[Early results of treating pituitary adenomas by means of transcranial and trans-phenoidal approach]

Among the methods of the surgical approach to the pituitary tumours, transsphenoidal (TS) route replaced transcranial (TC) route in the majority of patients. The authors present the development of the surgical treatment of pituitary tumours, and present the early results of treatment by means of both methods of surgery based on the experience of the Department of Neurosurgery in Kraków. Consecutive 45 cases of pituitary adenomas treated by means of TC route (1989-1998)--I group, were compared to 57 cases operated on by means of TS approach (1996-1999)--II group. The other tumours and re-operated patients were excluded from the study. The following factors were compared: the size of treated tumours, the radicality of tumour excision (subtotal, partial), the presence of the massive hypothalamic dysfunction, the presence of diabetes insipidus, changes in visual field, early results of treatment (good, bad, surgical deaths). Using transsphenoidal approach significantly more tumours were removed subtotally (except of large tumours), massive hypothalamic dysfunction was eliminated, surgical deaths were reduced, and the chance for the improvement of the visual field increased. In the last years more patients with small tumours were treated, and less with medium-sized. Percent of patients with large tumours remains unchanged. The prospective study should be performed to define the proper planning of surgical treatment of large and giant tumours, including two-stages procedures.