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Adoption of adjustable pressure endoscopic diving technique in pituitary tumor resection after radiotherapy
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H. Zhong   , Z.B. Ding , W.J. Xing , J.F. Zhang , G.F. Sun , W.P. Liu |
| Department of Neurosurgery, First Affiliated Hospital of Xi'an Medical University, School of General Medicine, Xi'an Medical University, Xi'an, Shaanxi Province, China , xyyfy1986@163.com |
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Abstract: (22 Views) |
Background: Endoscopic endonasal transsphenoidal pituitary adenoma resection faces challenges like bleeding and tissue folds that can reduce visual clarity, particularly in patients with prior radiotherapy, where altered tissue characteristics complicate the procedure. The adjustable-pressure endoscopic diving technique may help address these challenges by enhancing visualization through fluid medium regulation. The aim of this study is to assess the efficacy and safety of the adjustable-pressure endoscopic diving technique in pituitary tumor resection after radiotherapy. Materials and Methods: This retrospective multi-center study included 63 patients who underwent endoscopic endonasal tumor resection. The cohort consisted of patients with sellar and parasellar tumors, including pituitary adenomas, some of whom had previously received radiotherapy. Radiotherapy modalities included conventional fractionated external beam radiotherapy (EBRT) and/or stereotactic radiosurgery (SRS), depending on prior treatment history. During surgery, an adjustable-pressure saline irrigation system was used to fill the resection cavity, allowing enhanced visualization and detection of residual tumor tissue. Results: The diving technique was successfully implemented in 61 of 63 cases (96.8%). Following standard tumor debulking, intraoperative saline immersion allowed identification of residual tumor tissue in 53 of these cases (86.9%), primarily within recessed or irregular cavity surfaces. Tumor size was an independent predictor of intraoperative tumor residue (OR=5.15, P=0.010), and subtotal resection was linked to higher recurrence risk (OR=11.22, P=0.025). Complications included transient diabetes insipidus (22.2%) and cerebrospinal fluid leakage (14.3%). Conclusion: The adjustable-pressure endoscopic diving technique effectively identifies residual tumors, particularly in post-radiotherapy cases, and offers a favorable safety profile. It holds promise for wider clinical use. |
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| Keywords: Pituitary adenoma, neuroendoscopy, diving technique, adjustable pressure, radiotherapy, tumor resection. |
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Full-Text [PDF 1698 kb]
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Type of Study: Original Research |
Subject:
Radiation Biology
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