title: [Preservation of the pituitary stalk and the gland in transsphenoidal microsurgery for pituitary adenomas].
abstract: OBJECTIVE
  To improve the surgical outcome of pituitary adenomas by identifying and preserving the pituitary stalk and the gland during surgery.
  
  
  METHODS
  From October 2010 to September 2012, the author from the Department of Neurosurgery of Xiangya Hospital, Central South University operated on 51 patients with pituitary adenoma. During the operations, we carefully identified the normal adenohypophysis, pituitary stalk, neurohypophysis and the abnormal tissues either by direct observation or by medical images, aiming to excise the tumor thoroughly, protect the pituitary function and reduce the postoperative complications.
  
  
  RESULTS
  Totally 37 patients (72.5%, 37/51) had total resection of the tumor, 12 (23.5%, 12/51) had subtotal tumor resection and the other 2 had major removal. The gland and the pituitary stalk were well identified and reserved. Detection of hormone content proved that the operation had little effect on the free triiodothyronine (FT3) and adrenocorticotropic hormone (ACTH), while for free tetraiodothyronine (FT4) and thyroid stimulating hormone (TSH) and postoperative followup significant alleviation was found. There was no significant fluctuation for the testosterone in the men preoperatively and postoperatively (all the above results were obtained without hormone replacement therapy). The main postoperative complications were as follows: temporary diabetes insipidus in 5 patients (9.8%, 5/51); electrolyte disorder (the appearance of hyponatremia) in 17 (33.3%, 17/51); and cerebrospinal fluid rhinorrhea and postoperative intracranial infection in 1 (2%, 1/51). No one died during the perioperation period.
  
  
  CONCLUSIONS
  Microscopic transsphenoidal surgery is effective for pituitary adenomas including tumors violating the cavernous sinus. Accurate identification of the pituitary stalk, the gland and the abnormal tissue during the microscopic transsphenoidal operation plays a critical role in preserving the pituitary function and promoting postoperative rehabilitation.
authors.affiliation: Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China.
authors.forename: Haoyu
authors.initials: H
authors.lastname: Li
authors.forename: Xianrui
authors.initials: X
authors.lastname: Yuan
authors.forename: Yiwei
authors.initials: Y
authors.lastname: Liao
authors.forename: Yuanyang
authors.initials: Y
authors.lastname: Xie
authors.forename: Chi
authors.initials: C
authors.lastname: Zhang
authors.forename: Juan
authors.initials: J
authors.lastname: Li
authors.forename: Jun
authors.initials: J
authors.lastname: Su
authors.forename: Xiangyu
authors.initials: X
authors.lastname: Wang
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Chen
authors.forename: Qing
authors.initials: Q
authors.lastname: Liu
mesh_terms: D000236:Adenoma / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery; D019635:Neurosurgical Procedures / Q000379:methods*; D010902:Pituitary Gland / Q000601:surgery*; D010907:Pituitary Hormones / Q000097:blood; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome
chemical_list: D010907:Pituitary Hormones