Surgery of hypophyseal tumors by the trans=sphenoid approach. apropos of 164 cases
Haguenauer, J.P.; Goutelle, A.
Acta Oto-Rhino-Laryngologica Belgica 29(7): 1085-1100
1975
ISSN/ISBN: 0001-6497 PMID: 1241835 Document Number: 88480
This review touches on differential diagnosis of pituitary tumors, their histologic types, prognosis, X-ray appearance, the technique of transsphenoid ablation of pituitary tumors, indications of the transsphenoid vs. the upper approach and the results of 164 cases operated on since 1966. Diagnosis relies clinically on evidence of panhypopituitarism or hypersecretion of growth hormone of ACTH and ophthalmologic or neurologic signs. In their histologic cell types, somatotrophs correspond to eosinophils, nonfunctional adenomas to chromophobes, and hypercorticism to basophils. Various types of tumors can be distinguished by tomography, gas pneumoencephalography and carotid angiography. The technical details of transsphenoid surgery under a microscope of 350 mm focal length and televised gas encephalography are described. Macroscopically, the tumors may be invasive adenomas, soft friable, or cystic. Possible immediate complications, besides bleeding, may be collapse of the roof of the sella, or rupture of the sellar diaphragm causing leakage of cephalorachidian fluid. the transsphenoid route is indicated in 60% of cases with rounded tumors, in tumors evolving downward into the floor of the sella, in patients over 65 or blind because of optic nerve compression. The upper route is advised in tumors growing upward, restrained by the optic nerve or in patients with anatomic defects preventing the lower approach. In 164 operations the authors had 5 deaths, 6 fistulas of cephalorachidian fluid, 2 patients temporarily blinded, 2 with loss of visual acuity, and only 4 relapses.