Results of transsphenoidal surgery in a large series of patients with pituitary adenoma.
OBJECTIVE
To report the efficacy and safety of microsurgical transsphenoidal surgery in a series of previously untreated patients with pituitary adenoma.


METHODS
One thousand one hundred forty consecutive patients undergoing transsphenoidal resection of a pituitary adenoma at our department from January 1990 through December 2002 were included in our study. Postoperative results were classified uniformly during the period of the study. Patients were considered in remission of disease when strict hormonal and radiological criteria of cure were met.


RESULTS
The most frequent tumor type was clinically nonfunctioning adenoma (NFPA) (33.2%), followed by growth hormone-secreting adenoma (28.1%), adrenocorticotropin-secreting adenoma (23.0%), prolactin-secreting adenoma (13.2%), and last, thyrotropin-secreting adenoma (2.5%). The patient population was 59.7% female and 40.3% male. Mean age was 43.0 +/- 0.4 years. There were 788 macroadenomas (69.1%), and in 233 patients (20.4%), the tumor invaded one or both cavernous sinuses. The overall rate of early surgical success was achieved in 504 (66.1%) of the 762 patients with a hormone-active adenoma. Surgical outcome was better in patients with microadenomas than in patients with macroadenomas (78.9% and 55.5%, respectively), whereas tumors invading the cavernous sinus had a poorer outcome (7.4%). In patients with NFPA, no residual adenoma was present in 234 patients (64.8%). Normalization of visual defects occurred in 117 (40.5%) of the 289 patients with visual disturbances and improved in another 148 patients (51.2%). Three patients (0.3%) died as a consequence of surgery.


CONCLUSIONS
Transsphenoidal surgery is an effective and safe treatment for most patients with pituitary adenoma and could be considered the first-choice therapy in all cases except for prolactinomas responsive to dopamine agonists. Other treatment methods, such as radiotherapy, stereotactic radiosurgery, and medical therapy, play an important role in patients not cured by surgery.
Mortini
Pietro
P
Department of Neurosurgery, Istituto Scientifico San Raffaele, Università Vita-Salute, Milan, Italy. mortinone@yahoo.com
Losa
Marco
M
Barzaghi
Raffaella
R
Boari
Nicola
N
Giovanelli
Massimo
M
D000236:Adenoma / Q000145:classification / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D007016:Hypophysectomy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010907:Pituitary Hormones / Q000378:metabolism; D010911:Pituitary Neoplasms / Q000145:classification / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000601:surgery*; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology
D010907:Pituitary Hormones