I. Surgical methods
Generally speaking, surgical treatment of pituitary tumors is divided into two main categories: transcranial surgery and transsphenoidal surgery.
(1) Transcranial surgical approach mainly includes transfrontal inferior, transfrontal temporal (pterygoid point) and transtemporal approach, among which the first two approaches are most commonly used.
The transcranial approach is through the oronasal pterygoid sinus, transnasal pterygoid, and transseptal pterygoid, making it the most widely used surgical method for pituitary tumors.
Indications for surgery
Open surgical treatment: mainly transfrontal approach. It accounts for only 5% of pituitary adenoma surgery.
Transcranial approach is suitable for tumors that grow toward the suprasellar, paracranial, inferior frontal and slope.
Transnasal pterygoid approach: At present, transnasal pterygoid approach accounts for more than 95% of pituitary adenoma resections.
The indications for transnasal pterygoid surgery are.
1. various types of pituitary microadenomas.
2.Various types of pituitary macroadenomas.
3.Various types of giant pituitary adenomas (maximum diameter >3.0cm.)
4.For advanced giant tumors invading the cavernous sinus or even involving the cavernous sinus into the middle cranial fossa.
5.For those with optic cross anterior.
6.Tumors that grow towards the pterygoid sinus, grow backward and invade the saddle back and slope, and cerebrospinal fluid nasal leakage.
Complications of surgery
1.Nasal secretion: Within several months after surgery, nasal congestion often occurs and a small amount of bloody secretion or cool liquid flows out of the nasal cavity continuously. Nasal drops can be injected in the nasal cavity to reduce inflammation. Clean up the nasal secretions 1~2 times in ENT department after 1 week of surgery.
2, nasal bleeding: mostly occurs after the gauze stuffed in the nasal cavity is removed after surgery, individually after several days, the lighter nasal cavity can be seen by temporarily filling cotton balls. In severe cases (bleeding of several hundred milliliters), angiography is required.
3, headache: may be caused by multiple factors such as nasal mucosa edema butterfly sinus inflammation, heavy cases can take painkillers symptomatic treatment.
4, hypopituitarism: manifested as fever, general weakness, headache, nausea, vomiting, not thinking about eating and drinking, etc. Check blood cortisol and thyroid hormone, and after the diagnosis is clear, use prednisone and thyroxine for treatment under the guidance of doctors.
5. Hyponatremia: It usually occurs on the 4th to 8th postoperative day, manifested as hypothermia, weakness, headache, nausea, vomiting, and in severe cases, mental deterioration. Low blood and chloride values on laboratory tests. After the diagnosis is clear, infusion is supplemented with hypertonic saline, and water intake is restricted.
6. Nasal leakage of spinal fluid: constant flow of clear water in the nose, aggravated by low head, accompanied by headache and possible fever. Surgical repair in severe cases.
7.Urinary collapse: manifested by drinking more water and urinating more. More than 4000 ml a day. Appropriate control of drinking water, record the amount of water and urine, oral mydriatic tablets 0.05 mg (half a tablet), or dihydrocortisone 50 mg (2 tablets), 3 times a day, usually after 3 to 5 days more can improve. During the occurrence of uveitis should drink more orange juice and food vegetable soup with high salt content.
8, vision loss: early may be caused by factors such as vasospasm.
IV. Postoperative precautions
1.Can eat normally without special restrictions.
2, pay attention to proper rest, if there is no special situation, you can work normally after January.
3.After surgery, the loss of taste and smell is mostly temporary, no special treatment is needed, and most of them can recover by themselves.
4.For those who underwent surgery through the oronasal butterfly, the sutures of the upper lip mucosal incision are absorbable intestinal sutures, which will fall off by themselves and do not need to be removed. Those who undergo single nostril butterfly sinus surgery generally do not need stitches.
5.Some time after the surgery, there may still be blood in the sputum, if the amount is not much, it is normal and can be observed without treatment.
6, the nasal crust in the nasal cavity should not be buttoned by hand, should wait for it to fall off by itself.
7.Pay attention to whether there is clear liquid flowing out of the nostrils.
8.Be careful to avoid upper respiratory tract infection as much as possible.
9.The hormone is gradually reduced after discharge.
10. If the urine volume continues to exceed 3000ml/day or >200ml/h after discharge, you need to go to the hospital to draw blood to check electrolytes in time.
11. Routinely come to the hospital for review 3 months, 6 months and 1 year after discharge, and need to follow up for life.