Outcomes and complications of 111 patients with pituitary neoplasms after neuroendoscopic endonasal transsphenoidal surgeries
10.3760/cma.j.issn.1671-8925.2015.06.014
- VernacularTitle:神经内镜经鼻蝶入路垂体瘤切除术的临床疗效和并发症分析
- Author:
Wenjian ZHENG
1
,
2
;
Weiping LI
;
Tao JI
;
Xiejun ZHANG
;
Yongzhong GAO
;
Guodong HUANG
Author Information
1. 515041 汕头,汕头大学医学院临床医学系
2. 518035 深圳,深圳大学第一附属医院(深圳市第二人民医院)神经外科,深圳市神经外科学重点实验室
- Keywords:
Neuroendoscope;
Pituitary neoplasm;
Treatment outcome;
Postoperative complication
- From:
Chinese Journal of Neuromedicine
2015;14(6):609-613
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the outcomes and complications of 111 patients with pituitary neoplasms after neuroendoscopic endonasal transsphenoidal surgeries.Methods A retrospective review of clinical and radiographic data of 111 patients (113 procedures),admitted to our hospital from June 2010 to July 2014,was performed.The resection rate,clinical cured rate and complications in pituitary neoplasms of different Knosp classifications were compared.Results Gross total resection (GTR) rate for pituitary neoplasms according to Knosp classification was 97.4％ in grade 0,85.7％ in grade 1,88.7％ in grade 2,51.9％ in grade 3 and 0％ in grade 4,with significant differences (P＜0.05);GTR rate in pituitary neoplasms of grade 3 and 4 was significantly lower than that in pituitary neoplasms of grade 1 and 2 (P＜0.05).Clinical cured rate of the prolactin adenomas of different Knosp grades was significantly different,and that of grade 0 was statistically higher than that of grade 1-4 (P＜0.05).Clinical cured rate of growth hormone adenoma,adeno-corticotrophic stimulating hormone adenoma and mixed-functional adenomas of different grades showed no significant differences (P＞0.05).Chief complaints were improved in 75.0％-91.7％ non-functioning adenomas.Postoperative severe complications included 3 patients (2.7％) with cerebrospinal fluid rhinorrhea,4 (3.5％) intracranial hematoma,1 (0.9％);postoperative mild complications included 3 (2.7％) epistaxis,14 (12.4％) transient diabete insipidus,1 (0.9％) permanent diabetes insipidus and 3 (2.7％) hyponatremia.Mortality was observed in one patient with intracranial hematoma.Conclusions Neurendoscope provides a superior view of the sellar region,and improves the extent of resection of pituitary adenoma especially for those with cavernous sinus invasion;however,blind pursuit of GTR for tumor with Knosp classification greater than grade 3 will increase the risk of severe complications.Safety should always be the priority for a procedure with a long learning curve like neuroendoscopic surgery.Remission of residue tumor can be addressed by subsequent radiotherapy/stereotactic surgery.
