gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Secondary transcranial resection of suprasellar pituitary adenomas after initial transsphenoidal operation

Meeting Abstract

  • Boris El Hamalawi - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Neriman Özkan - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Oliver Müller - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Tobias Schömberg - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Ulrich Sure - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Erol Sandalcioglu - Klinik für Neurochirurgie, Universitätsklinikum Essen

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocDI.01.03

doi: 10.3205/13dgnc184, urn:nbn:de:0183-13dgnc1840

Published: May 21, 2013

© 2013 Hamalawi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Pituitary adenomas are generally resectable only via the transsphenoidal route. Residual supradiaphragmatic tumor can remain and cause symptoms due to compression of the optic chiasm which requires further transcranial operation. We present the functional and operative results of these patients who underwent secondary transcranial surgery after initial transsphenoidal surgery.

Method: Between 1991 and 2011 a total of 17 patients (12 male and 5 female) underwent secondary transcranial resection for residual pituitary adenoma. The mean age was 56,7 years (range 35 to 72 years). We retrospectively evaluated the clinical data, visual function and rate of resection as well as the complications.

Results: Preoperatively 76,5% (n=13) presented with visual impairment, two patients suffered from headache, one patient had a hydrocephalus and there was one case with acromegaly. The visual function was improved or equal in 76,5% (n=13) and deteriorated in 17,6% (n=3). One patient died in the early postoperative period. Complete tumor resection was achieved in 29% (n=5), incomplete in 52% (n=9) and in 2 cases only a partial resection was possible. Incomplete and partial resection was due to tumor infiltration into the parasellar regions.

Conclusions: Combined transsphenoidal and transcranial approach seems necessary for a subgroup of patients with pituitary adenomas and supradiaphragmatic extension causing visual impairment. Improvement of visual function can be achieved even in cases of incomplete resection. However, tumor consistency and adhesions are associated with a less favourable outcome.