X. Zhang et al., Management of nonfunctioning primary adenomas with suprasellar extensions by transsphenoidal microsurgery, SURG NEUROL, 52(4), 1999, pp. 380-385
BACKGROUND
We evaluated the feasibility and therapeutic effectiveness of transsphenoid
al microsurgical removal of nonfunctioning pituitary adenomas with suprasel
lar extensions. The diagnostic modes, surgical technique, and outcome were
reviewed in 208 patients with pituitary adenomas extending beyond the sella
turcica who were treated by transsphenoidal microsurgery. All patients exc
ept three presented with significantly diminished visual acuity and visual
field defects.
METHODS
Diagnosis was confirmed by skull X-ray plain films, CT, or MRI scanning. Op
erations were performed via a transsphenoidal approach under microscope. A
subarachnoid catheter was preoperatively inserted in the lumbar cistern, th
rough which saline was slowly injected during operation to increase the int
racranial pressure so as to move the suprasellar tumor into the operative f
ield to aid the removal.
RESULTS
In this series, gross total removal of an adenoma in 146 cases (70.2%) and
subtotal removal in 50 cases (24.0%) was achieved; partial removal was carr
ied out in the remaining 12 cases (5.8%) of fibrous or dumbbell-shaped aden
omas. There were no deaths in this group. Follow-up review (median 3.8 year
s) in 187 patients revealed that 97.8% of those with preoperative diminishe
d visual acuity had postoperative improvement; 2.2% had no change, and none
deteriorated significantly. Among 181 patients with preoperative visual fi
eld defects, postoperative improvement was good in 169 (93.4%), and poor in
12 (6.6%). The major complications were diabetes insipidus and cerebrospin
al fluid rhinorrhea, which occurred in 13.5% and 4.8% of patients, respecti
vely. The tumors recurred in 12 patients (6.4%) who were considered to have
a macroscopically complete removal at surgery. Continuing growth of residu
al tumors was found in 31 (16.6%) based on visual acuity decrease, visual f
ield defects, and CT or MRI examination. Of the recurrent and residual tumo
rs, 4, 9, 17, and 13 cases belonged to Grades A, B, C, and D, respectively.
CONCLUSIONS
Comparison with transfrontal surgery suggests that these results are as goo
d as those of transfrontal procedures and that the incidence of serious sid
e effects is considerably lower. We consider that the microsurgical removal
of pituitary tumors by the transsphenoidal approach is safe and effective
even in very large or giant adenomas, since it allows rapid and adequate de
compression of the optic nerves and chiasm. (C) 1999 by Elsevier Science In
c.