Ma Josh, Gooderham Peter, Akagami Ryojo, Makarenko Serge
Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Neurosurgery. 2023 Jun 1;92(6):1269-1275. doi: 10.1227/neu.0000000000002360. Epub 2023 Jan 18.
Endoscopic transsphenoidal surgery remains the technique of choice for resection of pituitary adenoma. Postoperative diabetes insipidus (DI) is most often transient and observed in 1.6% to 34% of patients, whereas permanent DI has been reported in 0% to 2.7% of patients. The proposed mechanism was the transduction of traction forces exerted by the surgeon on the descended diaphragma sellae and through the pituitary stalk.
To quantify and correlate the degree of pituitary gland descent with postoperative DI.
Of 374 patients who underwent transsphenoidal resection of a pituitary adenoma between 2010 and 2020 at our institution, we report a cohort of 30 patients (Group A) DI. We also report a matched cohort by tumor volume of 30 patients who did not develop DI (Group B). We quantified the tension on the pituitary stalk by calculating pituitary descent interval (PDI) by comparing preoperative and postoperative position of the pituitary gland and using Pythagoras' formula where , with craniocaudal (CC) and anterior-posterior (AP) representing measurements of pituitary translation in respective directions after resection.
Patients who developed DI had significantly greater pituitary gland translations in the craniocaudal (23.0 vs 16.3 mm, P = .0015) and anteroposterior (2.4 vs 1.5 mm, P = .0168) directions. Furthermore, Group A had a statistically greater PDI, which was associated with development of DI (23.2 vs 16.6 mm, P = .0017).
We were able to quantify pituitary descent and subsequent tension on the pituitary stalk, while also associating it with development of postoperative DI after pituitary adenoma resection.
内镜经蝶窦手术仍然是垂体腺瘤切除术的首选技术。术后尿崩症（DI）大多是暂时的，在1.6%至34%的患者中可见，而永久性尿崩症在0%至2.7%的患者中被报道。推测的机制是外科医生对下降的鞍隔和穿过垂体柄施加的牵拉力的传导。
量化垂体下降程度并将其与术后尿崩症相关联。
在2010年至2020年期间于我们机构接受垂体腺瘤经蝶窦切除术的374例患者中，我们报告了一组30例发生尿崩症的患者（A组）。我们还报告了一组按肿瘤体积匹配的30例未发生尿崩症的患者（B组）。我们通过比较垂体术前和术后位置，使用毕达哥拉斯公式计算垂体下降间隔（PDI）来量化垂体柄上的张力，其中，颅尾（CC）和前后（AP）分别代表切除后垂体在各自方向上的平移测量值。
发生尿崩症的患者在颅尾方向（23.0对16.3毫米，P = 0.0015）和前后方向（2.4对1.5毫米，P = 0.0168）的垂体平移明显更大。此外，A组的PDI在统计学上更大，这与尿崩症的发生相关（23.2对16.6毫米，P = 0.0017）。
我们能够量化垂体下降以及随后垂体柄上的张力，同时还能将其与垂体腺瘤切除术后尿崩症的发生相关联。
