Transsphenoidal approach to the sella: the Johns Hopkins experience

The transsphenoidal hypophysectomy has become a relatively frequent procedure in recent years, with the otolaryngologist playing a major role in its renewed popularity. This paper reviews the evolution of pituitary surgery, discusses the surgical technique currently used, and reviews the results and complications of 114 cases over a 13-year period. Of the 129 procedures performed at Johns Hopkins Hospital between 1970 and 1983, 114 charts were available for review. Twelve of these were palliative hypophysectomies and 102 were for sella tumors. Sixty-eight patients were treated with surgery alone, and 34 received surgery and postoperative irradiation. Significant complications such as CSF rhinorrhea, diabetes insipidus, meningitis, septal perforation, anosmia, and visual field defects are discussed. The mortality rate for the series was 1.7%. These results are compared with those of previously published series and the differences are discussed in detail. In analyzing these data we feel that the transseptal, transsphenoidal hypophysectomy has become a safe and effective therapy for sella lesions.