Management of sellar and suprasellar lesions

Abstract

Abstract Background Pathology in the sellar and suprasellar regions accounts for several disabling and distinctive neurological syndromes characterized by visual failure and upper cranial neuropathies. These features have a major impact on functional outcome more than the commonly associated endocrine morbidity. Objective this study aimed to present the incidence of various lesions in the sellar and suprasellar area and evaluate the different protocols for management of these lesions. Methods The study will include 40 cases of sellar& suprasellar lesions that will be admitted and treated in the neurosurgical departments in Ain Shams University Hospital as well as El-Galaa armed forces hospitals and 57375 Children Cancer Hospital between 12/2015-9/2018 Results: Pituitary adenoma was the most frequent(42.5%), followed by craniopharyngioma(30%), then Meningioma(12.5%) with other low frequent diagnoses , Headache was the most common complaint followed by blurring of vision, diplopia and nausea & vomiting. MRI sella was the most valuable investigation. 3 approaches were used and trans-sphenoidal approach was the most common used approach. Postoperative radiotherapy was significantly most frequent in Craniopharyngioma followed by pituitary adenoma and least frequent in meningioma. Conclusion we have reached to conclusion from this study, that transsphenoidal approach was suitable for most pituitary adenomas and Its main indication was mainly midline sellar and suprasellar tumors with limited lateral or posterior extension. The pterional approach was suitable for meningiomas and craniopharyngiomas and Its indication was a supra-or parasellar lesions with both lateral and posterior extension specially those reaching the clivus. Total excision was most frequent in pituitary adenoma followed by meningioma and least frequent in craniopharyngioma. Postoperative radiotherapy was significantly most frequent in Craniopharyngioma followed by Pituitary Adenoma and least frequent in meningioma.