Surgical management of sellar and suprasellar tumours

Abstract

Despite their shared location, sellar and suprasellar tumours are an extremely diverse group of lesions with multiple sources of origin. These tumours may be congenital lesions, such as lipomas, Rathke’s cleft (pars intermedia) cysts, arachnoid cysts, and hamartomas, or they may develop from any of the surrounding structures, resulting in pituitary adenomas, meningiomas, craniopharyngiomas, chordomas, optic nerve gliomas, among others. Non-neoplastic lesions, such as cavernous malformations, fibrous dysplasia, and inflammatory lesions such as sarcoidosis also present here, and tumours from remote sites are found in the form of metastasis in both the pituitary gland and the cavernous sinus. This extraordinary variety can make management of cases with these tumours more complicated because of the myriad of pathologies encountered. To add to the complexity of treatment for sellar and suprasellar tumours, there are numerous critical structures in this region, including the pituitary gland, critical vessels, and multiple cranial nerves. Avoiding injury to these important structures is a key component of treatment planning. In this chapter, we will discuss the anatomy of the sellar and suprasellar region with these factors in mind. We will discuss the workup, management, operative strategy, postoperative care, and complication management of these tumours then elaborate on controversies related to these issues.