TRANSCAVERNOUS SURGERY - AN EFFECTIVE TREATMENT FOR PITUITARY MACROADENOMAS

The endocrinological outcome in four patients with pituitary macroaden omas laterally invading the cavernous sinus, who were treated surgical ly by the transcranial transcavernous approach, was compared with that in four patients with macroadenomas that had been removed transspheno idally. The decrease in the elevated serum levels of anterior pituitar y hormones after transcavernous surgery ranged from 58.4% to 90.1%, wh ereas after transsphenoidal surgery it ranged from 0% to 46.1%. The re sponsiveness of pituitary hormones to stimulation tests was restored a nd maintained after transcranial transcavernous surgery, Transsphenoid al surgery achieved neither sufficient tumor reduction nor produced a satisfactory endocrinological remission. When cavernous sinus invasion is suspected by magnetic resonance imaging, even if it cannot be conf irmed with certainty, transcranial transcavernous surgery is recommend ed. It is a useful surgical procedure for obtaining a sufficient degre e of tumor extirpation and satisfactory endocrinological improvement i n patients with macroadenomas laterally invading the cavernous sinus, particularly somatotroph or corticotroph macroadenomas. Postoperativel y, mild cranial nerve paresis may occur, but this may resolve in 1-4 m onths.