Objective:To investigate the changes of sphenoid sinus and related risk factors of sphenoid sinusitis after microscopic transsphenoidal pituitary adenoma resection.Methods:The clinical and imaging data of 106 patients with large pituitary adenoma in 900 Hospital of the PLA Joint Logistics Team between August 2012 and March 2015 were continually collected. The changes of accumulated blood and fluid, inflammation, mucocele, mucosa remodeling in sphenoid sinus cavity at preoperative and postoperative different time points were observed through the analysis of magnetic resonance imaging (MRI). Binary logistic multiple factors regression model was used to analyze the independent risk factors for postoperative sphenoid sinusitis.Results:MRI results showed that the blood and fluid accumulated in sphenoid sinus cavity were absorbed and dissipated 3 months after the surgery, and the saddle bone windows were covered by new mucous membrane at this time, but they were not complete; the remaining tumors in the saddle all sank into the saddle to different degrees. The reconstruction of sphenoid sinus mucosa was basically complete 6 months after the surgery. There were 7 (6.6%) cases of mucocele in sphenoid sinus and 26 (24.5%) cases of sphenoid sinusitis 3 months after the surgery among 106 patients. The results of multivariate analysis showed that growth hormone adenoma ( OR = 2.981, 95% CI 1.480-26.207, P = 0.014), preoperative sphenoid sinusitis ( OR = 12.392, 95% CI 2.927-52.462, P = 0.001), frequency of multiple transsphenoidal surgery ( OR = 14.758, 95% CI 2.431-89.584, P = 0.003) and perioperative cerebrospinal fluid leakage ( OR = 11.644, 95% CI 2.175-62.344, P = 0.004) were independent risk factors for postoperative sphenoid sinusitis. Conclusions:The evolution of sphenoid sinus cavity contents has its own rules after microscopic transsphenoidal pituitary adenoma resection. Patients with growth-hormone pituitary adenoma, sinusitis before surgery, multiple transsphenoidal surgery and cerebrospinal fluid leakage during the surgery should receive enhanced anti-infection treatment and nasal care in perioperative period to reduce the possibility of sphenoid sinusitis after surgery. The staged time of reoperation for pituitary adenoma resection by transsphenoidal approach should be about 3 months after the previous operation.

Objective To evaluate the surgical strategy for giant pituitary adenomas apoplexy complicated with obstructive hydrocephalus.Methods Twenty-three patients with giant apoplectic pituitary adenomas associated with obstructive hydrocephalus,admitted to our hospital from January 2010 to March 2015,were chosen;their clinical and surgery data were retrospectively summarized.Results Transsphenoidal microsurgery was conducted in 22 patients and craniotomy in one.All tumors showed cystic degeneration and soft texture.Seven patients had faint yellow or hyaline cyst fluid and 16 had soybean sauce or dark red cyst fluid.Near-total tumor resection was achieved in 2 patients (8.7％),subtotal resection in 16 (69.6％),and partial resection in 5 (21.7％).Twenty-three patients were followed up for 4-38 months,one patient accepted repeated operation for residual rumors,5 had postoperative adjuvant radiation therapy,and no other patients showed re-growth or recurrence.Postoperatively,there was no long-term cerebrospinal fluid leakage and diabetes insipidus,with hydrocephalus disappeared in 100％,visual improved in 60.9％,and headache relieved in 81.8％.Conclusions Pituitary adenoma presented with apoplexy and concurrent obstructive hydrocephalus is often soft.Transsphenoidal microsurgery is the preferred safe and effective method which can relieve hydrocephalus and achieve improved clinical symptoms.

Hyponatremia is one of the common types of electrolyte disorders in neurosurgery. It is common in patients accepted surgeries, such as brain tumor surgery, pituitary surgery, subarachnoid hemorrhage and traumatic brain injury. Hyponatremia can easily lead to decreased levels of consciousness, seizures, and cerebral edema, therefore, it should be treated promptly to minimize brain damage. It is extremely important to correctly understand the causes of hyponatremia and accurately diagnose and treat. This review summarizes the recent advances in hyponatremia in neurosurgical patients.

Objective To investigate the related influence factors of the main extended direction of the pituitary macroadenoma in the vertical direction.Methods Clinical data of 184 pituitary macroadenoma patients were collected and analyzed retrospectively.The main extended direction in the vertical direction of the tumor was taken as the dependent variables.Patients were divided into two groups according to the suprasellar extension value of each tumor,(ie:suprasellar extension value＞0 and suprasellar extension value≤0).10 selected indicators (age,sex,tumor type,diameter of diaphragmatic opening,sphenoid sinus type,sella type morphology,main sphenoid sinus septum bias,maximum width of sphenoid sinus septum,tumor cyst,number of longitudinal sphenoid sinus septum) were taken as independent variables and the factors which may influence the main extended direction were analyzed and selected by logistic regression method.Results Among the 184 patients,there were 121 cases extending mainly to the suprasellar direction,while the left cases extending mainly to the opposite direction.Statistical analysis showed the tumor type (P=0.026),sphenoid sinus type (P=0.003),sella type morphology (P=0.046),diameter of diaphragmatic opening (P=0.003) and maximum width of the sphenoid sinus septum (P=0.009) were the independent predictors influencing the main expansion direction of pituitary macroadenomas in the vertical direction.Conclusions The pituitary macroadenoma is more likely to expand infrasellar in patients with sellar or sellaoccipital sphenoid sinus,sac sella turcica morphology,GH adenoma,smaller diaphragmatic opening diameter and narrower width of sphenoid sinus septum.The pituitary macroadenoma is more likely to expand suprasellar in patients with presellar sphenoid sinus,wok and cylinder sella turcica morphology,nonGH adenoma,larger diaphragmatic opening diameter and wider width of sphenoid sinus septum.

Objective To analyze the occurrence and location of posterior pituitary bright spot (PPBS) and its influence factors by analyzing the magnetic resonance T1-weighted imaging (T1WI) in patients with pituitary adenoma.Methods One hundred and twenty-three patients with pituitary adenoma,admitted to our hospital from September 2012 to September 2014,were collected in our study.All patients were performed T1WI and T2WI sagittal,coronal and axial scan and enhanced scan at SE sequence before operation.The occurrence and location of PPBS of the pituitary gland were observed;the clinical data of these patients from PPBS-visible group and PPBS-non-visible group were analyzed and compared.Re.sults Of the 123 patients,the PPBS-visible group included 98 patients (79.7％) and the PPBS-non-visible group included 25 patients (20.3％).The adenoma shapes were classified into hourglass-type (n=43),barrel-type (n=63) and wedge-type (n=17).The occurrencerateofPPBSin barrel-type patients was significantly lower than hourglass-type patients (P＜0.05);the signal intensity ratio of PPBS and pons in barrel-type patients and wedge-type patients was significantly higher than that in the hourglass-type patients (P＜0.05).Adenoma volume and height of the PPBS-visible group was significantly smaller than those in the PPBS-non-visible group (P＜0.05).The distribution of different adenoma types was significantly different between patients from PPBS-visible group and PPBS-non-visible group (P＜0.05).Conclusion The posterior lobe of pituitary could be displayed satisfactorily at T1WI,and appearance of PPBS is related to the morphology,volume and height of pituitary adenoma.