The Influencing Factors Analysis Of Diabetes Insipidus After Endoscopic Transsphenoidal Pituitary Adenoma Resection

Background Pituitary adenoma mainly derived from the pituitary gland and is a benign endocrine tumor in the brain.Its pathogenesis includes monoclonal theory and hypothalamic dysregulation mechanisms.Pituitary adenoma is one of the common intracranial tumors,and its incidence is lower than glioma and meningioma.Through hundreds of years of medical development,The treatment of pituitary adenoma includes drug therapy,radiotherapy and surgical treatment.At present,the most important method for the treatment of pituitary adenomas is by surgical removal of the tumor.Horsley performed the first tanscrainal surgery for Pituitary adenoma in 1889.In 1907,the transsphenoidal surgery for Pituitary Adenoma is firstly adopted by Schloffe.Hardy firstly used microscope in transsphenoidal surgery for pituitary adenoma in 1967.Jho and Carrau completed the first endoscopic endoonasal transsphenoidal surgery for pituitary adenomas in 1997.With the rapid development of neuroendoscopy techniques in recent years,it has became the first choice for neurosurgical removal of pituitary adenomas due to its safety and high efficiency.In addition to strict following operating indication and mastering structure of the saddle area?operating technique,operator should also understand the complications that may occur after surgery and master the prevention and treatment measures to minimize the possibility of surgical complications,so as to improve the effectiveness and safety of endoscopic surgery.Diabetes insipidus(DI)is one of the most common complications after transsphenoidal pituitary adenoma resection.The study of its influencing factors and treatment strategies has important guiding significance for the treatment and prognosis of pituitary adenoma.Objective To analyze the influencing factors analysis of diabetes insipidus after endoscopic transsphenoidal pituitary adenoma resection,and provide guidance for the prevention and treatment of postoperative DI.Methods A retrospective analysis was conducted on 148 cases of endoscopic transsphenoidal resection of pituitary adenomas between October 2016 to June 2018 at Neurosurgery Department at the First Affiliated Hospital of Zhengzhou University.The risk factors of postoperative were explored by univariate and multivariate logistic regression analysis(There is statistical significance when P<0.05).Results There are 32 cases of postoperative DI in the 148 patients who underwent endoscopic transsphenoidal pituitary adenoma resection.The incidence rate of DI was 21.6%.The statistical analysis implied that the tumor invasiveness is independent risk factors of DI after surgery(P=0.030,W=7.033,95%CI :1.202~41.159,OR=7.033),invasive pituitary adenomas are more susceptible to DI;The size of the tumor is independent risk factors of DI after surgery(P=0.007,W=7.201,95%CI :1.655~25.339,OR=6.475);the incidence of diabetes insipidus: giant adenoma>large adenoma> microadenomas.The growth direction(whether suprasellar extension)of the tumors is independent risk factors of of DI after surgery(P=0.037,W=4.355,95%CI :1.070~8.588,OR=3.031),the tumors with suprasellar extension are more susceptible to DI.The extent of tumor resection is independent risk factors of of DI after surgery(P=0.002,W=9.516,95%CI :2.528~63.987,OR=12.718),the tumors with total resection are more susceptible to DI.Conclusions 1.The incidence of diabetes insipidus after endoscopic endonasal transsphenoidal pituitary surgery is related to adenoma invasiveness?adenoma size?growth direction and extent of resection.Patients with invasive pituitary adenoma ? large pituitary adenomas ? tumors with suprasellar extension and total resection are more likely to develop intraoperative DI? 2.Intraoperative protection of the pituitary is the key to prevent postoperative diabetes insipidus...