). Besides, it is necessary to perform CT bone window scan of the saddle area (sagittal and coronal views are necessary) to fully understand the development of the septum of the pterygoid sinus, which is crucial to correctly locate the saddle base in certain patients with complex pterygoid sinus septum.
Intraoperative operation 1. The length of the nasal mucosa incision must be adequate. Only in this way can the nasal mucosa be peeled off completely without causing mucosal tearing defect, and the mucosal repositioning is also intact after surgery to reduce unnecessary postoperative pain of the patient.
2. When fracturing the nasal septal cartilage, slow and continuous force should be used to avoid tearing the contralateral nasal mucosa. Once the contralateral nasal mucosa is stripped out of a narrow space, the nasal speculum blade is inserted downstream until the anterior wall of the pterygoid sinus, then gradually expanded to fully expose the anterior wall of the pterygoid sinus.
3. After correct exposure to identify the bilateral pterygoid sinus openings, the plow bone is then occluded. Once this bone is occluded, it will be very difficult to locate it again if it is incorrectly positioned.
4.According to the preoperative CT of saddle area, fully reveal and distinguish the septum of pterygoid sinus, and locate the saddle base according to the direction of septum.
5. In most of the patients with pituitary tumor, the bone of saddle base is thin, with ping-pong feeling and bright color when touched (the larger the protrusion into the pterygoid sinus, the more obvious it is), which helps to locate the saddle base.
6. Tumor removal. Most of the pituitary tumors are soft and even mud-like, so it is not difficult to remove them by scraping the circle. Be careful not to remove the tumor tissue too quickly, which may cause the subarachnoid collapse of the saddle base too quickly, and some of the tumor tissue will be squeezed in the periphery, making resection difficult. Take care to protect the arachnoid membrane from rupture, which may increase the difficulty of repair and cause postoperative cerebrospinal fluid nasal leakage. Pay attention to protect the pituitary stalk and normal pituitary tissue.
7. Endoscopic use. Microscope with endoscope can further expand the surgical view, and the tumor tissues growing toward the saddle side can be removed under direct vision, which increases the scope of tumor resection and surgical safety.
Postoperative treatment Mainly, when removing the nasal oil and sand strip, the action should be gentle and slow to avoid causing the nasal crust to fall off and bleed.