The specific features of endonasal transsphenoidal approach in surgical treatment of pituitary adenoma

Abstract

Benign pituitary gland tumors (or adenomas) constitute the vast majority of all chiasmosellar tumors. There are various approaches in surgical treatment of the sella turcica pathology. Endonasal transsphenoidal approach is the method of preference. Choosing the approach to the skull base, the surgeon should carefully study the results of magnetic resonance imaging and computer-aided tomography. If there are anatomic features preventing the approach to the operated area, first of all the patient undergoes the correction of these structures. The surgical excision of pituitary adenoma through endonasal access is conditionally divided into three stages: nasal, sphenoidal and sellar. The final stage of surgical treatment is the stage-by-stage plastic surgery of the bottom of sella turcica with the layer-by-layer implantation of glue compositions and sealing the intracranial space. 12 patients diagnosed with pituitary adenoma with infra- and suprasellar growth were examined at the Chairs of Otorhinolaryngology and Neurosurgery with the participation of cytological laboratories. All the patients were examined by an otorhinolaryngologist on the 7th, 30th and 90th days after surgery. Endoscopic visualization of the surgical intervention area was performed and cytological examination of the nasal cavity secretion was made at the indicated time intervals. Therefore, it has been found that the reactive inflammatory phenomena associated with irrigation therapy were stopped by the 30th-40th day after the surgery. In 8 patients the treatment was supplemented with local antibacterial therapy, which provided the removal of the reactive inflammatory phenomena in the surgical intervention area. Therefore, all patients after endonasal transsphenoidal removal of pituitary adenoma are recommended the 30-day otorhinolaryngologists’ follow-up with the purpose of control of regeneration processes dynamics.