gms | German Medical Science

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.