Background: Neuroendoscopic transsphenoidal approach for resection of pituitary adenomas has the advantages of less damage, fewer complications, and a faster recovery than the traditional approach and has beening favored by neurosurgeons. However, there has no standard method of selecting suitable packing materials after the operation to relieve pain in patients and achieve the ideal hemostatic effect. We compared the postoperative complications and treatment effects of two different packing materials in patients with pituitary adenomas. Objective: To investigate the advantages and disadvantages of using a catheter balloon and iodoform gauze for hemostasis in patients undergoing pituitary tumor resection by neuroendoscopic transsphenoidal approach. Materials and Methods: We retrospectively analyzed these data of 48 cases treated with pituitary adenoma resection by the single nasal approach from January 2018 to October 2019 in Sun Yat-sen University Cancer Center. According to the type of sphenoid sinus packing material used, these patients were divided into balloon tamponade oppression group (24 cases) and tela iodoformum oppression group (24 cases), respectively. The balloon tamponade oppression group received catheter balloon tamponade oppression hemostasis, and the tela iodoformum oppression group underwent tela iodoformum oppression hemostasis. The outcomes and complications were compared between the two groups in which two kinds of sphenoid sinus packing materials were used for hemostasis after tumor resection by transnasal endoscopic approach. For the catheter balloon compression hemostasis method, on account of the plasticity of the balloon, the volume of water in the balloon can be adjusted according to the size of the patient’s own sphenoid cavity. The amount of bleeding and several complications in terms of discomfort during placement and removal of the packing material, rebleeding after removal of the packing, cerebrospinal fluid rhinorrhea and electrolyte disturbance are compared between the two groups. Results: 48 patients were enrolled. The two groups’ data of patients were similar in age structure, sex ratio, tumor size at baseline and so on. No complications, such as abscess formation, were found in both groups. The success rate in the compression with catheter balloon group was 100% (24 of 24 patients); and in the iodoform gauze group 83.33% (20 of 24 patients). A catheter balloon was more
References
[1]
Wang, Z.C. (2004) Neurosurgery. Hubei Science and Technology Press, Wuhan.
[2]
Chen, W.Z. (2013) Diagnostic Value and Clinical Significance of MRI in Invasive Pituitary Tumor. Chinese Imaging Journal of Integrated Traditional and Western Medicine, 11, 94-95.
[3]
Bao, M.Y. and Cheng, H.W. (2013) Current Status and Progress of Pituitary Tumor Treatment. Chinese Journal of Clinicians, No. 6, 2647-2649.
[4]
Chen, K., Wang, Z., Gao, H., et al. (2015) Efficacy Analysis of Transsphenoidal Sphenoidal Pituitary Tumor Resection in 27 Cases. Yunnan Medicine, No. 5, 501-502.
[5]
Gray, L.P. (1978) Deviated Nasal Septum: Incidence and Etiology. Annals of Otology, Rhinology & Laryngology, 87, 3-20. https://doi.org/10.1177/00034894780873S201
[6]
Brain, D. (1997) The Nasal Septum. In: Kern, A.G., Ed., Scott-Brown’s Otolaryngology, 6th Edition, Butterworth Heinemann, Oxford, Volume 4, 39-40.
[7]
Cruise, A.S., Amonoo-Kuofi, K., Srouji, I., et al. (2006) A Randomized Trial of Rapid Rhino Riemann and Telfa Nasal Packs Following Endoscopic Sinus Surgery. Clinical Otolaryngology, 31, 25-32. https://doi.org/10.1111/j.1749-4486.2006.01122.x
[8]
Weber, R.K. (2009) Nasal Packing and Stenting. GMS Current Topics in Otorhinolaryngology—Head and Neck Surgery, 8, 2.
[9]
Samad, I., Stevens, H.E. and Maloney, A. (1992) The Efficacy of Nasal Septal Surgery. Journal of Otolaryngology, 21, 88-91.
[10]
Bresnihan, M., Mehigan, B. and Curran, A. (2007) An Evaluation of Merocel and Series 5000 Nasal Packs in Patients Following Nasal Surgery: A Prospective Randomised Trial. Clinical Otolaryngology, 32, 352-355. https://doi.org/10.1111/j.1749-4486.2007.01517.x
[11]
Zhao, X. (2014) Clinical Application Analysis of Endoscopically Assisted Transnasal Pituitary Tumor Resection. Journal of Chinese and Foreign Medical Research, No. 23, 112-113.
[12]
Huang, T.X., Zhang, J.H. and Chen, G. (2011) Experience of Endoscopic Transsphenoidal Transsphenoidal Resection of Pituitary Tumor in 26 Cases. Journal of Chinese Modern Surgery, 8, 71-73.
Xu, G. (2012) Clinical Experience of Endoscopic Transsphenoidal Surgery for Pituitary Tumors. Guide of China Medicine, No. 29, 260-261.
[15]
Akkan, S., Çorbacıoğlu, Ş.K., Aytar, H., Emektar, E., Dağar, S. and Çevik, Y. (2019) Evaluating Effectiveness of Nasal Compression with Tranexamic Acid Compared with Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial. Annals of Emergency Medicine, 74, 72-78. https://doi.org/10.1016/j.annemergmed.2019.03.030
[16]
Semple, P.L. and Laws, E.R. (1999) Complications in a Contemporary Series of Patients Who Underwent Transsphenoidal Surgery for Cushing’s Disease. Journal of Neurosurgery, 91, 175-179. https://doi.org/10.3171/jns.1999.91.2.0175
[17]
Sudhakar, N., Ray, A. and Vafidis, J.A. (2004) Complications after Trans-Sphenoidal Surgery: Our Experience and a Review of the Literature. British Journal of Neurosurgery, 18, 507-512. https://doi.org/10.1080/02688690400012459a
[18]
Fatemi, N., Dusick, J.R., Neto, M.A.D. and Kelly, D.F. (2008) The Endonasal Microscopic Approach for Pituitary Adenomas and Other Parasellar Tumors: A 10-Year Experience. Neurosurgery, 63, 244-256. https://doi.org/10.1227/01.NEU.0000327025.03975.BA
[19]
Couldwell, W.T., Weiss, M.H., Rabb, C., Liu, J.K., Apfelbaum, R.I. and Fukushima, T. (2004) Variations on the Standard Transsphenoidal Approach to the Sellar Region, with Emphasis on the Extended Approaches and Parasellar Approaches: Surgical Experience in 105 Cases. Neurosurgery, 55, 539-547. https://doi.org/10.1227/01.NEU.0000134287.19377.A2
[20]
Kassam, A., Snyderman, C.H., Mintz, A., Gardner, P. and Carrau, R.L. (2005) Expanded Endonasal Approach: The Rostrocaudal Axis. Part I. Cristagalli to the Sella Turcica. Neurosurgical Focus, 19, E3. https://doi.org/10.3171/foc.2005.19.1.4
[21]
Alobid, I., Ensenat, J., Marino-Sanchez, F., Rioja, E., de Notaris, M., Mullol, J., et al. (2013) Expanded Endonasal Approach Using Vascularized Septal Flap Reconstruction for Skull Base Tumors Has a Negative Impact on Sinonasal Symptoms and Quality of Life. American Journal of Rhinology & Allergy, 27, 426-431. https://doi.org/10.2500/ajra.2013.27.3932
[22]
Dehdashti, A.R., Ganna, A., Witterick, I. and Gentili, F. (2009) Expanded Endoscopic Endonasal Approach for Anterior Cranial Base and Suprasellar Lesions: Indications and Limitations. Neurosurgery, 64, 677-687. https://doi.org/10.1227/01.NEU.0000339121.20101.85
[23]
Laws, E.R., Kanter, A.S., Jane, J.A. and Dumont, A.S. (2005) Extended Transsphenoidal Approach. Journal of Neurosurgery, 102, 825-827. https://doi.org/10.3171/jns.2005.102.5.0825
[24]
Kassam, A., Carrau, R.L., Snyderman, C.H., Gardner, P. and Mintz, A. (2005) Evolution of Reconstructive Techniques Following Endoscopic Expanded Endonasal Approaches. Neurosurgical Focus, 19, E8. https://doi.org/10.3171/foc.2005.19.1.9
[25]
Kitano, M. and Taneda, M. (2004) Subdural Patch Graft Technique for Watertight Closure of Large Dural Defects in Extended Transsphenoidal Surgery. Neurosurgery, 54, 653-660. https://doi.org/10.1227/01.NEU.0000108780.72365.DC
[26]
Zweig, J.L., Carrau, R.L., Celin, S.E., Schaitkin, B.M., Pollice, P.A., Snyderman, C.H., et al. (2000) Endoscopic Repair of Cerebrospinal Fluid Leaks to the Sinonasal Tract: Predictors of Success. Otolaryngology—Head and Neck Surgery, 123, 195-201. https://doi.org/10.1067/mhn.2000.107452
[27]
Nix, P., Tyagi, A. and Phillips, N. (2016) Retrospective Analysis of Anterior Skull Base CSF Leaks and Endoscopic Repairs at Leeds. British Journal of Neurosurgery, 30, 422-426.
[28]
Minni, A., Dragonetti, A., Gera, R., et al. (2010) Endoscopic Management of Recurrent Epistaxis: The Experience of Two Metropolitan Hospitals in Italy. Acta Oto-Laryngologica, 130, 1048-1052. https://doi.org/10.3109/00016481003621538
[29]
Zhu, Y.H. and Yu, J. (2016) Nasal Endoscopic Balloon Catheter Type Nasal Packing in the Treatment of Nasal Bleeding Effect Evaluation. World Latest Medicine Information, No. 1, 15-16.
[30]
Tang, W. (2013) Evaluation of Curative Effect of Water Bladder Catheter Nasal Cavity Packing under Nasal Endoscopy in the Treatment of Epistaxis. Chinese Journal of Ophthalmology and Otorhinolaryngology, 13, 258-260.
