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The indication for the operation of a pituitary adenoma is usually made in the presence of a chiasm syndrome (pressure of a large tumor on the overlying optic nerve junction) or a hormone excess, or if there is already an anterior pituitary insufficiency (by so-called. Pressure of a large tumor on the healthy pituitary ) has come. Prolactin-secreting adenomas (prolactinomas) are the only adenomas treated primarily with medication.
Today, essentially two surgical procedures are used, over which the majority of the pituitary adenomas can be completely removed: The transsphenoidal ("from below", usually through the nose) surgery in the vast majority of tumors and the transcranial ("from above", with Opening the skull from above or from the side) Surgery for very large and unfavorable tumors.
The mortality in such procedures is significantly less than 0.5% in larger current series of microsurgically experienced surgeons. Serious complications such as meningitis, CSF fistula and rebleeding are reported in less than 1% of cases. Injuries to the major cerebral arteries and the development of permanent diabetes insipidus or complete hypophyseal anterior lobe insufficiency requiring substitution are among the absolute rarities. Transsphenoidal surgery is suitable for all intrasellar tumors, as well as for those with a wide communication between the intrasellar and extrasellar tumors.
The principle of transsphenoidal surgery dates back to the beginning of the twentieth century, although a breakthrough of the method occurred only with the introduction of the microsurgical technique in the 1970s and the routine use of intraoperative image intensifier control. One can perform the intervention in several variations. With appropriate experience, it is possible to distinguish the softer and color different tissues of the pituitary adenoma from the more yellowish and firm normal pituitary gland, which has a typical vascularization structure (structure of the blood supply), and thereby selectively remove the tumor. Then it comes within a few hours to correct a hormonal over-secretion.
Due to the sophisticated surgical technique, which has been steadily developed in the years after 1970, it is also possible to radically remove invasively growing tumors, e.g. For example, by milling infiltrated bone from the clivus (bone behind the pituitary gland) or opening the medial wall of the cavernous sinus (which lies to the side of the pituitary gland and drains blood from the brain). In all these growth directions, the pituitary adenoma, as the only benign endocrine tumor, can also infiltrate into the environment.