Some features of the perioperative management of patients with a tumor of the chiasmal cellaric region: a review

Abstract

INTRODUCTION: Tumors of the chiasmal-sellar region (CSR) account for more than 20 % of all primary intracranial neoplasms, of which pituitary adenomas account for up to 20 % of the world population. Currently, removal of these neoplasms is performed using endoscopic transsphenoidal surgical accesses. OBJECTIVE: analysis of the results of publications concerning perioperative management of patients with CSO tumors. MATERIAL AND METHODS: publications were searched and selected in bibliographic databases PubMed, Web of Science, Scopus. To study the approach to perioperative management of patients with CSF tumors, the works published from 2013 to 2023 were analyzed. Search keywords: pituitary surgery, anesthesia. Based on the analysis of current problems in anesthesia planning for patients with CSF tumors, the search was expanded with additional keywords: “pituitary tumor”, “perioperative complications”, “endocrine disorders”, “difficult airway”, “acromegaly”, “cardiologic complications, acromegaly”, “peripheral neuropathy, acromegaly”, “trigemino-cardiac reflex”, 206 publications were additionally analyzed and the main key points in anesthesia planning were summarized. A total of 230 publications were included but 161 were excluded. A total of 69 studies were selected. RESULTS: The main features of patients with CSF tumors are: water-electrolyte disorders, cardiovascular pathology, difficult airway. This determines a multidisciplinary approach in preparation for surgery. It is necessary to take into account these features when planning anesthetic support and management of the early postoperative period. In addition, endoscopic transnasal-transsphenoidal access may cause a number of complications: damage to the hypothalamic region and large vessels, and in the postoperative period: respiratory disorders, hormonal insufficiency, Water and Sodium Disturbances. CONCLUSIONS: Additional vigilance is required when preparing a patient with CSF formation for surgery. Perioperative management of a patient with CSO tumor requires a team approach with participation of neurosurgeons, neurologists, ophthalmologists, endocrinologists, cardiologists, anesthesiologists-resuscitators.