Transsphenoidal surgery of pituitary adenomas developed towards the cavernous sinus

  • M. Buchfelder
  • R. Fahlbusch


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.


Pituitary Adenoma Cavernous Sinus Sphenoid Sinus Transsphenoidal Surgery Transsphenoidal Approach 
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  1. 1.
    Ahmadi J, North CM, Segall HD, Zee CS, Weiss MH (1985) Cavernous sinus invasion by pituitary adenomas. AJNR 6: 893–898Google Scholar
  2. 2.
    Fahlbusch R (1981) Surgery of pituitary adenomas. In: Beardwell C, Robertson GL (eds) Clinical endocrinology. The pituitary. Butterworths, London, pp 76–105Google Scholar
  3. 3.
    Fahlbusch R, Buchfelder M, Schrell U (1985) Neurochirurgische Therapie neuroendokrinologischer Störungen. Internist 26: 293–301PubMedGoogle Scholar
  4. 4.
    Guiot G, Derome P (1976) Surgical problems of pituitary adenomas. In: Krayenbühl H et al (eds) Advances and technical standards in neurosurgery, vol 3. Springer, Wien New York, pp 3–33Google Scholar
  5. 5.
    Huk W, Fahlbusch R (1985) Nuclear magnetic imaging of the region of the sella turcica. Neurosurg Rev 8: 141–150PubMedCrossRefGoogle Scholar
  6. 6.
    King LW, Molitch ME, Gittinger JW, Wolpert SM, Stern J (1983) Cavernous sinus syndrome due to prolactinoma: Resolution with bromocriptine. Surg Neurol 19: 280–284PubMedCrossRefGoogle Scholar
  7. 7.
    Kline LB, Acker JD, Post MJD, Vitek JJ (1981) The cavernous sinus. A computed tomographic study. AJNR 2: 299–305PubMedGoogle Scholar
  8. 8.
    Laws ER, Kern EB (1976) Complications of transsphenoidal surgery. Clin Neurosurg 23: 401–416PubMedGoogle Scholar
  9. 9.
    Rao KC, Allen HA, Haney PJ, Yu R, Levine H (1981) Vascular studies in the preoperative evaluation of pituitary adenomas before transsphenoidal surgery. Surg Neurol 21: 175–181CrossRefGoogle Scholar
  10. 10.
    Reid RL, Quigley ME, Yen SS (1985) Pituitary apoplexy—a review. Arch Neurol 42: 712–719PubMedGoogle Scholar
  11. 11.
    Schäfer M, Steudel WI, Grau H (1981) Paralysis of the extraocular muscles in tumours of the sella turcica. In: Samii M, Jannetta PJ (eds) The cranial nerves. Springer, Berlin Heidelberg New York Tokyo, pp 264–268Google Scholar
  12. 12.
    Sekhar LN, Moller AR (1986) Operative management of tumors involving the cavernous sinus. J Neurosurg 64: 879–889PubMedCrossRefGoogle Scholar
  13. 13.
    Taptas JN (1982) The so-called cavernous sinus: a review of the controversy and its implications for neurosurgery. Neurosurgery 11: 712–717PubMedCrossRefGoogle Scholar
  14. 14.
    Weinberger LM, Adler FH, Grant FC (1940) Primary pituitary adenoma and the symptom of the cavernous sinus. Arch Ophthalmol 97: 1197–1246Google Scholar
  15. 15.
    Wilson CB, Dempsey LC (1978) Transsphenoidal neurosurgical removal of 250 pituitary adenomas. J Neurosurg 48: 13–22PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 1987

Authors and Affiliations

  • M. Buchfelder
    • 1
  • R. Fahlbusch
    • 1
  1. 1.Department of NeurosurgeryUniversity Erlangen — NürnbergErlangenFederal Republic of Germany

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