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Transcranial surgery for pituitary adenomas.
A Samy Youssef1, Siviero Agazzi, Harry R van Loveren
1Department of Neurosurgery, University of South Florida, Tampa, Florida 33606, USA.
Neurosurgery
|July 1, 2005
Summary
The transcranial approach is rarely needed for pituitary tumors but is vital for specific cases. The frontotemporal-orbitozygomatic approach is the recommended default technique for this rare surgical necessity.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Transsphenoidal surgery is standard for most pituitary tumors.
- Transcranial surgery is reserved for 1-4% of complex pituitary tumors.
- Cranial base techniques have refined but not broadly changed indications.
Purpose of the Study:
- To define the indications for transcranial surgery in pituitary tumors.
- To standardize the transcranial approach for rare cases.
- To recommend a default surgical technique.
Main Methods:
- Review of indications for transcranial pituitary tumor resection.
- Analysis of tumor characteristics making transsphenoidal approach difficult.
- Standardization of a default transcranial surgical technique.
Main Results:
- Transcranial approach is indicated for tumors with specific anatomical challenges (e.g., diaphragma sellae isolation, cavernous sinus invasion).
- Factors like prolactin inhibition and lack of necessity for asymptomatic tumors can mitigate transcranial approach use.
- The frontotemporal-orbitozygomatic approach is proposed as the default technique.
Conclusions:
- Transcranial surgery for pituitary tumors is rare but essential in select cases.
- Standardizing to an experienced default technique like the frontotemporal-orbitozygomatic approach is recommended.
- Careful patient selection is crucial for successful transcranial pituitary tumor resection.