Advances in Pituitary Adenoma Surgery

Abstract

Following a century of technical developments and refinements, a variety of standard approaches are available today for the surgical treatment of pituitary tumors. The vast majority of the lesions can be dealt with satisfactorily utilizing minimally invasive trans-sphenoidal approaches. The goal of surgical treatment is a complete resection of the tumor mass, decompression of visual pathways, and elimination of hormonal oversecretion, while preserving normal glandular function and avoiding potential surgical complications. The tumor's size, extension, configuration, and the magnitude of hormonal oversecretion, respectively, are the essential factors that decide whether all these goals can be reached. Another important factor is the individual skill and experience of the surgeon. Still, several lesions that develop mainly outside of the sella require transcranial approaches, of which the pterional and subfrontal routes are the most widely used. With microsurgical techniques and standard approaches, mortality is far below 1% and morbidity is remarkably low. The most favorable surgical results are obtained with microadenomas which are visible using MR. Only recently has the recovery of pituitary function following surgery been convincingly demonstrated. With the extended trans-sphenoidal approaches, lesions have become accessible which previously have been considered contraindications for trans-sphenoidal surgery. The introduction of new technical tools such as neuronavigation, endoscopy, and intraoperative imaging open new avenues and widens even more the spectrum of accessible lesions. Indications for surgery, the preoperative workup, surgical techniques, results, limitations, and new technical developments are briefly reviewed.