Pituitary adenoma surgery

Pituitary adenoma Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]

Overview

The transsphenoidal microsugrical approach is the mainstay of treatment for growth hormone-(GH) producing, adrenocorticotropic hormone-(ACTH) producing, and macroadenomas.

Surgery

Surgical treatment and contraindication for pituitary adenoma:

• Rapid deterioration of vision is considered as an immediate indication for surgery to relieve pressure produced by an expanding tumor mass.
• The transsphenoidal microsurgical approach to a pituitary lesion is the most widely employed surgical approach to pituitary lesions and represents a major development in the safe surgical treatment of both hormonally active and nonfunctioning tumors.
• This approach is often successful in debulking tumors, even those that have a significant suprasellar extension (without hourglass-shape appearance).
• The contraindications to transsphenoidal microsurgical approach include:

• Tumors with a significant suprasellar extension with an hourglass-shaped narrowing between the intrasellar and suprasellar component, blind attempts to reach the suprasellar tumor may lead to cerebral damage.
• An infection in the sphenoid sinus

• Craniotomies via a pterional or subfrontal approach may be performed if transsphenoidal microsurgical approach is contraindicated.