Transsphenoidal surgery in complex treatment of pituitary adenoma

Abstract

Objective: to compare the results of a different type of surgical treatment of pituitary adenomas, to report the efficacy and safety of microsurgical removal of adenomas via transsphenoidal surgery. Methods: 67 patients with pituitary adenomas underwent surgical treatment in the department of neurosurgery of Institute of Neurology and Neurosurgery from January 2005 through December 2009. Postoperative results were classified uniformly during the period of the study. Surgical intervention with use of standard transnasal transsphenoidal approach was performed on 45 patients. 22 patients were operated via transcranial approach mainly using of right subfrontal approach. Results: According to hormonal activity operated adenomas were spread as following: prolactinomas -16, 3%, somatotropinomas- 27, 8%, corticotropinomas – 8, 2%, thireotropinomas -0, 5%, and hormonally inactive tumors – 47, 2%. Among operated patients were 36 (53, 7%) males and 31(46, 3%) females. The mean age was 37, 6 ± 5, 4 years. Male/female rate was 1, 2:1. There were 50 macroadenomas (76%) and at 11 patients tumor invaded one or both cavernous sinuses. The overall rate of surgical success in transsphenoidal surgery was 65%, compared to 34% in transcranial surgeries. The surgical outcome was better in microadenomas treated with transsphenoidal approach than in macroadenomas treated with transcranial route (82% and 51% respectively), whereas tumors invading the cavernous sinus had a poorer outcome. In patients with nonfunctioning pituitary adenomas no residual adenomas were present in 62% cases. Normalization of visual defects occurred in 22 (52%) of 45 patients with visual disturbances. One patient died as a consequence of surgery (1, 4%).