A Longitudinal Study Of Preoperative And Postoperative Changes In Cognitive Function And Brain Structure In Patients With Pituitary Adenoma

Pituitary adenoma is a common nervous system tumor which originating from the pituitary gland.With the improvement of national health awareness,Upgrade of medical facilities,deeper understanding of disease?the prevalence rate of pituitary adenoma is 3.5-5 times higher than previously reported.At present?the incidence of pituitary adenoma has been estimated to account for 16.5%of the incidence of central nervous system tumors,ranking second in the central nervous system.In the treatment of pituitary adenoma,except for prolactinoma,resection of pituitary adenoma via transsphenoidal surgery(TSS)has become the first choice for the treatment of pituitary adenoma.TSS can safely and effectively remove the tumor mass effect and control hyperpituitary.Most patients can be cured at endocrine or imaging levels,thus the survival rate of patients with pituitary adenoma is significantly improved.however,It has been reported in literature that During the course of disease progression-preoperatively and even after receiving standardized clinical intervention-patients with pituitary adenoma will suffer from decreased quality of life?Cognitive impairment?Dysregulation of emotion.These "subclinical" symptoms place a heavy burden on patients and society.Cognitive function and emotional abnormality are closely related to the quality of life of patients.However,there is still a lack of extensive discussion on the outcome of patients' cognitive function after transsphenoidal surgery,and the The results of existing studies are inconsistent.The effects of surgery on cognitive function in patients with pituitary adenomas need to be further explored and the underlying neural mechanisms need to be traced.Longitudinal design of experiment,This study was based on the occurrence of cognitive impairment and emotional abnormalities in patients with pituitary adenoma before and after surgery.Based on the clinical characteristics of serum hormone level and tumor volume of the subjects,neuropsychological assessment and high-resolution magnetic resonance imaging were used to explore the potential effects of transsphenoidal pituitary adenoma resection on the cognitive function of patients from multiple dimensions,and to explore the potential neural mechanism behind the phenomenon.The main research work of this paper includes the following two parts:In pathological diagnosis of pituitary adenoma surgery patients a total of 20 cases,collect the participants in preoperative and postoperative serum hormone levels,Neuropsychological assessments were performed on all subjects before and after surgery,including the Wisconsin card sorting experiment,which evaluated executive function,and the Chinese version of the wechsler memory scale(WMS-RC),which evaluated memory function.After statistical analysis,it was found that after successful transsphenoidal pituitary adenoma resection,patients with pituitary adenoma had higher scores in some cognitive domains,including executive function and short-term memory.There is a positive correlation between the size of sellar expansion of the tumor and the degree of improvement of postoperative executive function,that is to say,the removal of sellar expansion is an important factor affecting the improvement of postoperative cognitive function.In patients with pituitary adenoma presenting with hyperprolactinemia,the degree of postoperative prolactin decline was positively correlated with the patient's higher score on the wechsler memory test,that is,correcting hyperprolactinemia could improve the patient's memory function.In the second part,the subjects were the same as in the first part,The three-dimensional high-resolution magnetic resonance image(MRI)data of all subjects were collected.After the control of data quality eliminated two cases that did not meet the criteria,the region of interest(ROI)analysis method was applied to evaluate the gray matter structure of all subjects.The results showed that the volume of anterior cingulate gyrus decreased significantly in patients with pituitary adenoma.The volume of cingulate gray matter could be predicted by the volume of sellar expansion.The larger the volume of sellar expansion,the smaller the volume of cingulate gray matter would be.The mean volume of gray matter in hippocampus after TSS was higher than that before surgery.Moreover,the difference in the volume of hippocampal gray matter was more obvious in patients with hyperprolactinemia.In conclusion,this study,by means of multi-angle cognitive neuroscience assessment,explored the changes in cognitive function and brain structure of patients with pituitary adenoma after transsphenoidal pituitary adenoma resection.This study has deepened our understanding of the effects of transsphenoidal surgery on the cognitive function of patients with pituitary adenoma and provided clues for further research.