Transsphenoidal surgery of pituitary adenomas developed towards the cavernous sinus

Abstract

Today various therapeutic surgical approaches are available for the treatment of pituitary adenomas. Modern radiology provides an excellent image of the localization and extent of tumors extending towards the cavernous sinus and the topographical pathology of the adjacent anatomical structures. Particularly the information gained by thin-collimation computerized tomography [1, 7], angiography [9] and nuclear magnetic resonance (NMR) scanning [5] is helfpul in the preoperative evaluation of parasellar tumors and facilitates the decision making between the transcranial and transsphenoidal approach. It is not so much the total size of the adenoma but the delineation and the connection between the intra- and parasellar tumor parts which influence the indication for the “upper” or “lower” approach [2, 4, 12]. Since the introduction of computerized tomography we have learned that only a small minority of those pituitary adenomas displacing or invading the cavernous sinus cause a cavernous sinus syndrome as described in the past [14]. Mostly endocrine symptoms due to hormone oversecretion in functioning adenomas or hypopituitarism in hormonally inactive adenomas lead to the diagnosis of these intra- and parasellar tumors. Cranial nerve palsy, although providing clinical information about the tumor site, occurred in only 8/77 in this series. This report is focused on the endocrinological results and the prognosis of extraocular nerve muscle palsy.