Surgery on pituitary adenomas in patients in a subarctic region

The present series consists of 18 consecutive patients with pituitary adenomas operated on between 1977 and 1979 using the transfrontal route. Ten adenomas were 10, 20 or 30 times the normal maximum size of the pituitary measured according to Di Chiro and Nelson's (2) index (Table 2). Tumours without obvious suprasellar growth were operated on using the trans-sphenoidal route and thus are not included in the present series. Large and giant pituitary adenomas are preferably removed by the transfrontal route and using microsurgical techniques. Really poor vision associated with very large tumours seem to improve but not to normal level. A blind eye stays blind. Less poor vision returns to normal (Table 4). Prolactin values associated with giant prolactinomas are extremely high and may remain raised even after apparently radical extirpation. Isolated tumour-containing sellar crypts associated with these large tumours may be responsible for this observation. Postoperative radiotherapy and bromocriptine administration therefore seem advisable. Further operations may be necessary on patients with extensive posterior or lateral growths. Redundant partially intraosseous tumour fragments may be more easily removed later, possibly owing to the beneficial effects of radiation therapy. It is hoped that large and giant adenomas in the future will pass into history, even in the peripheral parts of the world. The trans-sphenoidal approach is always a better solution than the transfrontal approach whenever it can be carried out, but it requires earlier diagnosis.