Pituitary tumor treatment points to share
1, sub-disciplinary construction is a trend in the development of neurosurgery in a hospital. And decide whether the department can flourish, most hospitals have taken neurosurgery as the key development object.
When pituitary tumor occurs, the thin anterior wall of saddle is squeezed forward and the angle of saddle node is reduced to a right angle, which is the earliest objective diagnostic basis for pituitary microadenoma on lateral cranial film and an important sign for identifying saddle base during operation.
3.90% of pituitary tumors can be operated by nasal butterfly approach, but there are 5-10% of patients who cannot be operated by butterfly.
4.Do sterilize with iodine volt before opening the pterygoid sinus.
5.On the repair of the saddle base, there are different opinions.
① Use fat and thigh broad fascia as support and multi-layer repair, but pay attention not to leave dead space or void, otherwise it is easy to cause cerebrospinal fluid leakage after surgery. Disadvantages: the pterygoid sinus may be filled, and some patients experience dull head pain and discomfort or a heavy nasal voice, which affects the quality of life.
②If no obvious leak is seen intraoperatively, fill it with quick instant gauze or gelatin sponge. If there is an obvious leak, cover it with dural patch externally and close it with biogel around it.
6. The relationship between bromocriptine and prolactin adenoma.
Prolactin adenoma accounts for about 40% of pituitary adenoma, with peak incidence during the reproductive period. 75-90% of patients take oral bromocriptine effectively, and it is the first-line drug. In individual patients, oral bromocriptine can reduce the hormone level to near normal and the tumor disappears completely. If the tumor remains after surgery, oral bromocriptine can be used to treat the tumor, and some of the tumors can disappear. The relationship between oral bromocriptine and pregnancy. There are no reports that bromocriptine can cause fetal malformation, and it is considered safe to take bromocriptine orally. However, it is generally recommended to discontinue bromocriptine after pregnancy. Surgery in patients with fertility requirements is dangerous, and oral bromocriptine treatment is recommended.
7.90-95% of microadenomas will not increase progressively, so suppression of tumor volume is not the purpose of treatment, and follow-up observation is recommended. 5-10% of microadenomas progress to larger adenomas.
8. Patients taking oral aspirin before surgery are considered safe to stop taking the drug for at least one month. According to Yuan Shaoji, the metabolic cycle of aspirin is 3 weeks, and generally 1W of drug discontinuation can be operated, but in clinical practice, some patients with normal coagulation routine are still prone to postoperative secondary bleeding.
9, postoperative cerebrospinal fluid leakage after transsphenoidal surgery is usually cured by lying down or lumbar pool placement for 3-5 days, but recalcitrant cerebrospinal fluid leakage is a difficult problem. Patients with recurrent repair are recommended to be covered with muscle end (minced meat) in addition to multi-layered repair, using the fibrin adhesion effect of muscle, along with biologic adhesive closure.
10.The repair of cerebrospinal fluid leak is difficult to heal if there is a dead cavity.
11.Pay attention to the distinction between tumor and normal pituitary gland during surgery to prevent postoperative pituitary hypofunction and serious manifestations of patients such as weakness and aging.
12.The caudal part of the superior turbinate is the opening of the pterygoid sinus, which can also slide backward through the pharyngeal wall and turn the corner.
13.The plough bone crest-right in the middle of the sign.
14.Choosing the right doctor and an experienced neurosurgery center determines the prognosis of the patient.
15.The development of neuroendoscopy is promising and is a cutting-edge weapon for master neurosurgeons.
16.Don’t just pursue to shorten the operation time, the operation quality is the biggest responsibility to the patient.
17.The resection of transsphenoidal pituitary tumor has the advantages of small surgical trauma and short operation time, but certain complications may be fatal. For example, infection, cerebrospinal fluid leakage, hypopituitarism, etc.
18, Pre-operative visual acuity and visual field examination is necessary to prevent unnecessary post-operative disputes.