医学
尿崩症
外科
脑膜炎
经蝶手术
泄漏
脑脊液漏
脑脊液
内窥镜检查
回顾性队列研究
死亡率
麻醉
垂体腺瘤
内科学
腺瘤
环境工程
工程类
作者
Jean Raymond,Thomas Graillon,J. Lassave,Frederic Castinetti,Sébastien Boissonneau,Emline Tabouret,Stéphane Fuentes,Lionel Velly,Régis Gras,Henry Dufour
标识
DOI:10.1016/j.wneu.2016.02.059
摘要
To analyze complications of endoscopic transsphenoidal surgery (ETS) for nonfunctioning pituitary macroadenomas (NFPAs).A retrospective study of 300 NFPAs was performed. Complications and factors that could influence these complications were analyzed.Visual and pituitary functions worsened in 2.4% and 13.7% of cases, respectively. Postoperative diabetes insipidus was permanent in 6.2% of cases. Postoperative meningitis occurred in 3.3% of patients. Meningitis was strongly associated with intraoperative cerebrospinal fluid (CSF) leaks (P = 0.01), postoperative CSF leaks (P = 0.0001), and operation times longer than 1 hour (P = 0.023). Detection of Staphylococcus aureus and preoperative treatment with mupirocin in the nostrils did not impact the occurrence of meningitis. Two patients with meningitis died (unique causes of death). Postoperative CSF leaks occurred in 2.7% of cases and were associated with intraoperative CSF leaks (P = 0.007) and permanent diabetes insipidus (P = 0.028). The rate of CSF leak decreased from 4% to 0.8% (P = 0.048) after we moved from a soft to hard reconstruction of the sella. The rate of postoperative epistaxis decreased from 6.7% to 1.25% after we stopped using monopolar coagulation (P = 0.013).ETS permits a wide view, allowing good conditions for a satisfactory resection in the majority of NFPAs. Some pitfalls of endoscopy can lead to complications that improve with modification of the operative technique (i.e., CSF leak and postoperative epistaxis). This study confirms an acceptable rate of complications associated with ETS.
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