomas prior to surgeries and to evaluate the gross-total resection(GTR)rate in each case with postoperative MRI.Results:1.With the endoscopic findings as golden standard,the author defines invasiveness of the tumors by grouping those cases into an invasive group and a non-invasive group,of which the ratios(X)are with statistical significance(P<0.05)and the ratio of the invasive group is lower.Grouping those cases by the median of the ratios(1.5911),the group with lower ratio(X?1.5911)shows lower invasiveness.Compared with the microscopic data,Knosp-III endoscopic cases show lower invasiveness(42.9%vs.86%)with statistical significance(P<0.05).2.Out of 75 Knosp?-?cases,there are 51 cases with invasion into CS,confirmed with endoscopic tecniques.Among 44 Knosp-III cases,out of 75,there are 36 Knosp IIIA,among which 12 are invasive cases(33.3%)and 24 are squeezing cases(66.6%);8cases,out of the 42 Knosp-III cases,are Knosp IIIB,which are all invasive.Out of 75cases,the rest 31 are Knosp-?cases,and all are invasive.Gross-total resection cases of Knosp-III are 36(GTR=82%),confirmed by post-operated MRI.3.?A macroadenoma invasive the posterosuperior division,most of the?B tumor invasive front-lower division,the others invasive both front-lower and posterior-lower division,and Knosp IV macroadenoma invasive the posterosuperior,front-lower and posterior-lower division.Conclusion:With the ratio of the distances between midpoints of C4 and C2 of ICA and the vertical distances between the farthest points of tumors and C2&C4 ligatures,doctors are able to better identify the invasiveness of pituitary adenoma before surgery:more invasiveness appears when ratio is lower than 1.5911.With the higher grade of tumors,the probability of invasiveness becomes higher with lower GTR.Compared to the microscopic data,Knosp?endoscopic cases show lower invasiveness,among which?A cases are with lower invasiveness than?B cases,and all the grade-?cases are invasive.