[Pituitary adenomata. Status of diagnosis and therapy (author's transl)]

The advances in pituitary surgery are based on the diagnosis of neuroendocrinological function and the microsurgical operative technique with the help of which pituitary adenomata are approached by the transsphenoidal route in approximately 90% of cases and transcranially in about 10%. On the one hand, hormone-active microadenomata can presently be detected in good time endocrinologically and 80-90% can be removed selectively while retaining the pituitary. On the other hand, it can be shown that the greater the tumor the more frequently hormone excesses persist after the operation. Tumors can be directly visualized in the cranial computer tomogram if they ar not smaller than 5-7 mm. Also, larger extrasellar remains of tumors left after operation can be demonstrated by computer tomography. Larger suprasellar adenomata produce a chiasma syndrome which improves in 80% of patients after transphenoidal operation. The slight operative risk is shown in a total of 737 operations for pituitary adenomata in the last 11 years.