Neurosurgery for pituitary tumors - Indications for surgery and outcome

Two main feature: Indication for surgery in patients with pituitary tumors depends first on the anatomical situation: the enclosed or invasive nature of the tumor. Total resection of an enclosed tumor, even if it is a huge on e, can be expected to be successful. For invasive tumors, surgery will be s ubtotal unless the invasion is very limited. The second consideration is th e efficacy and limitations of medical treatment. At present, only secreting pituitary adenomas are accessible to medical therapy. Other pituitary tumo rs, and non-functioning pituitary adenomas are not suitable for valid medic al treatment and may warrant a surgical strategy. Choice of the operative approach: Anatomical acid radiological consideratio ns are determining. For secreting pituitary adenomas, first intention surge ry via a transphenoidal access is advocated when surgery can be expected to achieve complete tumor resection without damaging the normal gland. For ot her cases, medical treatment has to be instituted prior to surgery which wi ll be discussed in case of failure, intolerance or for tumor reduction. Tra nsphenoidal surgery is strongly advocated in case of a pituitary incidental oma with a visual danger, even in old patients. Outcome: Visual symptoms are often improved after neurosurgery for pituitar y tumors. Hormone cure is frequent in microsecreting pituitary adenomas, ra rely in invasive tumors.