Surgical Treatment Strategies Research Articles

Assessing the Predictive Impact of Preoperative Lactate Dehydrogenase to Albumin Ratio on Outcomes Following Coronary Artery Bypass Graft Surgery.

Background: The lactate dehydrogenase to albumin ratio (LAR) is a novel inflammatory marker and a potential predictor of mortality in various conditions. No research has yet examined LAR's impact on mortality in cardiac surgery patients. This study evaluated LAR's role in predicting mortality and complications in isolated coronary artery bypass grafting (CABG) patients. Methods: A retrospective analysis of 377 CABG patients (93 women, 24.7%; 284 men, 75.3%; mean age 65.9 years) from 2020 to 2024 was conducted. Data included demographics, preoperative characteristics, surgical details, and postoperative outcomes, along with ICU and hospital length of stay (LOS). Results: In-hospital mortality was 6.1% (n = 23). Independent predictors were low preoperative ejection fraction (EF) (OR: 0.96, p = 0.024), baseline LAR (OR: 1.08, p = 0.000), LOS-ICU (OR: 1.1, p = 0.000), postoperative ventricular tachycardia (OR: 37.9, p = 0.006), and acute renal failure (OR: 12.1, p = 0.000). Mortality cases had a higher median LAR than survivors (8.6 vs. 5.2, p = 0.000). Elevated LAR correlated with lower preoperative EF (r = -0.227, p = 0.000), longer LOS-ICU (r = 0.17, p = 0.001), and longer LOS-hospital (r = 0.208, p = 0.000). A LAR cut-off of 7.097 predicted mortality (AUC: 0.823, sensitivity 78.3%, specificity 77.1%). Elevated LAR values were observed in all groups with postoperative complications (p < 0.05), indicating its consistent association with negative outcomes. Conclusions: LAR is a valuable predictor of in-hospital mortality and postoperative complications in CABG patients. Elevated LAR is associated with longer ICU/hospital stays and poorer outcomes. Preoperative LAR assessment can guide risk stratification, forecast mortality, and inform surgical planning and treatment strategies.

Robert's uterus treated with ultrasound-guided laparoscopy and hysteroscopy: a case report.

We report the case of a woman in her early 30 s who was diagnosed with Robert's uterus. She had been experiencing progressive dysmenorrhea for a decade and sought treatment for infertility at our hospital. Preoperative ultrasound imaging resulted in a misdiagnosis of a complete uterine septum with an accompanying ovarian cyst. However, intraoperative ultrasound-guided laparoscopy and hysteroscopy confirmed the presence of an asymmetric mediastinal uterus with a blind cavity, consistent with Robert's uterus, along with endometriosis. We performed a combined hysteroscopy and laparoscopy to excise the septum and endometrial cyst in the uterine cavity, and we inserted a uterine cavity stent to prevent postoperative intrauterine adhesions. Subsequent evaluations confirmed the success of the surgical and postoperative treatment strategies. The findings in this case suggest that despite the risk of a misdiagnosis before surgery, accurate assessment and effective surgical intervention for Robert's uterus can be achieved by the combined application of hysteroscopy and laparoscopy, with guidance by ultrasound. Furthermore, our findings highlight the importance of addressing concurrent conditions in the management of Robert's uterus.

Photon-Counting CT Effects on Sensitivity for Liver Lesion Detection: A Reader Study Using Virtual Imaging.

Background Detection of hepatic metastases at CT is a daily task in radiology departments that influences medical and surgical treatment strategies for oncology patients. Purpose To compare simulated photon-counting CT (PCCT) with energy-integrating detector (EID) CT for the detection of small liver lesions. Materials and Methods In this reader study (July to December 2023), a virtual imaging framework was used with 50 anthropomorphic phantoms and 183 generated liver lesions (one to six lesions per phantom, 0.4-1.5 cm in diameter). Virtual CT platforms simulated PCCT and EID CT scanners. Phantoms were virtually scanned using routine (6 mGy) and low-dose (1.5 mGy) conditions and reconstructed with three kernels. A subset of 300 scans (150 PCCT vs EID CT pairs) were selected. Four radiologists independently reviewed all scans to mark liver lesions, assigned confidence scores for detection, and rated scan quality. Analysis was performed on a per-lesion basis to determine sensitivity for several variables and on a per-scan basis for scan quality. The McNemar test, two-sided paired t tests, and mixed-effects logistic regression models were fitted; P < .05 was considered indicative of statistically significant difference. Results Consensus reader sensitivity in detecting lesions was 82.1% (451 of 549) for PCCT versus 77.6% (426 of 549) for EID CT (P < .001), with a mean sensitivity gain of 4.3 percentage points ± 1.3 (P < .001 to P = .02 per reader). Readers had better subjective confidence for lesions at PCCT (mean score, 61.5 ± 22 vs 56.1 ± 24 [on a 101-point scale]; P < .001). Sensitivity was lower for lesions smaller than 1 cm, with more pronounced difference between PCCT and EID CT (74.0% [271 of 366] vs 67.2% [246 of 366]; P < .001). At the lower dose level, PCCT showed higher sensitivity than EID CT (68.9% [168 of 244] vs 61.1% [149 of 244]; P < .001) for subcentimeter lesions. In a multivariable model, PCCT was independently associated with increased odds of lesion detection (odds ratio, 1.55; P < .001). Image quality was slightly higher for PCCT (mean score, 55.3 vs 50.6 [on a 101-point scale]; P < .001). Conclusion Compared with EID CT, PCCT showed better sensitivity in the detection of small liver lesions. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Menu in this issue.

Radical surgical treatment methods for pancreatic tumors

Annotation. Pancreatic cancer is the leading cause of cancer-related mortality worldwide, ranking seventh among other neoplastic diseases with high mortality rates. The purpose of the work is to review and analyze the effectiveness of various surgical methods of pancreatic cancer treatment. Currently, the only radical treatment method for pancreatic cancer is surgical intervention. There is a range of surgical operations for pancreatic cancer, requiring the surgeon to differentiate and appropriately apply them to each clinical case. The choice of surgical treatment strategy primarily depends on assessing the resectability of the tumor, with the goal of achieving R0 resection and conducting lymphadenectomy. This article presents the results of an analysis of literature data and the outcomes of our own surgical experience over the past 15 years. It has been determined that among all radical surgical methods for treating pancreatic tumor lesions, segmental resections lead to significantly better overall patient condition with a lower percentage of complications and early mortality. Additionally, segmental resections allow for tumor removal while preserving the maximum volume of healthy parenchyma and maintaining normal anatomical and physiological conditions of the gastrointestinal tract. This substantially reduces the risk of pancreatic endocrine insufficiency, while maintaining a high quality of life and work capacity for patients. The main goal of treating pancreatic cancer is to improve and optimize radical surgical treatment methods while adhering to all oncological principles, reducing complication and mortality rates, and improving the rehabilitation period and overall patient condition.

Diagnosis and Optimal Surgical Treatment Strategy Selection for Asymptomatic Large Cardiac Myxomas: Review of Modern Approaches and Own Clinical Case Presentation

Cardiac myxoma (CM) is the most common primary tumor of the heart and can be asymptomatic for a long time. CMs have an increased risk of systemic embolization, intracardiac obstruction, transient ischemic attacks, and strokes, potentially leading to patient disability and/or sudden cardiac death. The aim. To highlight the data of modern scientific literature and demonstrate a case of plastic reconstruction of the heart after resection of a large tumor. Materials and methods. We report a case of incidentally discovered left atrial myxoma in a 67-year-old woman with no significant medical history. Transthoracic echocardiography revealed a large mass located in the left atrium. An open surgical intervention was performed, during which the giant CM was completely removed. Histopathological examination confirmed the diagnosis. The patient was discharged on the 7th day of the postoperative period without any complaints. Also, we carried out a comprehensive search and analysis of previously published cases of asymptomatic myxomas and methods of their surgical treatment in the scientific literature of the main electronic databases. Results. In our proposed report, a satisfactory clinical outcome was obtained in a patient with giant myxoma who underwent open cardiac surgery. According to the current literature, transthoracic echocardiography, computed tomography and magnetic resonance imaging of the heart are the gold standards for the diagnosis of heart neoplasms, which corresponded to our diagnostic algorithm. In the opinion of most specialists, the minimally invasive approach is a promising and attractive treatment method for surgeons, however, a complete median sternotomy remains the standard approach in patients with CMs. Conclusions. Asymptomatic CM is a rare incidental finding with a high probability of serious adverse cerebral and cardiovascular events. Early diagnosis of CM is crucial to prevent life-threatening complications, and the most valuable tool is transthoracic echocardiography. The strategy of surgical treatment varies depending on their size and anatomical localization, in particular, resection of large and septal myxomas is usually performed through median sternotomy.

Reduce Flap Necrosis After Autologous Breast Reconstruction: A Systematic Review.

Autologous breast reconstruction provides substantial benefits in terms of aesthetics and longevity. However, the risk of flap necrosis poses potential challenges to patients' appearance and psychological well-being, while also escalating health care costs. Consequently, examining the risk factors, assessment techniques, and therapeutic approaches for flap necrosis is critically important. The authors conducted a comprehensive search for relevant studies from January 2010 to August 2024 using PubMed, Web of Science, and the Cochrane Library. The search terms included "autologous breast reconstruction", "flap necrosis", "risk factor", "assessment", and "treatment". The authors initially screened titles and abstracts, followed by a detailed review by 3 investigators to determine the studies that met the inclusion criteria. A total of 68 studies were ultimately selected for analysis. Identified risk factors for flap necrosis include smoking, advanced age, obesity, diabetes, large breast volume, previous radiotherapy, and abdominal surgery. Various assessment methods (e.g., preoperative imaging, intraoperative blood flow monitoring, and postoperative evaluations) can enhance flap survival. The review also covered surgical treatment strategies and non-surgical interventions, including local wound care, hyperbaric oxygen therapy, and pharmacological treatments. This review highlights the critical role of thorough planning and management in minimizing the risk of flap necrosis after autologous breast reconstruction. Effective preoperative assessments, perioperative monitoring, and specific postoperative interventions can significantly lower the incidence of flap necrosis.

Partial replacement of the tricuspid valve using cryopreserved tricuspid homograft: 20-year outcomes.

There is limited consensus on the optimal strategy for surgical treatment of severe tricuspid valve pathology. At our institution, we have implemented a unique technique of using a tricuspid homograft with its supporting apparatus for partial replacement of the native tricuspid valve. We now present the long-term outcomes of these patients. We analysed a cohort of patients who underwent partial tricuspid valve replacement using tricuspid homograft. Yearly clinical and echocardiographic follow-up was performed. Fine-Gray methods were used to estimate freedom from death and reoperation and reverse Kaplan-Meier methods were used to calculate follow-up. Fourteen patients were included (age range 15 days to 73 years). Indications included congenital anomalies (n = 9, 64%) and infective endocarditis (n = 5, 36%). The median follow-up was 17 years (95% confidence interval (CI) 10-21 years). Two patients (14%) died due to causes unrelated to the primary tricuspid valve surgery, and three (21%) underwent redo tricuspid valve operations. In the remaining cohort, seven (50%) were asymptomatic and two (14%) reported class II dyspnoea, while none had severe tricuspid regurgitation on echocardiogram. Estimated freedom from death was 93% at 10 years and 83% at 15 and 20 years, while estimated freedom from reoperation was 77% at 10, 15 and 20 years. Partial replacement of the tricuspid valve using tricuspid homograft tissue effectively restores the anatomical conformity of the native tricuspid valve and has durable long-term survival and freedom from severe tricuspid regurgitation in patients with congenital anomalies and infective endocarditis.

The role of artificial intelligence in the diagnosis, imaging, and treatment of thoracic empyema.

The management of thoracic empyema is often complicated by diagnostic delays, recurrence, treatment failures and infections with antibiotic resistant bacteria. The emergence of artificial intelligence (AI) in healthcare, particularly in clinical decision support, imaging, and diagnostic microbiology raises great expectations in addressing these challenges. Machine learning (ML) and AI models have been applied to CT scans and chest X-rays to identify and classify pleural effusions and empyema with greater accuracy. AI-based analyses can identify complex imaging features that are often missed by the human eye, improving diagnostic precision. AI-driven decision-support algorithms could reduce time to diagnosis, improve antibiotic stewardship, and enhance more precise and less invasive surgical therapy, significantly improving clinical outcomes and reducing inpatient hospital stays. ML and AI can analyse large datasets and recognize complex patterns and thus have the potential to enhance diagnostic accuracy, preop planning for thoracic surgery, and optimize surgical treatment strategies, antibiotic therapy, antibiotic stewardship, monitoring complications, and long-term patient management outcomes.

Radical Mastectomy Efficiently Improves Long-Term Clinical Outcomes in Dogs with Malignant Mammary Tumors.

The incidence of mammary gland tumors in dogs is a significant issue, characterized by notable rates of malignancy, recurrence, and disease burden. However, the lack of comprehensive information and correlated studies has presented challenges in establishing an effective surgical treatment strategy. In this study, a cohort of 95 dogs diagnosed with mammary tumors underwent evaluation using various surgical methods, medications, ovariohysterectomy, and assessments of margin completeness to analyze clinical outcomes. Significant clinical outcomes were observed following radical mastectomy and conservative surgeries, irrespective of TNM stages and histopathological grade of malignancy. Complete excision demonstrated significantly improved survival time and disease-free interval compared to incomplete excision. It is noted that complete surgical excision provides benefits, even in cases where lymphatic invasion is present. However, further investigations are necessary to validate the clinical results and mitigate side effects from radical mastectomy. Despite postoperative complications, several studies continue to advocate for more radical mastectomies due to their favorable risk-benefit ratio. Moreover, advanced inpatient treatments can now effectively manage or mitigate many of these complications. This study emphasizes the critical role of surgical proficiency and postoperative medication in treating malignant mammary tumors in dogs, and it provides insights that may contribute to the development of more effective treatment strategies for this condition.

IMPACT OF COMORBID PATHOLOGY ON THE CHOICE OF CORONARY REVASCULARIZATION METHOD

Global mortality statistics give coronary heart disease a leading role. Surgical treatment remains the gold standard for improving prognosis and quality of life in these patients. Comorbid pathology, such as type 2 diabetes mellitus and chronic kidney disease, significantly increases the severity of ischemic heart disease, as well as the incidence of perioperative complications and the duration of the rehabilitation period. There are several methods of coronary artery atherosclerosis surgical treatment, such as: percutaneous coronary intervention, coronary artery bypass grafting, as well as a relatively new method of hybrid myocardial revascularization. The decision on the choice of surgical treatment method is made by the Heart Team, which should also include a specialist in the relevant comorbid pathology. Percutaneous coronary interventions are statistically more likely to result in the need for repeat myocardial revascularization than coronary artery bypass grafting. However, open major intervention is accompanied with a great number of postoperative complications and prolonged patient rehabilitation period. Hybrid myocardial revascularization is an alternative method that reduces the risks of adverse complications of multivessel coronary bypass and balloon angioplasty with coronary artery stenting and combines the advantages of both procedures. The choice of the optimal strategy of surgical treatment in patients with comorbid pathology requires special attention.

Comparison of two surgical treatment strategies for fragility fractures of the pelvis based on early postoperative mobility outcomes using insole force sensors.

Increasing incidences for fragility fractures of the pelvis (FFP) have been reported and surgical treatment remains demanding. While conventional screw osteosynthesis is a common method, complications may arise due to altered bone morphology in the osteoporotic pelvic bone. The iFuse implant system is a novel implant, first introduced for treatment of degenerative sacroiliac joint dysfunction, which offers promising biomechanical characteristics with potential benefits for treatment of FFP. Yet data on the use for FFP is limited. The objective of this study is to compare early postoperative mobility of patients treated with screw osteosynthesis only versus patients treated with additional iFuse stabilization based on insole force sensor gait analysis. We hypothesized that additional iFuse implantation leads to superior postoperative mobility. In the prospective observational study, 37 orthogeriatric patients with FFP types II-IV were included. Postoperative mobility of patients treated with conventional screw osteosynthesis only (group 1) and patients with additional iFuse implantation (group 2) was compared. Mobility was examined using insole force sensors (Loadsol®, Novel GmbH). Postoperative comparison of gait analysis showed no significant difference in average (APF) and maximum peak force (MPF) between group 1 (n = 19, APF 64.9% ± 13.3, MPF 76.0% ± 14.1) and group 2 (n = 18, APF 67.6% ± 9.9, MPF 78.2% ± 10.1). Gait symmetry measured by FTI (force-time integral) ratio was significantly higher in group 2 (48.5% ± 3.3) than in group 1 (44.9% ± 5.4; p = 0.023). Median Barthel Index was higher in group 2 (55) compared to group 1 (45), yet not significantly (p = 0.058). Postoperative pain levels showed no significant differences between both groups. Comparison of early postoperative mobility showed similar mobility outcomes in both groups. Patients with additional iFuse implantation had a more balanced gait pattern, whereas no significance was found in peak force parameters. Additional iFuse implantation showed promising results regarding patient mobility, therefore our hypothesis was partly confirmed. In future long-term examinations with larger patient cohorts should be aimed for.

Developing effective intervention strategies for congenital cataract to facilitate visual rehabilitation

Congenital cataract is a blinding condition that presents at birth. Form-deprivation amblyopia can be developed and has become the leading cause of childhood blindness in China. For the problems and challenges in the treatment of congenital cataract, this article discusses the surgical treatment and postoperative rehabilitation strategies and emphasizes the importance of developing effective intervention strategies to improve the visual outcomes in children with congenital cataract, providing valuable guidance for clinical treatment.

Update on Resection Strategies for Hepatocellular Carcinoma: A Narrative Review.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer, the incidence of which is rising globally. Despite recent advancements in immunotherapeutic and surgical treatment modalities, the prognosis for HCC remains poor. The surgical treatment strategy for HCC comprises a multimodal effort that ranges from ablative therapy and surgical resection to liver transplantation. Thanks to collective efforts from the surgical society, there have been rapid advances in resection strategies, such as 3D printing for surgical planning and minimally invasive techniques to minimize surgical trauma. This review examines recent advancements in surgical techniques, patient selection criteria, and perioperative management for HCC resection. The purpose of this review was to provide clinicians and researchers with an up-to-date perspective on the evolving role of surgical resection in HCC treatment, and to identify key areas for future investigation to improve patient outcomes.

Case Report: Large mediastino-abdominal hydatid cyst extending through the Larrey's hiatus: A rare case report

Background The extension of hydatid liver cysts into the mediastinum through diaphragmatic hiatus is extremely rare. In this report, we describe a rare case of a hydatid liver cyst with mediastinal extension through Larrey’s hiatus, emphasizing the surgical strategy for successful treatment. In this report, we present the first documented case of a hydatid liver cyst extending into the mediastinum through Larrey’s hiatus. Case presentation We report the case of a 65-year-old male who presented with right-upper-quadrant and left-sided chest pain evolving for two months. Physical examination showed dullnes in the epigastric region. A thoraco-abdominal CT scan, revealed a 13 cm mediastino-abdominal hydatid cyst, centered on the left liver lobe with extension into the mediastinum through the Larray’s diaphragmatic hiatus. The patient underwent surgical management. Both thoracic and visceral surgeons were involved. The surgical management involved both thoracic and visceral surgeons. A Makuuchi incision allowed resection of the hydatid liver cyst. The mediastinal portion of the cyst, resting on the pericardium was aspirated through Larrey’s hiatus, followed by irrigation with a scolicidal solution. The postoperative course was uneventful. Conclusion Transmediastinal hydatid liver cysts are rare and should be operated on in close collaboration between visceral and thoracic surgeons to prevent complications.

Isolated Fracture of the Greater Tuberosity: Prediction of Superior and Posterior Fracture Displacement on Plain Radiographs.

Isolated fractures of the greater tuberosity represent up to 20% of all proximal humeral fractures. Conservative and surgical treatment strategies are reported. Fracture displacement on radiographs is a key factor in treatment decisions, but the accuracy of measurement methods can limit this process. This study aimed to (Aim I) assess the inter- and intraobserver reliability of established radiographic measurements of fracture displacement and (Aims II/III) determine if these measurements can predict superior, posterior, or combined superior + posterior fracture displacement quantified on CT scans in a patient cohort. Forty-nine cases of isolated greater tuberosity fractures with complete radiographs and CT scans were analyzed. (Aim I) Displacement was measured on radiographs in millimeters as superior ('sup') and lateral ('lat') displacement, along with Mutch's superior ratio ('sGT'), anterior/posterior ratio ('apGT'), and Nyffeler's impingement index ('I-Ind'). Reliability was assessed by three independent observers. (Aim II) A humerus saw-bone model with predefined superior, posterior, and combined fracture displacements was used to validate a CT-based measurement technique. (Aim III) This CT-based method was applied to patient CT scans, and linear regression was used to test if radiographic measurements predicted the CT-measured displacements. (Aim I) Inter- and intraobserver reliability was excellent for 'I-Ind' (inter 0.98/intra 0.94), good-excellent for 'lat' (0.82/0.76) and 'sGT' (0.75/0.94), and moderate for 'sup' (0.73/0.66) and 'apGT' (0.64/0.49). (Aim II) The CT-based technique accurately measured superior (R2=0.99), posterior (R2=0.99), and combined (R2=0.99) displacement. (Aim III) Patient CT scans showed mean displacement of 3.3±2.5 mm superior, 8.4±5.6 mm posterior, and 11.6±7 mm combined. Superior displacement correlated with 'sup' (p<0.001), posterior with 'lat' (p<0.001), 'apGT' (p=0.004), 'I-Ind' (p=0.048), and combined displacement with 'lat' (p<0.001) and 'apGT' (p=0.006). In fractures displaced ≥5mm, 'sup' (p=0.002) correlated with superior, 'lat' (p=0.003) and 'I-Ind' (p=0.049) with posterior, and 'lat' (p<0.001) with combined displacement. The CT-based technique accurately measured fragment displacement in the saw-bone model. For fractures with ≥5mm displacement, 'lat' was the best predictor of combined displacement (interobserver reliability: 0.82-0.94). However, in the reported cohort, 'lat' underestimated the "true" fragment displacement. Therefore, in 'lat' measurements ≥ 3mm, a CT scan for quantification of fragment displacement should be considered. However, these findings must be confirmed in bigger patient populations before clinical translation.

AB010. Surgical treatment strategy for thymic cancer invading the aorta: a case report

AB010. Surgical treatment strategy for thymic cancer invading the aorta: a case report

Surgical treatment methods and strategies for cervical intervertebral disc herniation

Surgical treatment methods and strategies for cervical intervertebral disc herniation

Paradigms in periorbital scar management

Periocular scarring following surgery or trauma is of great aesthetic and functional concern and is difficult to predict. In today’s era, with increasing scientific knowledge and technological advances, both physicians and their patients are highly concerned with minimizing scar appearance as a rising number of patients feel disappointed with their scars and are frequently seeking help for functional and aesthetic improvement. Although various non-surgical and surgical treatment strategies are available it is still difficult to improve excessive scarring. Thus, the importance of thorough knowledge of eyelid anatomy and heal­ing mechanisms along with appreciation of wound closure techniques like placing the sutures at natural cosmetic subunit junctions and along relaxed skin tension lines (RSTLs) in order to achieve scar camouflage and to ensure decreased tension on the wound cannot be more emphasised. Periorbital area should be tackled by the oculoplasty surgeons in view of their distinct anatomy and close proximity to the eye.Scars are commonly treated with a combination of non-surgical techniques, including watchful waiting, scar massage, pressure therapy, silicone gel sheeting, topical or intralesional injections, cryotherapy, laser therapy or radiotherapy. Surgical approaches include pincushioning debulking, direct scar excision, broken line closure techniques, scar lengthening procedures (Z plasty, V-Y/Y-V advancement) and scar excision with lid reconstruction. Mastery of this content is essential for consistent operative success. For good cosmetic and functional outcomes, scar revision techniques should be thoughtfully tailored to the individual and scar subtype.

A CASE OF THE FORMATION OF A ROUGH CYCLITIC MEMBRANE IN A CHILD AGAINST THE BACKGROUND OF INTERMEDIATE UVEITIS

Intermediate uveitis often occurs asymptomatically, and children tend to underestimate changes in vision until the first complications appear, leading to a prolonged course of the disease without treatment. The formation of opacities in the lens is one of the most common complications of uveitis in children that require surgical intervention. However, lens opacification is often considered in isolation from other changes in the eye, which in turn defines the goal of the surgery as achieving a quick functional result. At the same time, one of the complications of intermediate chronic uveitis, existing alongside cataract, is the cyclitic membrane, which is an important factor in determining the strategy for surgical treatment. This article presents a clinical case of treating complications of uveitis in a child, where the intervention strategy aimed to minimize the number of complications in the future despite the delayed functional outcome.

Protective Strategies for Pituitary Function During Endoscopic Transnasal Pituitary Adenoma Surgery: A Single-center Experience.

This study investigated the impact of endoscopic transnasal pituitary adenoidectomy on function and discussed the factors that contribute to postoperative pituitary function. To provide a foundation for protecting pituitary function and improving the curative effect of pituitary adenoma neuroendoscope resection. From January 2019 to January 2022, in the Neurosurgery Pituitary Tumor Diagnosis and Treatment Research Center, the First Affiliated Hospital of Shenzhen University, the clinical data of 306 patients who underwent endoscopic transnasal pituitary adenoma surgery were analyzed retrospectively. The surgical treatment strategy was discussed and explored, while the factors related to pituitary function were examined based on tumor size and Knosp grade. There were 40 cases (67.8%) of pituitary-thyroid axis, 18 cases (60%) of pituitary-adrenal axis, 25 cases (45.4%) of pituitary-gonad axis, 5 cases (62.5%) of pituitary-growth hormone axis, and 8 cases (72.7%) of diabetes insipidus with postoperative improves of hypopituitarism. Postoperative newly developed hypopituitarism occurred in 20 cases (8.1%) of pituitary-thyroid axis, 15 cases (5.4%) of pituitary-adrenal axis, 10 cases (4.0%) of pituitary-gonad axis, 5 cases (1.7%) of pituitary-growth hormone axis, and 8 cases (2.7%) of new diabetes insipidus. The incidence of pituitary-adrenal axis hypofunction in giant pituitary adenomas was significantly higher than that in microadenomas and macroadenomas (P<0.05). The incidence of hypopituitarism of Knosp grade 4 pituitary adenoma before operation was higher than that of other groups (P<0.05), but there was no significant difference in the incidence of new hypopituitarism after operation (P>0.05). In endoscopic transnasal pituitary adenoma surgery, the incidence of hypothyroidism and adrenal gland dysfunction is higher than in other hormone axes, but the recovery rate is also higher, and the recovery rate of sex hormones is lower. The incidence of postoperative hypothyroidism increases dramatically with tumor size and tumor invasiveness.