Application of multiple techniques in endoscopic transnasal transsphenoidal resection of large pituitary adenomas

Huang Jin; Sun Jun; Ji Wei; Cheng Chao; Jiao Jiantong; Huang Weiyi; Shao Junfei

doi:10.11850/j.issn.1009-122X.2024.02.004

Abstract：Objective To explore the application value of neuronavigation image fusion,extracapsular dissection,and intraoperative individualized cranial base repair technique in endoscopic transnasal transsphenoidal resection of large pituitary adenomas.Methods The clinical data of 43 patients with large pituitary adenomas were analyzed retrospectively.Thin-slice CT of the sella region and pituitary MRI+MRA navigation sequences were performed,and preoperative evaluation was conducted using neuronavigation image fusion reconstruction technique.All the patients underwent endoscopic transsphenoidal pituitary adenoma resection.After incision of the dura of the sellar floor,the membranous structure around the adenoma was identified,and blunt dissection was performed along the extracapsular interface as much as possible.The pseudocapsule and adenoma were resected together.Among the patients,36 without cerebrospinal fluid leakage and 4 with low-flow cerebrospinal fluid leakage underwent suture of the sellar floor dura and nasal external gauze support,2 with obvious cerebrospinal fluid leakage during surgery were stratified repaired by autologous fat,fascia lata,and suture of the sellar floor dura and 1 case with high-flow cerebrospinal fluid leakage was treated with autologous fat,absorbable artificial dura,autologous fascia lata,and a pedicled nasal septal mucosal flap,with interrupted suturing of the dura and packing of the tumor cavity postoperatively,followed by nasal packing with gauze.Results No postoperative cerebrospinal fluid rhinorrhea occurred,transient diabetes insipidus was observed in 9 cases,and intracranial infection occurred in 3,all of which were improved after symptomatic treatment.Total tumor resection was achieved in 39 cases,and subtotal resection was in 4.Postoperative MRI was performed at 3 months,6 months,and 1 year postoperatively.No recurrence was observed in 39 cases of total resection.Among 4 cases of subtotal resection,3 showed no significant progression,and 1 case underwent reoperation with good recovery.Conclusions Neuronavigation image fusion technique is helpful for surgeons to assess the positional relationship between the tumor and its surrounding structures.Endoscopic identification of the membranous structure around the adenomas,and individualized cranial base repair techniques are effective and worthy of clinical application.