Treatment of pituitary adenomas with a transsphenoidal approach.
OBJECTIVE
To evaluate the overall therapeutic effectiveness of transsphenoidal microsurgery for pituitary adenomas and explore the surgical technique, application of new technology, and postoperative follow-up.


METHODS
The clinical presentation, imaging features, endocrine examination, pathological types, conditions of operation, postoperative complications, and follow-up of 4050 patients with pituitary adenomas who had undergone transsphenoidal microsurgery from December 1981 to January 2004 were analyzed retrospectively.


RESULTS
During the past 6 years, total tumor resection (under microscope) has been achieved in 97.3% of the patients with Hardy Grade I adenomas, 95.2% of Hardy Grade II, 90.4% of Hardy Grade III, and 47.4% of Hardy Grade IV. The percentages of total and subtotal resection achieved extended from 87.6% before 1987 to 96.9% in 2003.


CONCLUSIONS
With the improvement of microsurgical technique and application of novel technology, the indications for transsphenoidal microsurgery for pituitary adenomas were increasingly extended. We believe that more than 90% of pituitary adenomas could be treated by the transsphenoidal approach and totally removed through the microscope. The transnasal perpendicular plate-sphenoid sinus approach will be the dominant mode. Routine postoperative radiotherapy is not required for patients with total resection.
Shou
Xue-fei
XF
Institution of Neurosurgery, Hua Shan Hospital, Fu Dan University, Shanghai, China. shouf@sina.com
Li
Shi-qi
SQ
Wang
Yong-fei
YF
Zhao
Yao
Y
Jia
Pi-feng
PF
Zhou
Liang-fu
LF
D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D010911:Pituitary Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013100:Sphenoid Bone