Research And Application Of Invasive Pituitary Adenomas Growth Corridors

Objective:Based on an accurate understanding of the dural invasion and growth rule of pituitary adenomas,further research found that invasive pituitary adenomas form five different tumor corridors along the tumor crevasse: sphenoid sinus,clivus,cavernous sinus,Diaphragm sella turcica and saddle back corridor.Various types of invasive pituitary adenomas are removed along the tumor corridor under neuroendoscope,and the anatomical structure,classification,application in surgery and clinical efficacy of different tumor corridors are discussed in combination with clinical case data.Methods:Five corridors and pathways were anatomically confirmed and graded on fresh cadaver head specimens perfused with silicone rubber.Prospective study analyzed the clinical data of 336 pituitary adenomas patients in neurosurgery department of our hospital from January 2017 to December 2018.Through the study of preoperative and postoperative MRI plain scan and enhanced examination,head CT and intraoperative video of surgery,5 different types of tumors were summarized: sphenoid sinus,clivus,cavernous sinus,Diaphragm sella turcica and saddle back(named as A,B,C,D and E corridor respectively).The number of cases of tumors in each corridor that met the conditions were counted in detail and named as Group a,which included 54 cases.The clinical data of 396 patients with pituitary adenomas from January 2014 to December 2016 were analyzed retrospectively,from which tumors of different corridors were screened out and named as group b with 42 cases included.SPSS17 software was used and Chi-square,rank sum test and other methods were used.The difference was statistically significant with P < 0.05.Results:41.7%(40/96)of non-functional adenomas and 58.3%(56/96)of functional adenomas were found.Among them,25.0%(24/96)of non-functional adenomas in group a,31.2%(30/96)of functional adenomas include prolactin adenoma16.7%(16/96),mixed adenoma 7.3%(7/96),mixed prolactin growth hormoneadenoma 4.1%(4/96),mixed gonadotropin adenoma 3.1%(3/96),gonadotropin adenoma 4.1%(4/96),adrenocorticotropic hormone adenoma 2.0%(2/96),growth hormone adenoma 1.0%(1/96);Group b had 16.7%(16/96)nonfunctional adenomas,27.1%(26/96)functional adenomas including 13.5%(13/96)prolactin adenomas and5.2%(5/96)mixed adenomas,including 3.1%(3/96)mixed prolactin growth hormone adenomas,2.0%(2/96)mixed gonadotropin adenomas,3.1%(3/96)gonadotropin adenomas and 1.0%(1/96)growth hormone adenomas.Sphenoid sinus corridor 42.7%(41/96),clivus corridor 44.7%(43/96),cavernous sinus corridor 33.3%(32/96),Diaphragm sella turcica corridor 32.3%(31/96),saddle back corridor 10.4%(10/96),multi-corridor 42.7%(41/96)(≥2 corridor).The total resection rate in group a was 90.7%(including 100%,96.0%,95.0%,89.4%,100%for sphenoid sinus,clivus,cavernous sinus,Diaphragm sella turcica and saddle back corridor respectively),and 71.4% in group b(including 100%,72.2%,58.3%,58.3%,66.6% for sphenoid sinus,clivus,cavernous sinus,Diaphragm sella turcica and saddle back corridor respectively).The total resection rate of group a and group b was82.2%,subtotal resection was 12.5%,and most resection was 5.2%.Perioperative Complication(medicine)incidence rate in group a was 10.4%(including 9.4% of transient diabetes and 1.0% of permanent diabetes),3.1% of intracranial infection,2.1% of pituitary function decrease,1.0% of oculomotor nerve paralysis,1.0% of epileptic seizure and 1.0% of death.In group b,7.3% of patients suffered from diabetes insipidus(including 6.3% of transient diabetes insipidus and 1.0% of permanent diabetes insipidus),5.2% of intracranial infection,3.1% of pituitary function decrease,3.1% of cerebrospinal fluid leakage,2.1% of oculomotor nerve paralysis,1.0% of postoperative sellar hemorrhage,1.0% of Trochlear nerve paralysis and 2.1% of death.Follow-up ranged from 3 to 57 months,with an average follow-up of 26.54±15.33 months.There were no missed cases.The recurrence rate was 3.1%,and the clinical symptoms were mostly relieved half a year after operation.There is no serious Complication such as permanent cranial nerve palsy or ICA injury.Conclusion:1.Epidural invasion in different regions forms tumors with different growthcorridors(A→E);2.Complex pituitary adenomas are different combinations of A→E corridors;3.It is very important to find the inner dural laceration during the operation,and remove the tumor along the tumor corridor formed by the dural laceration.4.The establishment of multi-channel concept and detailed understanding of each corridor path are beneficial to improve the total tumor resection rate,avoid omission,reduce complication and improve clinical efficacy.