Transsphenoidal microneurosurgery.--Part 1. Operative technique and results of 150 cases (author's transl)

Abstract

The purpose of this study is to evaluate the results of 150 transsphenoidal pituitary operations in light of the clinical, endocrinological and neuroradiological findings obtained preoperatively in these patients. There were 63 cases of pituitary adenomas, 68 cases of hypophysectomies, 9 arachnoid cysts (“empty sella”) and 10 other cases in this series. The mortality was 2 percent, occurring only in patients undergoing transsphenoidal hypophysectomies for metastatic breast cancer. The cumulative morbidity, including three cases each of CSF rhinorrhea and meningitis, two cases of rhinorrhagia and a single case of a temporary sixth nerve palsy, was 6 percent. The combined recurrence rate for both nonfunctioning and functioning adenomas was 9.5 percent. Improvement of visual field defects was observed in 92.3 percent of cases who preoperatively exhibited visual field loss. Improvement of endocrinological findings in functioning adenomas was also discussed. Postoperative change of water and sodium metabolism were carefully studied in 49 patients harboring pituitary adenomas and in 36 patients undergoing transsphenoidal hypophysectomy. Diabetes insipidus was seen more frequently following transsphenoidal hypophysectomies than after removal of pituitary tumors. In 85 cases of transsphenoidal pituitary operations studied in relationship to the developement of diabetes insipidus, a permanent diabetes insipidus lasting over a month (Grade III) occurred only in 8 patients following transsphenoidal hypophysectomy. Temporary diabetes insipidus, on the other hand, lasting less than a month (Grade II and I) could be observed following 20 operations for a pituitary tumor and in 17 hypophysectomized patients. Recurrence of the pituitary adenoma was observed in 6 out of 63 cases. All cases had large mass radiologically demonstrating destruction of the sella turcica and suprasellar extension of the tumor. Operative results by transcranical operation were also discussed reviewing literatures. The attempt will be made to define the indications for transsphenoidal approach in the light of the neuroradiological findings and to summarize our experiences with the postoperative management of these patient in part—2 and 3.