TECHNIQUE OF TRANSSPHENOIDAL MICROSURGICAL REMOVAL FOR LARGE PITUITARY ADENOMAS / 解放军医学杂志

ABSTRACT

To probe the effect of transsphenoidal microsurgical removal on large pituitary adenomas (LPA), a total of 1 520 patients suffering from LPA were diagnosed by skull X ray plain films, CT, or MRI scanning. Operations were performed via a transsphenoidal approach under microscope. The results showed that gross total removal of an adenoma in 1 264 cases ( 83 2% ) and subtotal removal in 195 cases ( 12 8% ) were achieved; partial removal was carried out in the remaining 61 cases ( 4 0% ) of fibrous or dumbbell shaped adenomas. Death occurred in two patients (0 1%) after surgery. Long term follow up review( median 3 5 years ) in 1 240 patients revealed that 1 219 cases( 98 3%) of those with preoperative diminished visual acuity had postoperative improvement; 21 cases (1 7%)had no change, and none deteriorated significantly. Among the 1 226 patients with preoperative visual field defects, postoperative improvement was good in 1 186 (96 7%), and poor in 40(3 3%).It is concluded that microsurgical removal of pituitary tumors by transsphenoidal approach is safe and very effective even for very large or giant adenomas except for fibrous and dumbbell shaped ones, since it allows rapid and adequate decompression of the optic nerves and chiasm.