Goyal Pawan, Gupta Aditya, Srivastava Sanjeev, Modi Shilpi
Department of Neurosurgery, Artemis Hospital, Gurgaon, Haryana, India.
Department of Pathology, Artemis Hospital, Gurgaon, Haryana, India.
Asian J Neurosurg. 2020 Dec 21;15(4):899-907. doi: 10.4103/ajns.AJNS_121_20. eCollection 2020 Oct-Dec.
We aimed to analyze the difficulties and complications experienced while as a beginner in endoscopic transnasal transsphenoidal approach for pituitary adenomas.
We retrospectively analyzed 83 cases done from June 2016 to August 2019. Navigation-guided endoscopic transnasal transsphenoidal approach was used in all the cases.
Gross total tumor removal was achieved in 55 (66.26%) patients. We found that gross total resection rate was inversely proportional to Knosp grading, and the extent of resection was found to have a statistically significant correlation with grade of tumor ( < 0.05). Surgery-related complications were present in 33 of our patients. Nasal complications occurred in six patients: three epistaxis (3.6%) and two hyposmia (2.4%) and one case of septal hematoma (1.2%). Postoperative cerebrospinal fluid leak occurred in six (7.2%) cases, two (2.4%) cases had sinusitis, while two (2.4%) cases had meningitis. There was a very rare case of subarachnoid hemorrhage and one case had sellar hematoma. Endocrinologic complications occurred in 15 (18.07%) patients: anterior pituitary deficiency in five (6.02%) patients, transient diabetes insipidus (DI) in nine (10.84%) patients, and permanent DI in one (1.2%) patient. There was no vascular injury or mortality noted in our study.
Endoscopic approach is an effective modality for pituitary surgery; with patience, learning lessons from your own mistakes and by adopting right technique, learning curve can be flattened significantly.
我们旨在分析垂体腺瘤经鼻内镜经蝶窦入路初学者所经历的困难和并发症。
我们回顾性分析了2016年6月至2019年8月期间完成的83例病例。所有病例均采用导航引导下的内镜经鼻经蝶窦入路。
55例（66.26%）患者实现了肿瘤全切除。我们发现肿瘤全切除率与克诺斯普分级呈负相关，且切除范围与肿瘤分级具有统计学显著相关性（<0.05）。我们的33例患者出现了手术相关并发症。6例患者出现鼻腔并发症：3例鼻出血（3.6%）、2例嗅觉减退（2.4%）和1例鼻中隔血肿（1.2%）。6例（7.2%）患者发生术后脑脊液漏，2例（2.4%）患者发生鼻窦炎，2例（2.4%）患者发生脑膜炎。有1例非常罕见的蛛网膜下腔出血病例，1例患者发生鞍区血肿。15例（18.07%）患者出现内分泌并发症：5例（6.02%）患者出现垂体前叶功能减退，9例（10.84%）患者出现短暂性尿崩症（DI），1例（1.2%）患者出现永久性DI。我们的研究中未发现血管损伤或死亡病例。
内镜入路是垂体手术的一种有效方式；通过耐心、从自身错误中吸取教训并采用正确的技术，可以显著缩短学习曲线。
