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Endoscopic Endonasal Transsphenoidal Approach to the Sellar Region

  • E. de Divitiis
  • P. Cappabianca
  • L. M. Cavallo
Chapter

Abstract

This chapter deals with the main aspects of the standard transsphenoidal approach to the sella by means of a “pure” endoscopic technique. With this term we mean a transsphenoidal procedure performed with an endoscope as the sole visualizing instrument during the whole operation. After almost a decade, this can be considered a regular way of surgical management of lesions of the sellar compartment, routinely employed in some centers. Special aspects, such as extended approaches to the skull base by means of variations of the standard procedure, will be treated in detail in next chapters of the book, and must be reserved to experienced surgeons.

Keywords

Pituitary Adenoma Cavernous Sinus Sphenoid Sinus Nasal Septum Transsphenoidal Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Abe T, Lüdecke DK (1999) Transnasal surgery for infradiaphragmatic craniopharyngiomas in pediatric patients. Neurosurgery 44: 957–966PubMedCrossRefGoogle Scholar
  2. 2.
    Alfieri A, Jho HD (2001) Endoscopic endonasal cavernous sinus surgery: an anatomic study. Neurosurgery 48: 827–837PubMedGoogle Scholar
  3. 3.
    Alfieri A, Jho HD (2001) Endoscopic endonasal approaches to the cavernous sinus: surgical approaches. Neurosurgery 49: 354–362PubMedGoogle Scholar
  4. 4.
    Arita K, Kurisu K, Tominaga A, Kawamoto H, Iida K, Mizoue T, Pant B, Uozumi T (1998) Transsellar color doppler ultrasonography during transsphenoidal surgery. Neurosurgery 42: 81–86PubMedCrossRefGoogle Scholar
  5. 5.
    Barrow DL, Tindall GT (1990) Loss of vision after transsphenoidal surgery. Neurosurgery 27: 60–68PubMedCrossRefGoogle Scholar
  6. 6.
    Barrou Z, Abecassis JP, Guilhaume B, Thomopoulos P, Bertagna X, Derome P, Bonnin A, Luton JP (1997) Magnetic resonance imaging in Cushing disease. Prediction of surgical results. Press Med 26: 7–11Google Scholar
  7. 7.
    Baskin DS, Wilson CB (1984) Transsphenoidal treatment of non-neoplastic intrasellar cysts. A report of 38 cases. J Neurosurg 60: 8–13PubMedCrossRefGoogle Scholar
  8. 8.
    Black P.M.c.L., Zervas NT, Candia GL (1987) Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery 20: 920–924PubMedCrossRefGoogle Scholar
  9. 9.
    Bohinski RJ, Warnick RE, Gaskill-Shipley MF, Zuccarello M, van Loveren HR, Kormos DW, Tew JM Jr (2001) Intraoperative magnetic resonance imaging to determine the extent of resection of pituitary macroadenomas during transsphenoidal microsurgery. Neurosurgery 49: 1133–1144PubMedGoogle Scholar
  10. 10.
    Cappabianca P, Alfieri A, de Divitiis E (1998) Endoscopic endonasal transsphenoidal approach to the sella: towards Functional Endoscopic Pituitary Surgery (FEPS). Minim Invasive Neurosurg 41: 66–73PubMedCrossRefGoogle Scholar
  11. 11.
    Cappabianca P, Alfieri A, Thermes S, Buonamassa S, de Divitiis E (1999) Instruments for endoscopic endonasal transsphenoidal surgery. Neurosurgery 45: 392–396PubMedCrossRefGoogle Scholar
  12. 12.
    Cappabianca P, Alfieri A, Colao A, Cavallo LM, Fusco M, Peca C, Lombardi G, de Divitiis E (2000) Endoscopic endonasal transsphenoidal surgery in recurrent and residual pituitary adenomas. Technical note. Minim Invasive Neurosurg 43: 38–43CrossRefGoogle Scholar
  13. 13.
    Cappabianca P, Alfieri A, de Divitiis E, Tschabitscher M (2000) Atlas of endoscopic anatomy for endonasal intracranial surgery. Springer, Wien New York, pp 134Google Scholar
  14. 14.
    Cappabianca P, Briganti F, Cavallo LM, de Divitiis E (2001) Pseudoaneurysm of the intracavernous carotid artery following endoscopic endonasal transsphenoidal surgery, treated by endovascular approach. Acta Neurochir (Wien) 143: 95–96CrossRefGoogle Scholar
  15. 15.
    Cappabianca P, Cavallo LM, Mariniello G, de Divitiis O, Becerra Romero ADC, de Divitiis E (2001) Easy sellar reconstruction in endoscopic transsphenoidal surgery with polyester-silicone dural substitute and fibrin glue: technical note. Neurosurgery 49: 473–476PubMedGoogle Scholar
  16. 16.
    Cappabianca P, de Divitiis E (2001) Endoscopic pituitary surgery. Endo-Press, Tuttlingen, pp 62Google Scholar
  17. 17.
    Cappabianca P, Cavallo LM, Colao A, de Divitiis E (2002) Surgical complications of the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 97: 293–298PubMedCrossRefGoogle Scholar
  18. 18.
    Cappabianca P, Cavallo LM, Esposito F, Valente V, de Divitiis E (2002) Sellar repair in endoscopic endonasal transsphenoidal surgery: results of 170 cases. Neurosurgery 51: 1365–1372PubMedGoogle Scholar
  19. 19.
    Cappabianca P, Cavallo LM, Colao A, Dei Basso De Caro M, Esposito F, Cirillo S, Lombardi G, de Divitiis E (2002) Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg 45: 1–8CrossRefGoogle Scholar
  20. 20.
    Ciric IS, Cozzens JW (1980) Craniopharyngiomas: transsphenoidal method of approach-for the virtuoso only? Clin Neurosurg 27: 169–187PubMedGoogle Scholar
  21. 21.
    Ciric I, Ragin A, Baumgartner C, Pierce D (1997) Complications of transsphenoidal surgery: results of anational survey, review of the literature, and personal experience. Neurosurgery 40: 225–237PubMedCrossRefGoogle Scholar
  22. 22.
    Ciric I, Rosenblatt S, Zhao Je (2002) Transsphenoidal microsurgery. Neurosurgery 51: 161–169PubMedCrossRefGoogle Scholar
  23. 23.
    Cockroft KM, Carew JF, Trost D, Fraser RA (2000) Delayed epistaxis resulting from external carotid artery injury requiring embolization: a rare complication of transsphenoidal surgery: case report. Neurosurgery 47: 236–239PubMedGoogle Scholar
  24. 24.
    Colao A, Ferone D, Cappabianca P, Dei Basso De Caro M, Marzullo P, Ponticelli A, Alfieri A, Merola B, Can A, Lombardi G, de Divitiis E (1997) Effect of octreotide pretreatment on surgical outcome in acromegaly. J Clin Endocrinol Metab 82: 3308–3314PubMedCrossRefGoogle Scholar
  25. 25.
    de Divitiis E, Spaziante R, Iaccarino V, Stella L, Genovese L (1981) Phlebographyofthe cavernous and intercavernous sinuses. Surg Neurol 15: 306–312PubMedCrossRefGoogle Scholar
  26. 26.
    de Divitiis E, Spaziante R, Stella L (1981) Empty sella and benign intrasellar cysts. In: Krayenbühl H (ed) Advances and technical standards in neurosurgery. Springer, Wien New York, vol 8, pp 3–74CrossRefGoogle Scholar
  27. 27.
    de Divitiis E, Spaziante R (1987) Osteoplastic opening of the sellar floor in transsphenoidal surgery: technical note. Neurosurgery 20: 445–446PubMedCrossRefGoogle Scholar
  28. 28.
    de Divitiis E, Cappabianca P, Cavallo LM, Spaziante R (2001) Sellar repair. J Neurosurg 94: 861–862PubMedGoogle Scholar
  29. 29.
    de Divitiis E, Cappabianca P (2002) Endoscopic endonasal transsphenoidal surgery. In: Pickard JD (ed) Advances and technical standards in neurosurgery. Springer, Wien New York, vol 27, pp 137–177CrossRefGoogle Scholar
  30. 30.
    de Divitiis E, Cappabianca P, Cavallo LM (2002) Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions. Neurosurgery 51: 699–707PubMedGoogle Scholar
  31. 31.
    de Divitiis E, Cappabianca P, Laws ER Jr (2002) Microscopic and endoscopic transsphenoidal surgery. Neurosurgery 51: 1527–1530PubMedGoogle Scholar
  32. 32.
    de Herder WW, Uitterlinden P, Pieterman H, Tanghe HL, Kwekkeboom DJ, Pols HA, Singh R, van de Berge JH, Lamberts SW (1994) Pituitary tumour localization in patients with Cushing’s disease by magnetic resonance imaging. Is there a place for petrosal sinus sampling? Clin Endocrinol 40: 87–92Google Scholar
  33. 33.
    Doppman JL, Ram Z, Shawker TH, Oldfield EH (1994) Intraoperative US of the pituitary gland. Work in progress. Radiology 192: 111–115PubMedGoogle Scholar
  34. 34.
    Elias WJ, Chadduck JB, Aiden TD, Laws ER Jr (1999) Frameless stereotaxy for transsphenoidal surgery. Neurosurgery 45: 271–277PubMedCrossRefGoogle Scholar
  35. 35.
    Elias WJ, Laws ER Jr (2000) Transsphenoidal approachei to lesions of the sella. In: Schmidek HH (ed) Schmidek and sweet operative neurosurgical techniques. Indications, methods and results. W.B. Saunders Company, Philadelphia, pp 373–384Google Scholar
  36. 36.
    Ellegala DB, Maartens NF, Laws ER Jr (2002) Use of FloSeal hemostatic sealant in transsphenoidal pituitary surgery: technical note. Neurosurgery 51: 513–516PubMedGoogle Scholar
  37. 37.
    El-Mahdy W, Powell M (1998) Transsphenoidal management of 28 symptomatic Rathke’s cleft cysts, with special reference to visual and hormonal recovery. Neurosurgery 42: 7–17PubMedCrossRefGoogle Scholar
  38. 38.
    Fahlbusch R, Heigl T, Huk W, Steinmeier R (1996) The role of endoscopy and intraoperative MRI in transsphenoidal pituitary surgery. In: Werder von K, Fahlbusch R (eds) Pituitary adenomas: from basic research to diagnosis and therapy. Elsevier, Amsterdam, pp 237–241Google Scholar
  39. 39.
    Fahlbusch R, Ganslandt O, Buchfelder M, Schott W, Nimsky C (2001) Intraoperative magnetic resonance imaging during transsphenoidal surgery. J Neurosurg 95: 381–390PubMedCrossRefGoogle Scholar
  40. 40.
    Frank G, Pasquini E, Calbucci F (2001) Endoscopic approach to the cavernous sinus via an ethmoido-pterygo-sphenoidal route. Presented at the 5th European skull Base Society Congress, Copenhagen, June 15-17, 2001: Additional abstracts, p009bGoogle Scholar
  41. 41.
    Frank G, Pasquini E (2002) Endoscopic endonasal approaches to the cavernous sinus: surgical approaches. Neurosurgery 50: 675PubMedGoogle Scholar
  42. 42.
    Fujii K, Chambers SM, Rhoton AL Jr (1979) Neurovascular relationship of the sphenoid sinus. A microsurgical study. J Neurosurg 50: 31–39PubMedCrossRefGoogle Scholar
  43. 43.
    Guiot G (1973) Transsphenoidal approach in surgical treatment of pituitary adenomas: general principles and indications in non-functioning adenomas. In: Kohler PO, Ross GT (eds) Diagnosis and treatment of pituitary adenomas. Excerpta Medica, Amsterdam, pp 159–178Google Scholar
  44. 44.
    Honegger J, Buchfelder M, Fahlbusch R, Däubler B, Dörr HG (1992) Transsphenoidal microsurgery for craniopharyngioma. Surg Neurol 37: 189–196PubMedCrossRefGoogle Scholar
  45. 45.
    Jane JA Jr, Thapar K, Aiden TD, Laws ER Jr (2001) Fluoroscopic frameless stereotaxy for transsphenoidal surgery. Neurosurgery 48: 1302–1308PubMedGoogle Scholar
  46. 46.
    Jane JA Jr, Thapar K, Kaptain GJ, Maartens N, Laws ER Jr (2002) Pituitary surgery: transsphenoidal approach. Neurosurgery 51: 435–444PubMedGoogle Scholar
  47. 47.
    Jho HD, Carrau RL, Mc Laughlin ML, Somaza SC (1996) Endoscopic transsphenoidal resection of a large chordoma in the posterior fossa. Neurosurgical Focus 1: 1–7Google Scholar
  48. 48.
    Jho HD, Carrau RL (1997) Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87: 44–51PubMedCrossRefGoogle Scholar
  49. 49.
    Jho HD (1999) Endoscopic surgery of pituitary adenomas. In: Krisht AF, Tindall GT (eds) Comprehensive management of pituitary disorders. Lippincott Williams & Wilkins, Hagerstown, pp 389–403Google Scholar
  50. 50.
    Jho HD (2000) Endoscopic transsphenoidal surgery. In: Schmidek HH (ed) Schmidek and sweet operative neurosurgical techniques. Indications, methods and results. W.B. Saunders Philadelphia, pp 385–397Google Scholar
  51. 51.
    Jho HD (2001) Endoscopic endonasal approach to the optic nerve: a technical note. Minim Invasive Neurosurg 44: 190–193PubMedCrossRefGoogle Scholar
  52. 52.
    Johnson DM, Hopkins RJ, Hanafee WN, Fisk JD (1985) The unprotected parasphenoidal carotid artery studied by high resolution computed tomography. Radiology 155: 137–141PubMedGoogle Scholar
  53. 53.
    Kalushar SK (1997) Pre and post operative mucociliary clearance in functional endoscopic sinus surgery. Ear Nose Throath J 76: 884–886Google Scholar
  54. 54.
    Kaptain GJ, Vincent DA, Sheehan JP, Laws ER Jr (2001) Transsphenoidal approaches for extracapsular resection of midline suprasellar and anterior cranial base lesions. Neurosurgery 49: 94–101PubMedGoogle Scholar
  55. 55.
    Kato T, Sawamura J, Abe H, Nagashima M (1998) Transsphenoidal-transtuberculum sellae approach for supradiaphragmatic tumours: technical note. Acta Neurochir (Wien) 140: 715–719CrossRefGoogle Scholar
  56. 56.
    Kawamata T, Iseki H, Shibasaki T, Hori T (2002) Endoscopic augmented reality navigation system for endonasal transsphenoidal surgery to treat pituitary tumors: technical note. Neurosurgery 50: 1393–1397PubMedGoogle Scholar
  57. 57.
    Kelly DF, Oskouian RJ, Fineman I Collagen (2001) Sponge repair of small cerebrospinal fluid leaks obviates tissue grafts and cerebrospinal fluid diversion after pituitary surgery. Neurosurgery 49: 885–890PubMedGoogle Scholar
  58. 58.
    Kelley TF, Stankiewicz JA, Chow JM, Origitano TC, Shea J (1996) Endoscopic closure of postsurgical anterior cranial fossa cerebrospinal fluid leaks. Neurosurgery 39: 743–746PubMedCrossRefGoogle Scholar
  59. 59.
    Kennedy DW, Cohn ES, Papel ID, et al (1984) Transsphenoidal approach to the sella: the Johns Hopkins experience. Laryngoscope 94: 1066–1074PubMedCrossRefGoogle Scholar
  60. 60.
    Kennedy DW, Zinreich SJ, Hassab MH (1990) The internal carotid artery as it relates to endonasal sphenoethmoidectomy. Am J Rhinol 4: 7–12CrossRefGoogle Scholar
  61. 61.
    Kim J, Choe I, Bak K, Kim C, Kim N, Yang Y (2000) Transsphenoidal supradiaphragmatic intradural approach: technical note. Minim Invasive Neurosurg 43: 33–37PubMedCrossRefGoogle Scholar
  62. 62.
    Kouri JG, Chen MY, Watson JC, Odfield EH (2000) Resection of suprasellar tumors by using a modified transsphenoidal approach. J Neurosurg 92: 1028–1035PubMedCrossRefGoogle Scholar
  63. 63.
    Landolt AM, Zachmann M (1991) Results of transsphenoidal extirpation of craniopharyngiomas and Rathke’s cysts. Neurosurgery 28: 410–415PubMedCrossRefGoogle Scholar
  64. 64.
    Landolt AM Schiller Z (1996) Surgical technique: transsphenoidal approach. In: Landolt AM, Vance ML, Reilly PR (eds) Pituitary adenomas. Churchill Livingstone, New York, pp 315–331Google Scholar
  65. 65.
    Lasio G, Ferroli P, Felisati G, Broggi G (2002) Image-guided endoscopic transnasal removal of recurrent pituitary adenomas. Neurosurgery 51: 132–137PubMedCrossRefGoogle Scholar
  66. 66.
    Laws ER Jr, Kern EB (1976) Complications of trans-sphenoidal surgery. Clin Neurosurg 23: 401–416PubMedGoogle Scholar
  67. 67.
    Laws ER Jr (1980) Transsphenoidal microsurgery in the management of craniopharyngioma. J Neurosurg 52: 661–666PubMedCrossRefGoogle Scholar
  68. 68.
    Laws ER Jr, Kern EB (1982) Complications of transsphenoidal surgery. In: Laws ER Jr, Randall RV, Kern EB, Abboud CF (eds) Management of pituitary adenomas and related lesions. Appleton Century Croft, New York, pp 329–346Google Scholar
  69. Laws ER Jr (1994) Transsphenoidal removal of craniopharyngioma. Pediatr Neurosurg 21: 57–63 (1994)PubMedCrossRefGoogle Scholar
  70. 70.
    Laws ER Jr (1996) Comment to the article: Rodziewicz GS, Kelley RT, Kellman RM, Smith MV Transnasal endoscopic surgery of the pituitary gland: technical note. Neurosurgery 39: 193Google Scholar
  71. 71.
    Laws ER Jr (2001) Comment to the article: Cappabianca P, Cavallo LM, Mariniello G, de Divitiis O, Becerra Romero ADC, de Divitiis E: Easy sellar reconstruction in endoscopic transsphenoidal surgery with polyester-silicone dural substitute and fibrin glue: technical note. Neurosurgery 49: 475–476Google Scholar
  72. 72.
    Mason RB, Nieman LK, Doppman JL, Oldfield EH (1997) Selective excision of adenomas originating in or extending into the pituitary stalk with preservation of pituitary function. J Neurosurg 87: 343–351PubMedCrossRefGoogle Scholar
  73. 73.
    Moreland OB, Diaz-Ordaz E, Czajka GA (2000) Endoscopic endonasal hemisphenoidotomy for resection of pituitary lesions confined to the sella: report of 3 cases and technical note. Minim Invasive Neurosurg 43: 57–61PubMedCrossRefGoogle Scholar
  74. 74.
    Newfield P, Albin MS, Chestnut JS, Maroon J (1978) Air emboli sm during trans-sphenoidal pituitary operations. Neurosurgery 2: 39–42PubMedCrossRefGoogle Scholar
  75. 75.
    Newmark Hill, Kant N, Duerksen R, et al (1983) Orbital floor fracture: an unusual complication of trans-septa I transsphenoidal hypophysectomy. Neurosurgery 12: 555–556PubMedCrossRefGoogle Scholar
  76. 76.
    Ohhashi G, Kamio M, Abe T, Otori N, Haruna S (2002) Endoscopic transnasal approach to the pituitary lesions using a navigation system (InstaTrak system): technical note. Minim Invasive Neurosurg 45: 120–123PubMedCrossRefGoogle Scholar
  77. 77.
    Onesti ST, Post KD (1993) Complications oftranssphenoidal microsurgery. In: Post KD, Friedman ED, Mc Cormick P (eds) Postoperative complications in intracranial neurosurgery. Thieme Medical Publishers, Chicago, pp 61–73Google Scholar
  78. 78.
    Page RB (1994) Craniopharyngioma: indications for transsphenoidal surgery. Curr Ther Endocrinol Metab 5: 33–34PubMedGoogle Scholar
  79. 79.
    Ram Z, Shawker TH, Bradford MH, Doppman JL, Oldfield EH (1995) Intraoperative ultrasounddirected resection of pituitary tumors. J Neurosurg 83: 225–230PubMedCrossRefGoogle Scholar
  80. 80.
    Renn WH, Rhoton AL Jr (1975) Microsurgical anatomy of the sellar region. J Neurosurg 43: 288–298PubMedCrossRefGoogle Scholar
  81. 81.
    Ross DA, Norman D, Wilson CB (1992) Radiologic characteristics and results of surgical management of Rathke’s cysts in 43 patients. Neurosurgery 30: 173–179PubMedCrossRefGoogle Scholar
  82. 82.
    Saito K, Kuwayama A, Yamamoto N, Sugita K (1995) The transsphenoidal removal of non functioning pituitary adenomas with suprasellar extension: the open sella method and intentionally staged operation. Neurosurgery 36: 668–676PubMedCrossRefGoogle Scholar
  83. 83.
    Sandeman D, Moufid A (1998) Interactive image-guided pituitary surgery. An experience of 101 procedures. Neurochirurgie 44: 331–338PubMedGoogle Scholar
  84. 84.
    Seiler RW, Mariani L (2000) Sellar reconstruction with resorbable vicryl patches, gelatin foam, and fibrin glue in transsphenoidal surgery: a 1 O-year experience with 376 patients. J Neurosurg 93: 762–765PubMedCrossRefGoogle Scholar
  85. 85.
    Sempie PL, Laws ER Jr (1999) Complications in a contemporary series of patients who underwent transsphenoidal surgery for Cushing’s disease. J Neurosurg 91: 175–179CrossRefGoogle Scholar
  86. 86.
    Spaziante R, de Divitiis E (1989) Forced subarachnoid air in transsphenoidal excision of pituitary tumours (pumping technique). J Neurosurg 71: 864–867PubMedCrossRefGoogle Scholar
  87. 87.
    Spaziante R, de Divitiis E (1997) Drainage techniques for cystic craniopharyngiomas. Neurosurgery Quarterly 7: 183–208CrossRefGoogle Scholar
  88. 88.
    Spaziante R, de Divitiis E, Cappabianca P (2000) Repair of the sella after transsphenoidal surgery. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques. Indications, methods and results. W.B. Saunders, Philadelphia, 1, pp 398–416Google Scholar
  89. 89.
    Spencer WR, Das K, Nwagu C, Wenk E, Schaefer SD, Moscatello A, Couldwell WT (1999) Approaches to the sellar and parasellar region: anatomie comparison of the microscope versus endoscope. Laryngoscope 109: 791–794PubMedCrossRefGoogle Scholar
  90. 90.
    Stankiewicz JA (1991) CSF fistula and endoscopic sinus surgery. Laringoscope 101: 250–256CrossRefGoogle Scholar
  91. 91.
    Vincentelli F, Grisoli F, Bartoli JF, Ledere T, de Smedt E, Salamon G (1982) Anatomicoradiologic basis of sellar surgery and its nasoseptal approach. J Neuroradiol 9: 284–303PubMedGoogle Scholar
  92. 92.
    Yamasaki T, Moritake K, Hatta J, Nagai H (1996) Intraoperative monitoring with pulse Doppler ultrasonography in transsphenoidal surgery: technique application. Neurosurgery 38: 95–98PubMedCrossRefGoogle Scholar
  93. 93.
    Watson JC, Shawker TH, Nieman LK, DeVroom HL, Doppman JL, Oldfield EH (1998) Localization of pituitary adenomas by using intraoperative ultrasound in patients with Cushing’s disease and no demonstrable pituitary tumor on magnetic resonance imaging. J Neurosurg 89: 927–932PubMedCrossRefGoogle Scholar
  94. 94.
    Wigand ME, Steiner W, Jaumann MP (1978) Endonasal sinus surgery with endoscopic control: from radical operation to rehabilitation ofthe mucosa. Endoscopy 10: 255–260PubMedCrossRefGoogle Scholar
  95. 95.
    Wilson CB, Dempsey LC (1978) Transsphenoidal microsurgical removal of 250 adenomas. J Neurosurg 48: 13–22PubMedCrossRefGoogle Scholar
  96. 97.
    Wilson CB (1990) Role of surgery in the management of pituitary tumors. Neurosurg Clin N Am 1: 139–159PubMedGoogle Scholar
  97. 98.
    Zervas NT (1984) Surgical results in pituitary adenomas: Results of an international survey. In: Black P.M.c.L., Zervas NT, Ridgway EC Jr, Martin JB (eds) Secretory tumors of the pituitary gland. Raven, New York, pp 377–385Google Scholar

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© Springer-Verlag Wien 2003

Authors and Affiliations

  • E. de Divitiis
  • P. Cappabianca
  • L. M. Cavallo

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