Transsphenoidal neurosurgery of intracranial neoplasm

Abstract

Because of the benign, rapid, and nontraumatizing nature of the extracranial transsphenoidal approach to the base of the skull, this procedure is indicated as the method of choice in nearly all cases of surgery for pituitary fossa and parasellar region access. Some of the largest pituitary chromophobe adenomas with voluminous suprasellar expansion have been successfully excised from below, as well as some calcified tumors, craniopharyngiomas, Rathke's pouch cysts, chordomas, chondromas, and meningiomas. At the other extreme, the smallest intrapituitary microadenomas (as little as 3 mm in diameter) were selectively removed under optic magnification with the surgical microscope. This method is now the most appropriate for the treatment of oversecreting pituitary disorders, even with normal-sized sella turcica (acromegaly - Cushing -galactorrhea). Early detection of intrapituitary microadenoma allows achievement of its selective excision with preservation of the normal gland. Thus, the ideal goal can be achieved by immediate biological cure of hyperpituitarism with preservation of other pituitary functions, resulting in normal physiological eupituitarism.