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KMID : 0942820070060020095
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Journal of Korean Brain Tumor Society
2007 Volume.6 No. 2 p.95 ~ p.101
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Clinical Analysis of Transsphenoidal Approach for Pituitary Adenomas
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Yang Moon-Seok
Cha Seung-Heon
Cho Won-Ho
Lee Sang-Won
Song Geun-Seong
Choi Chang-Hwa
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Abstract
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Objective：Transsphenoidal approach(TSA) for pituitary tumor has evolved significantly since it was described initially during the first decade of the 20th century. This study was to evaluate the efficacy of TSA and prognosis of pituitary
adenoma after TSA.
Methods：This study included 132 cases of pituitary adenoma which underwent transsphenoidal approach from 2000 to 2006. We analyzed radiologic findings, symptoms, results, prognosis and reviewed the literatures. Mean follow-up period was 22 months. Statistical analysis was performed using paired t-test and considered significant for value less than 0.05.
Results：There were 80 functional adenomas, 52 non-functional adenomas among 132 cases. Tumors were removed totally in 63.6% and subtotally in 36.4%. Follow-up magnetic resonance imagings(MRIs) showed that remnant mass after TSA existed on medial compartment of cavernous sinus and suprasellar area that did not descend during the operation in spite of Valsalva maneuver. 18 cases(13.6%) recurred after TSA. Among them, 4 cases underwent repeated TSA, 2 cases endured transcranial approach and Gamma-Knife radiosurgery applied to another 11 cases. A case which had been removed totally, but presented hormonal symptoms after 6 months. There was statistically significance between stage and extent of removal(p=0.0012). There was no major complications and mortality related to TSA.
Conclusion： Although remnant rate of pituitary adenoma after TSA was 38.0%, this approach offered excellent decompression to optic chiasm. It could be a safer and more effective approach to pituitary adenoma if it is supported with
endoscopic introduction to pituitary fossa and additional therapy such as Gamma-Knife radiosurgery.
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KEYWORD
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Pituitary adenoma, Transsphenoidal approach, Gamma-Knife radiosurgery
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