Since 2000, a total of 27 pituitary adenomas were resected using the single nostril-paranasal sinus approach. 23 small and medium-sized tumors were completely resected, 4 large adenomas were completely resected in 1 case, 1 large adenoma in 1 case, and 2 partial resections. After surgery, one case had a fracture of the medial orbital wall-optic nerve canal and optic nerve damage, with severe loss of vision on the affected side.
For large pituitary tumors, especially those with hard and tough texture considered preoperatively, the transsphenoidal approach should be carefully chosen, and the efficacy of transcranial surgery may be more certain. Preoperative assessment of tumor texture should be emphasized. For large tumors with short T2 in MRI T2 phase, it is suggested that the tumor is hard and tough, and transcranial surgery should be considered appropriately for better efficacy. The single nostril approach requires the rhinoscope to reach the anterior inferior wall of the pterygoid sinus directly, which is the key step of this approach to reduce the scope of nasal soft tissue injury and shorten the operation time, and is also its most significant advantage. The angle and depth of the anterior wall of the pterygoid sinus to the nostril are measured on MRI or cranial X-ray before surgery; 2. The head is positioned horizontally during surgery, not overflexed or overextended, to facilitate the accurate entry of the rhinoscope; 3. If the exact orientation of the anterior wall of the pterygoid sinus cannot be determined, the insertion of the rhinoscope should emphasize the principle of “lower rather than higher, shallower than deeper”. After removal of the tumor, the saddle base can be satisfactorily repaired by using gelatin sponge or autologous fat plus EC ear brain gel. If there is no cerebrospinal fluid leakage, the pterygoid sinus should be filled with gelatin sponge only, expecting that the tumor may descend into the saddle after surgery, so that the patient can recover the vision. In the case of postoperative uremia combined with low sodium and low chloride, the clinical manifestations are frequent nausea and vomiting, accompanied by discomfort or pain in the upper abdomen, and a preference for cool foods, such as cold drinks.
The blood biochemical measurement of sodium and chloride is lower than the normal value. Treatment In addition to the treatment for uremia, the change of blood ions should be measured at least twice a day. For light patients, oral saline treatment can be given, and for patients with obvious symptoms, 3% hypertonic sodium chloride injection should be given intravenously immediately to correct low sodium and low chloride. Otherwise, severe sodium and chloride disorders can lead to shock or even death.