V.Yu. Cherebillo, V.R. Gofman, A.V. Polezhaev, V.A. Manukovsky
Chair of Neurosurgery, Medicomilitary Academy, Saint Petersburg, Russia
Results
The results of operations were estimated on the basis of such conventional criteria, as postoperative CT examination of the chiasm-sellar region and arresting of hormonal changes in blood. Radical, subtotal and partial removal of tumors was performed in 87%, 11% and 2% of cases respectively. The relapse rate in the whole group was 12%. It should be noted, that there was a gradual decrease of this rate from 18% in the group of patients, operated without intraoperative endovideomonitoring, up to 7% in the group, where endoscopes were applied. Comparison of the first and second groups revealed higher regress of visual disturbances (64% and 87%) and hormonal disorders (74% and 88%). Besides, endovideomonitoring resulted in considerable regress of intra- and postoperative complications (see the Table, given below).
Table
|
|
Amount of Intra- and Postoperative Complications (%) |
|
|
A Type of Complications |
Before Use of Endovideomonitoring (n=316) |
After Use of Endovideomonitoring (n=298) |
|
Intraoperative nasal liquorrhea |
12.3 |
3.1 |
|
Damage of cavernous sinuses |
2.1 |
0.7 |
|
Damage of a carotid artery |
0.9 |
- |
|
Postoperative paresis of oculomotor nerves |
2.7 |
0.1 |
|
Damage of optic nerves |
3.6 |
- |
|
Hemorrhage into neoplastic tissue |
4.5 |
- |
|
Damage of planum sphenoidale, subarachnoid hemorrhage |
2.3 |
- |
|
Meningitis |
3.2 |
- |
Conclusion
Intraoperative monitoring permits to perform operations under constant visual control, to increase their efficacy and to decrease a number of complications. Improvement of surgical technique and high professionalism of a surgeon ensure a "functional" character of intervention even in big tumors by arresting both visual and hormonal disorders.
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