RESUMO
The aim of this retrospective study of 142 patients, who were admitted for tumours of the sellar area [TSA], was to analyse the clinical, neuroimaging, histological features and neurosurgical approaches employed to treat these lesions. One-hundred and forty-two TSA were operated by the senior author between 1990 and 2004 in 72 women and 70 men. Among them there were 36 patients less than 15 years of age. Common clinical presentation included headache, vision impairment and endocrinological symptoms. Blindness, uni or bilateral was observed in 30 cases [21%] and diabetes insipidus in 20 cases [14%]. Imaging features showed tumour diameter at presentation greater than 5 cm in 49 tumours [34.5%]. Histological examination revealed a predominance of craniopharyngiomas in 68 patients [47.8%] and meningiomas in 39 patients [27.4%]. Neurosurgical approaches were chosen according to the size, extent, and components of the tumour. The most practised approach was subfrontal in 77 tumours [54.2%] and pterional or fronto pterional in 55 tumours [38.7%]. Radical tumour removal was achieved in 41 patients [28.8%]: 14 cases [35.9%] of meningiomas, 13 cases [52%] of invasive adenomas, 11 cases [16.1%] of craniopharyngiomas and 3 cases [75%] of epidermoid cysts. Twenty-four patients underwent a second surgical procedure for recurrence or residual tumour. Among them, 6 patients with cystic craniopharyngiomas had undergone radioactive yttrium [6 cases] or bleomycin injection [2 cases]. Mortality rate was 11% [15 patients]; mostly due to brain swelling, brain oedema or meningitis. There is not a standardised neurosurgical approach for TSA but this should result from a careful study of the neuroimaging features. When to stop the operation was mandated by the operative findings and the concern for respect of the optic pathways, pituitary stalk and vessels of this area