Role of transsphenoidal operation in the management of pituitary adenomas with suprasellar extension

59 consecutive patients with suprasellar extending pituitary adenomas were operated on by the transsphenoidal approach. The suprasellar tumour extension was in 30 cases stage A (Hardy-Wilson), in 18 stage B and in 11 stage C. 14 patients were above 65 years of age and in this latter group 9 cases had large tumours (B or C). 78% of endocrinologically active tumours did not reach the chiasm (stage A) whereas 72% of functionless adenomas compressed the chiasm or grossly the third ventricle. Visual field defects and loss of visual acuity was both present in roughly 90% of stage B and C tumours. Radical surgical removal with regard to suprasellar extension was possible in all but 6 cases. Four of these patients had tumour remnants large enough to require removal by a second intracranial operation. No patient developed visual deterioration post-operatively. Pre-operative visual dysfunction was normalized or markedly improved in more than 90% of the cases. Failure to normalize vision was closely linked to the presence of pale optic discs. Pre-operative hypersecretion was normalized in 70% of the cases. Addition of permanent pituitary insufficiency occurred in three patients.