Treatment strategies of giant nonfunctioning pituitary adenomas with obstructive hydrocephalus

Abstract

Objective To analyze the treatment strategies of obstructive hydrocephalus caused by giant nonfunctioning pituitary adenomas (NFPA).Methods The clinical data of 41 cases of NFPA with obstructive hydrocephalus were analyzed retrospectively.Twenty-eight cases were treated through transsphenoidal approach.36 transsphenoidal procedures were carried out,including 19 sub-lip nasal septum sphenoidal sinus approach procedures and 17 nasal septum sphenoidal sinus approach procedures.The pterional craniotomies were used in 13 cases.Results Twenty-five tumors were totally removed,and the overall resection rate was 61％.The total resection rate was 61％ (17/28) in transsphenoidal approach and 62％ (8/13) in pterional craniotomy approach,respectively.The total resection rate was 50％ (4/8) in two-stage of transsphenoidal approach.The external ventricular drainage was used in 8 cases.Among them,4 procedures were performed preoperatively before 2007.The obstructive hydrocephalus was relieved in 3 cases after extracting the external ventricular drainage,and ventricles-peritoneal shunt was used in the other case because of the residual tumor.Another 4 cases were done postoperatively after 2007,including 2 cases of transsphenoidal approach and 2 cases of pterional craniotomy approach.The obstructive hydrocephalus was unrelieved in these 4 cases,including 2 cases were tumor cavity hematoma and 2 cases were tumor residual.Of all the cases,the cerebral ventricles-peritoneal shunt was used in 5 cases.Conclusions The treatment strategies of NFPA with obstructive hydrocephalus should select suitable operative approaches according to the shape and size of sellar floor,growth pattern,texture and blood supply of tumors.The transsphenoidal microsurgery was the primitive approach and could get good surgical effects.The pterional craniotomy,combined with the transsphenoidal and craniotomy,and two-stage of transsphenoidal approach were used in unsuitable transsphenoidal approach cases.The preoperative external ventricular drainage and cerebral ventricles-peritoneal shunt should be used reasonably according to the degree of hydrocephalus and the clinical symptoms and shouldn't be used in every case routinely. Key words: Pituitary adenoma; Obstructive hydrocephalus; Transsphenoidal surgery; Pterional craniotomy