Transsphenoidal microsurgical operation for pituitary adenomas with suprasellar extensions

Thepituitaryadenomaswithsuprasellarextensions(PASE)includethepituitarymacroadenomaandgiantpituitaryadenoma.Onlywhenthetumourmassislargeenoughtoimpingeonsellaturcicaresultinginapparentvisualfielddefectorlossofvisualacuity,thepatientisurgedtogotohospitalfortreatment1.2],soitisdifficulttodiagnosethetumorsintheearlystagewithlackofendocrinesymptoms.PASEisconventionallytreatedbytranscranialoperation.Butrecently,ithasbeenreportedthatthetumorscouldbetreatedbytranssphenoidaloperation3,4].Comparedw…

Transsphenoidal microsurgical operation for pituitary adenomas with suprasellar extensions

Objective: To evaluate the feasibility and therapeutic effectiveness of the transsphenoidal microsurgical removal of pituitary adenomas with suprasellar extensions. MethodS: We reviewed the diagnosticmodes, surgical technique, and outcomes of 152 patients suffering from pituitary adenomas with suprasellarextensions who were treated by transsphenoidal microsurgery in our department. Diagnosis was confirmed byCT or MRI scanning. All tumours with diameter >10 mm were characterized by suprasellar extensions. Op.erations were performed via either sublabio-septo-sphenoidal approach or naso-vestibulo-sphenoidal approachunder microscope. A subarachnoid catheter was preoperatively inserted in the lumbar cistern, through whichsaline was slowly injected during operation to increase the intracranial pressure (ICP) so as to deliver thesuprasellar tumour into the operative field to aid the removal. Result: Of the 152 cases, the gross total removal of adenoma in 106 cases (69. 7% ) and subtotal removal in 37 cases (24. 4% ) were achieved, and partial removal was carried out in the remaining 9 cases (5. 9 % ) of fibrous or dumbbell-shaped adenomas. Therewere no deaths after operation in this group. Follow-up review (median 3. 5 years) in 137 patients revealedgood recovery in 97 patients (70. 8% ), and late recurrence in 40 patients (29. 2% ) who need reoperativemanagement, drug therapy, radiotherapy, or radiosurgery used either alone or combined. Conclusion: Microsurgical technique via transsphenoidal approach is a safe and effective way to remove the pitoitary adenomas with suprasellar extensions but not for fibrous or dumbbell-shaped ones.