[Repair and reconstruction of diaphragmatic defect during transcranial pituitary adenoma surgery].

Objective: To investigate the application value of titanium-clip and artificial menigeal in the sella diaphragm repair and reconstruction during transcranial pituitary adenoma surgery.

Methods: Thirty eight patients undergoing transcranial pituitary adenoma surgery received sella diaphragmatic defect repair and reconstruction after the removal of tumor, intraoperative diaphragmatic defect was classified as three grades, titanium-clip, artificial menigeal and EC glue were used for the sella diaphragmatic repair and reconstruction. The short-term and long-term complications were compared with those in the control group which contains 74 patients without diaphragmatic reconstruction.

Results: As 14 to 46 months' follow-up in the diaphragmatic reconstruction group, there were no leakage of cerebrospinal fluid(CSF), infections, empty sella syndrome (ESS), optic nerve damage, and any other severe complications was found. Only one inter-sella hemorrhage without optic nerve damage was found 3 hours after surgery by CT scan. In the group without diaphragmatic reconstruction, more secondary empty sella, cerebrospinal fluid rhinorrhea and intra-cranial infection were found after the following transsphenoidal surgery (P < 0.05), there was one case underwent the 2nd time transcranial surgery 1 hours later due to severe inter-sella hemorrhage resulting in vision damage and conscious disturbance. There was no significant difference in pituitary function and vision improvement between the two groups as the occurrence of diabetes insipidus (P > 0.05).

Conclusion: It is important to repair the sellae diaphragm defect during transcranial pituitary adenoma surgery, which could reduce short-term and long-term complication.