[Neurosurgery and pituitary tumors: surgical indications and outcome].
TWO MAIN FEATURE: Indication for surgery in patients with pituitary tumors depends first on the anatomical situation: the enclosed or invasive nature of the tumor. Total resection of an enclosed tumor, even if it is a huge one, can be expected to be successful. For invasive tumors, surgery will be subtotal unless the invasion is very limited. The second consideration is the efficacy and limitations of medical treatment. At present, only secreting pituitary adenomas are accessible to medical therapy. Other pituitary tumors, and non-functioning pituitary adenomas are not suitable for valid medical treatment and may warrant a surgical strategy.
Anatomical and radiological considerations are determining. For secreting pituitary adenomas, first intention surgery via a transphenoidal access is advocated when surgery can be expected to achieve complete tumor resection without damaging the normal gland. For other cases, medical treatment has to be instituted prior to surgery which will be discussed in case of failure, intolerance or for tumor reduction. Transphenoidal surgery is strongly advocated in case of a pituitary incidentaloma with a visual danger, even in old patients.


RESULTS
Visual symptoms are often improved after neurosurgery for pituitary tumors. Hormone cure is frequent in microsecreting pituitary adenomas, rarely in invasive tumors.
Visot
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Service de Neurochirurgie, Hôpital Foch, 40, rue Worth, F 92150 Suresnes. a.visot@hopital-foch.org
D000236:Adenoma / Q000150:complications / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000601:surgery; D011379:Prognosis; D015175:Prolactinoma / Q000150:complications / Q000601:surgery; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology